Social Policy in Ontario

Here’s some not-so-surprising news: Canadians want better health care… but they don’t want to pay more for it.

According to a new Ipsos Reid poll,

The majority of Canadians, 61%, said focusing on finding more efficient ways to deliver health care is their preferred option, while 28% said a bigger piece of the tax-dollar pie should be devoted to health care, which could mean cuts in other government services.

Only 11% said the best way for governments to address rising health-care costs is to provide more opportunities for Canadians to pay out of their own pockets for services, effectively expanding a network of private facilities to offer those services.

On the surface, this looks like another sign of entitlement culture run amok.   Surely, to improve the system, we will have to spend more, and someone will have to foot the bill?  It also looks like an indictment of private health care – not surprising if respondents think having private options means they will have to pay more at the end of the day.

Actually, more money isn’t the answer to better health care.  If it were, wait times should have gone down, not up, in the last two decades.  But despite ballooning health care budgets, hospital wait times were 73 per cent longer in 2009 than they were in 1993 – an average of 16.1 weeks.

Simply calling on the government to find efficiencies in the current monopoly public-payor system, as the poll implies, will not solve the problem.  It is a recipe for delisting services, as Ontario did with optometry, chiropracty and physiotherapy in 2004 (note Premier McGuinty also saw fit to impose a “health premium” at the same time).

The issue is not just who runs the health care system today (the state, which is notoriously inefficient), but the fact that it has no competition.  Monopolies by definition aren’t efficient, because they don’t have to be.  They have no financial incentive to do better; while political pressure can be applied, and has been for decades, it has failed to adequately improve the level of care.  Patients become hostages of the system, and are treated as such, because they have no other options available.   They may complain about waiting 12 hours in the emergency room, but if they can’t vote with their feet and go to a competitor, what incentive is there to speed things up?

What is the answer is changing the delivery mix from a monopoly public system to a competitive mixed delivery system, such as exists in most of the western world.  By allowing a private sector model to flourish, as well as using private delivery services within the publicly-funded system, the government would inject a healthy dose of competition into the sector, which would ultimately reduce health care costs.   Those savings should be passed on to taxpayers in the form of lower taxes, leaving them more money to purchase private care, private health insurance, or whatever else they choose to do with their money.

The real question for Canadians is this: would you prefer to pay the same amount of money for health care, or possibly less, in a different mix: ie, have lower taxes and the option of private care?  Now that is a poll waiting to be done.

National Post