If we don’t fix medicare, we may lose it
TheStar.com – Opinion/Editorials – The future of medicare may depend on governments’ ability to address the systemic public failings that have created a rising demand for private care.
June 16, 2017. By STAR EDITORIAL BOARD
It is a source of national pride that in Canada health care is supposedly provided based on need, not on ability to pay. But recent evidence suggests the principle of equal care for all is in increasing jeopardy.
Across the country, private clinics are popping up that are illicitly charging fees for essential health services that patients have already paid for through their taxes. A second tier of our system is emerging by stealth, providing quicker access to care for those who can afford to pay for it. This is undermining our most prized national program, perhaps irreversibly if governments don’t act quickly.
A new study from the Ontario Health Coalition is the latest to sound the alarm. It found that at least 88 private health clinics in six provinces regularly charge patients hundreds or thousands of dollars for needed diagnoses, tests or surgeries. In some cases, doctors levy user fees and bill the public system, charging twice for the same service.
As the report concludes, part of the problem is that people don’t know which services are not covered by medicare and which they must therefore pay for out of pocket. What constitutes a “medically necessary” procedure is ambiguous and what’s excluded varies by province.
In hundreds of interviews, patients told the report’s authors that when a doctor presents them with a bill, they assume the service is not covered. Even when they doubt the legitimacy of the charge, many are reluctant to challenge a doctor who will soon, for instance, perform surgery on them.
Such exploitative extra charges are prohibited by the Canada Health Act, yet these clinics operate with impunity. In British Columbia and Quebec, where extra fees and double billing are most common, patients have launched court challenges in an attempt to force governments to uphold their laws and protect medicare.
Last February, the government of Saskatchewan passed legislation allowing for the introduction of for-profit MRI scans, creating an express queue for those who can buy their way into it. Ottawa, which has the power to impose penalties on provinces that fail to uphold the Canada Health Act, wrote a letter to Saskatchewan urging it to repeal the law on the grounds that it violates the principle of equal care for all. Instead, the province broadened the legislation beyond MRIs. Seven months later, Ottawa still has taken no action.
The result of this failure of enforcement, as the new study shows, is creeping privatization, the slow emergence of a system in which care is rationed based increasingly on wealth rather than need. And because this burgeoning second tier is the result of drift more than deliberate choice, it remains largely unregulated. Prices and quality of care vary widely among private clinics.
Ottawa and the provinces should protect medicare by enforcing the Canada Health Act and cracking down on bad-acting private clinics and double-billing doctors. But enforcement alone is not enough.
Reports of extra fees and double billing reveal not simply the bad behaviour of a small minority of doctors. They also point to something deeply wrong with the way we’re managing our public health-care system.
Canada spends more per person on health than many comparable countries, yet our actual health outcomes are often poorer. We wait too long for many procedures, especially surgeries and MRIs. The countries that outperform us don’t necessarily spend more overall, but have a higher proportion of public to private spending, largely because they cover essential services that we do not, such as prescription drugs, dental care and home care.
As our aging population places an increasing burden on the system, and funding remains squeezed, there’s simply not enough to go around. Unless this changes, we are left with two options: accept inadequate care for all, or find a safety valve.
The rise of private clinics providing necessary services is an example of the latter. In British Columbia, privatization advocates are fighting in court to officially open the door to a two-tier system. Their argument: the current system violates patients’ Charter rights to “life, liberty and security of the person” because it prevents them from seeking medical care privately even if the public system can’t provide it in a timely fashion. Ultimately, the future of medicare may depend on governments’ ability to address the systemic public failings that have created a rising demand for private care.
Unfortunately, the federal government has shown little interest in making the kind of investments necessary to build a 21st-century national health-care system. Provinces have long called for the federal portion of total health spending to rise to 25 per cent, yet under the Trudeau government’s new bilateral agreements, Ottawa’s share will move in the wrong direction.
While the deals include dedicated investments in some priority areas, such as home care and mental health, as well as “system transformation,” it’s not clear how the provinces can succeed in transforming health care when Ottawa is not even planning to do its parts to keep the lights on.
That’s dangerous. If governments don’t find a way to fix medicare, those who want to dismantle it may win.
https://www.thestar.com/opinion/editorials/2017/06/16/if-we-dont-fix-medicare-we-may-lose-it-editorial.html
Tags: budget, economy, featured, Health, ideology, Indigenous, privatization
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