Inconvenient truth: We don’t have the best health-care system

Posted on in Health Debates – commentary
Jan. 11 2013.   Jeffrey Simpson

Two provincial health ministers have scrubbed the usual clichés and begun to tell their citizens an inconvenient truth.

Alberta’s Fred Horne and Ontario’s Deb Matthews, rather than blathering on about Canada’s having the best health-care system in the world, now tell audiences that this country has an underperforming, expensive one by international standards.

This statement of fact, supported by international comparative studies, was political heresy until recently. Canadians were repeatedly told – and they loved being told – that Canada’s health care was the best.

Now, at least a few provincial leaders have dropped the clichés, which were never supported by hard evidence anyway. From this new starting point – truth – serious discussion can begin. (Little progress, after all, could occur from clichés – why consider change if you have the best of something?)

Something else happened recently, too. Canadians no longer believe, according to the latest public opinion data from the Environics Institute, that more money is the answer to what ails the system.

A decade ago, that seemed to be the answer. Roy Romanow’s commission said so, based in part on what citizens told it and on public opinion surveys at the time. Governments apparently thought so, too, since they agreed to spend an additional $41-billion over the next decade – indexed at 6 per cent.

The public now seems to understand that all that money prevented things from getting worse but didn’t make them discernibly better – at least not tens of billions of additional dollars better.

So now, according to the Environics Institute, only 32 per cent of respondents think there’s “not enough funding for the system,” as opposed to 55 per cent who blame “inefficient management of the system” for the problems.

“Inefficient management” is an elastic phrase. Who’s management? The provincial health ministry? Regional health authorities? Hospital and community care administrators? Family clinics? Care provision inside institutions? Maybe “inefficient management” means too much care in hospitals and not enough in communities with home care, nursing homes or long-term care? Or all of the above?

“Inefficient management,” therefore, doesn’t really tell us much, except that people seem to think it’s more important than lots more money.

Canadians don’t want to pay more in tax for health care. They reject this option, 56 per cent to 42 per cent, in the Environics Institute survey. A “small” user fee for seeing a doctor or visiting an emergency room? Rejected, but only by 51 per cent to 46 per cent. Cutting back on services covered by public health care? Absolutely not, by 72 per cent to 24 per cent.

What about private payment? The institute asked whether Canadians should have the right to buy private health care – here comes the condition – “if they do not receive timely access to services in the public system” – and here comes another condition – “even if this might weaken the principle of universal access to health care for all Canadians because some people might have quicker access to services.” Fifty-five per cent said yes, 43 per cent no. There’s more openness there than we might have expected.

What about “giving Canadians the option to pay out of their own pockets for faster access to Canadian hospitals, or to specialized services such as MRIs and cancer care?” A split verdict: 49 per cent opposed, 48 per cent in favour.

One poll can hardly be considered definitive. As you can see in the Environics Institute survey, the answers depend in part on the conditions attached to the questions. Nonetheless, it would appear Canadians don’t want to pay more, but they don’t want anything taken away from health care, either.

But respondents did say they wanted a full-blown public drug plan to cover any medications that “a patient and their doctors agree are the most effective treatment.” Great, except respondents weren’t asked how to pay for such a plan, and the majority don’t want to pay additional taxes for health care.

Canadians’ instincts are partly right: Heaps of more money won’t make the system more efficient. We learned that lesson in the past decade. Where their instincts go awry, typically, is believing they can get more services without paying more for them.

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