Social Policy in Ontario

My heart, my health, my choice. With those six words, Danny Williams neatly summed up the case for private health care. No matter how much the Newfoundland and Labrador Premier goes on to defend Canada’s state health care monopoly, the damage has been done to the case for a single-payer system. He has exposed it for what is: a charade with often tragic consequences; a system which purports to be fair but which ends up treating people unfairly.

There is one system for the rich and one for the rest of us. Mr. Williams and others in his income bracket can afford to jet down to a posh Florida hospital for the latest procedure. Joe and Jane Canadian cannot.

It’s worth noting that Mr. Williams is not an anomaly. Many politicians have sought treatment in the United States or in private facilities. The late Quebec premier Robert Bourassa sought skin cancer treatment in Maryland. Former MP Belinda Stronach had breast cancer surgery in California. And even NDP leader Jack Layton turned to the private sector for a hernia operation, though he managed to get it on home soil.

Why did Mr. Williams elect to play medical tourist in Miami? Because he wanted to undergo a type of minimally-invasive heart valve surgery rather than the traditional procedure, which involves cracking open a patient’s sternum. While the new surgery is offered in a few hospitals in Canada, his doctors recommended that he have it in the United States.

This type of surgery, and thousands of other procedures like it, would be more widely available in our country if we allowed private medicine to deliver them. Private hospitals, competing with each other and with the “free” public system, would have to offer cutting-edge medicine (so to speak) to attract customers. They would also be competing in the American market, for a share of U.S. health-care dollars. It is entirely possible that American customers might elect treatment in Canada, if available at lower cost, thus creating jobs and opportunities for doctors and medical personnel in our country where none existed before.

Private hospitals would have to price these alternatives competitively — and most of their clients would not be paying out of pocket. They would purchase private health insurance which, in the event of need, would foot the bill. Such insurance would be available not just to the rich, but to the middle class. It would open up true choice for a wide segment of the Canadian public.

And contrary to popular belief, these private hospitals would not destroy the public system. Instead, they would provide incentive for the public system to improve, something missing in a state monopoly. This is what happened in Alberta in the 1990s when private clinics were allowed to perform cataract surgery under contract to the provincial government, with the patient paying an $1,100 fee. The percentage of procedures performed by the private clinics actually declined from 32 to 17 over a period of four years, as the public system improved and became more attractive to patients.

Private hospitals would also free up space in the public system for those who need care that they currently cannot get in a timely manner, because of scarcity. Scarcity is another pernicious result of state monopoly. Government budgets dictate a finite supply of hospitals, doctors and beds, while patient needs create an ever-expanding demand for health services. The only way to deal with scarcity is rationing. Our current single-payer system rations health care, Soviet-style, with predictable results: long queues of patients suffering, in some cases for a year or more, while they wait for procedures.

Putting more money in the public system is not the answer. According to the Fraser Institute, mean wait times in 2009 were 16.1 weeks for surgical and other procedures — the same level they were at in 2001, despite billions of dollars spent to speed lineups.

It was these wait times which led to a major health-care reform in Quebec, prompted by the Supreme Court’s 2005 decision in the Chaouilli case. Since then, the Quebec government has enacted legislation allowing private insurance to cover three types of operations: knee, hip and cataract surgery. These surgeries can also be contracted out from the public system to specialized private clinics. The province has expanded the list of procedures the clinics can deliver to 56, including mastectomies, hysterectomies and bariatric surgery.

Instead of decrying private health care, Quebec is embracing it, as an important means of delivering quality and timely health care to its citizens, just as other nations do around the world. Together with North Korea, Canada is the lone holdout that denies its people choice over one of the most important aspects of their lives: their personal health and well-being.

Mr. Williams was perfectly within his rights to opt for his superior surgery. But all Canadians should enjoy this choice — and they shouldn’t have to show their passport to get it.

< http://www.nationalpost.com/opinion/story.html?id=2605502 >