Our medical system needs choice to survive

Posted on September 7, 2016 in Health Delivery System

NationalPost.com – Full Comment
September 7, 2016.   National Post View

Defenders of public health care in Canada should welcome Dr. Brian Day’s constitutional challenge to Canada’s health-care system, which has finally reached British Columbia’s Supreme Court. The system needs choice to survive.

Day’s critics clearly don’t see it that way. Predictably, they warn that a victory for the former Canadian Medical Association president will sentence Canadians to “U.S.-style health care” and an inevitable decline in standards or access. The claim suggests a curious myopia. First, there is no reason to assume the only alternative to our current system is 100 per cent private medicine, which ceased to be the case in the U.S. in the 1960s with Medicaid and Medicare for the poor and elderly, and has been further diluted through Obamacare, a very different public system than ours with its own instructive deficiencies. Many other countries — such as Sweden, New Zealand and Australia — combine some form of public and private operation, while upholding the same standards of care and accessibility as Canada.

There is no reason to assume the only alternative to our current system is 100 per cent private medicine

Even worse myopia exists among those who treat the 1984 Canada Health Act as inviolable, as if it were perfect in design and practical effect. They ignore the enormous financial burden placed on governments and the inefficiencies that impact patients. Health care consumes at least 40 per cent of program spending in virtually every province, while long waiting lists persist a decade after the Supreme Court ruled, in Chaoulli vs. Quebec, that they violated Quebecers’ right to life and security of person.

It is odd to place the Canada Health Act above the Charter of Rights and Freedoms in the nationalist pantheon, even if the Chaoulli ruling stated only that the ban on private medical insurance violated the Quebec charter.

It is also very odd that Day’s critics raise the spectre of preferential treatment for the rich or well-connected when these are already well-established features of the existing situation. Elements of private care have penetrated many levels of the Canadian system, to be taken advantage of by those in the know, who, hypocritically, are often sent by public-sector clients. Turning a blind eye to this while striving to limit access is hardly a benefit to those in need of treatment.

The point has been made, ad nauseam, that no one has ever suggested applying the Canada Health Act model to any other essential need, from food supply to power generation. And nobody, not even in Moscow or Havana, still argues that rigid central planning is the most effective and successful approach to serving public needs. Competition and incentives are widely accepted as the best and most effective means to ensure efficient allocation of resources. And without efficiency, our system will collapse.

Canadians who doubt that our medical system needs a breath of fresh air should look at Britain’s National Health Service, on which our own was modelled, and which is now in a financial crisis so severe that obese patients and smokers have been warned they could be denied surgery for non-life-threatening ailments. Or at the increasingly indisputable evidence of ever-longer waiting lists here at home even as costs explode. Or at Quebec, where the Chaoulli ruling failed to produce the predicted collapse of public health.

It is curiously condescending to suggest Canadians are incapable of integrating some element of competition and choice into the system, while protecting the fairness, access and high standards of care that we take for granted. It is similarly obtuse to assume that, in the wake of a Day victory, Canadian governments would be helpless to design an improved system that would accommodate these essentials. Of the five “pillars” of the Canada Health Act that Canadians are said to value — comprehensiveness, universality, portability, accessibility and public administration — only the last has stood consistently over the last third of a century. Surely we can do better.

Defenders of public health care should be focused on attaining a greater level of flexibility and innovation within a guarantee that no one will be denied quality care through insufficient means. Which is exactly what Day is advocating. If we do not do something, escalating costs and insufficient public resources will eventually mean lesser standards for everyone. That’s not the sort of “universality” Canadians expect.

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