Public health care worth saving

Posted on June 5, 2009 in Governance Debates, Health Debates – Opinion – Public health care worth saving
June 05, 2009.  Ahmed Mian, Community Editorial Board

As a medical student, I feel honoured to provide care to Canadians through our publicly funded health-care system, a system often taken for granted and incorrectly labelled as ineffective.

Despite valid concerns with aspects of our health-care delivery model, overall it serves Canadians well. Any criticism directed toward it should not be attributed to the fact that it is a public system requiring privatizing interventions.

Escalating the role of the private sector in health care would have disastrous implications. My reasons for advocating a strict adherence to a publicly funded system and searching for solutions within this model of delivering health care stems from my own recent internship experiences in the United States and the United Kingdom.

The U.S. has a market-based health-care system where private for-profit care is the prevailing method of delivery. Health care comprised nearly 16 per cent of the U.S. GDP ($6,714 per capita) in 2006, the highest of all developed nations (in Canada it was 10 per cent of GDP or $3,678 per capita).

The U.S. consistently scores poorly on indicators of population health, with a life expectancy below the OECD average and infant mortality above the OECD average, and an obesity rate that is the highest in the world at 34 per cent. This is mainly due to the lack of a strong, publicly funded primary health-care system that promotes health screening and prevention.

Publicly funded health care in the U.S. stems from two main programs: Medicare (for those over 65) and Medicaid (for those on social assistance). Combined, these programs cover 33 per cent of Americans. The majority of Americans have health insurance either through their employer or privately purchased. It is scarcely comprehensive. Additionally, nearly 20 per cent (the working poor) are completely uninsured.

The U.S. may have a greater availability of diagnostic equipment but most Americans do not benefit from these resources. The U.S. system does not provide better quality care or better access to it, which explains Barack Obama’s emphasis on prioritizing an overhaul of the current system. Unfortunately, once private industry is entrenched in a system, it will be next to impossible to decrease its influence.

Working in England permitted me to witness once again the drain that privatizing health care has on the public system and how it contributes to a two-tiered system.

Like Canada, the U.K. has a largely publicly funded system. Yet private services are not strictly considered against the spirit of the public system as they are in Canada. Over the years the government has increased involvement of the private sector in health care.

Parallel private hospitals and clinics exist where physicians work and even those employed by public trusts may earn a portion of their income from private work. In some cases, the public primary care trust contracts with a private hospital to treat its patients. The result is a two-tiered system with escalating costs and waiting times associated with contracting out services and losing publicly trained physicians to the private sector.

Witnessing how these systems work only increased my respect for our health-care system. Despite the problems inherent in our model, they pale in comparison with the health-care issues of other developed nations. I believe that if more Canadians realized this, they would work constructively to rectify issues with fierce adherence to the principles enshrined by the Health Care Act – without ever considering options involving any form of privatized health-care delivery.

Ahmed Mian worked as a high-school teacher before deciding to become a doctor.


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