The answer is clear: we can’t afford privatized health care

Posted on August 24, 2023 in Health Debates

Source: — Authors: , – Opinion/Contributors
August 24, 2023.   By Danyaal Raza, Hasan Sheikh, Contributors

Instead of asking about more privitzation we should ask: why does Canada continue to fall behind our peers on publicly financed health care?

Family doctor shortages, long waits for specialty care and overcrowded emergency departments — these are challenges made even worse as the health system copes with the echoes of the pandemic. As doctors, we share our patients’ and the public’s frustration and fatigue. We are all desperate for solutions.

Into this reality, the Canadian Medical Association (CMA) is sponsoring cross country town halls asking participants to “wonder if there’s a greater role to play for the private sector.”

Despite the CMA’s scope and size, its framing falls prey to tired pitfalls that have long characterized this health care controversy. A more informed and modern question is this: why does Canada continue to fall behind our peers on publicly financed health care?

On the surface, there is nothing wrong with discussing the “blend of public and private providers for health care services and funding” — lots of other countries have a blended system.

In fact, so does Canada. But when we look deeper, we see that we spend less on our public health system — and more out-of-pocket and privately than most of our peers. As a share of all health spending, Canada allocates 75 per cent as public investment.

How does that compare? Canada is a standout Scrooge. The Netherlands, Germany, Sweden and France all spend 85 per cent or more via public funding.

Canadians have seen versions of this public-private “debate” countless times. A typical pattern happens whenever our health system is in crisis, as it is today. Following alarmist claims of spiralling public health care spending, calls for increased private financing and two-tier health care soon follow.

But this time around, the debate around private spending has been settled legally. The B.C. Supreme Court found in an 880 page ruling that more privately paid care would result in more waiting and worse care.

The decision was so comprehensive that after losing a second time at the B.C. Court of Appeal, the Supreme Court of Canada declined to entertain the case.

The second pitfall the CMA has fallen into is an amorphous and shape-shifting definition of “private health care.” Is the organization asking if care should be paid increasingly with credit cards, if hospitals should be converted from not-for-profit organizations into private investment opportunities, or both?

We need only look as far back as the early days of COVID-19 to recall the consequences of for-profit delivery of publicly funded services. The toll enacted by COVID-19 on older adults was a cruel illustration. Mortality in for-profit, investor-owned long-term care homes in Ontario was 78 per cent higher than in non-profit homes, with some of the most devastating consequences affecting corporate chains.

In England, outsourcing of publicly funded health care services to for-profit companies has been consistently increasing for years. An Oxford research team found that such outsourcing corresponded with significantly increased rates of avoidable death, attributed to a decline in the quality of health care services.

The third, is the “fallacy of the golden mean,” a concept that dates back to Aristotle and Ancient Greek philosophy. Debates like these lead observers to believe that both sides of an argument have equal value and that the truth lies halfway.

There is no “bothsidesing” science. Whether discussing private pay or for-profit investor-owned delivery, the evidence tells a clear story: we can’t afford privatized health care.

Are these the reforms the CMA thinks Canadians need?

The CMA should focus on modern solutions to improve our health care system. Team-based primary care for everyone in Canada, universal pharmacare, single entry specialist referrals and improving work conditions are just a few evidenced-based policy reforms to help.

If “private” health care is presented as the only option in an already overly privatized system, the CMA’s efforts will do more harm than good.

Drs. Danyaal Raza and Hasan Sheikh are board members of Canadian Doctors for Medicare, assistant professors at the University of Toronto and physicians.

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