Monday, July 23, 2007

Canada Moving Toward "Mixed" Health Care System?

I once favored Canadian-style health care for the USA, but no more. Having visited that wonderful country frequently and paid much attention to its politics and culture, I reluctantly concluded that full nationalized funding--even with doctors remaining in the private sector--does not work. (We recently discussed this issue here at SHS with regard to the UK's National Health Service.) I thus shifted my thinking to supporting a combination of private/public health care funding to provide close to universal coverage.

Apparently Canada is moving slowly in the same direction--although with a far more limited private sector than I think necessary--at least for now. From the story in the Washington Times:

For the first time, private health care clinics are proliferating throughout Canada and arguments for allowing private physicians to practice freely are being heard. "You are seeing the Medicare orthodoxy of the last 30 years being questioned in Canada," said Dr. David Gratzer, a registered physician in Canada and the U.S., and senior fellow at the Manhattan Institute, a nonprofit public-policy think tank. "Over the last two years, the health care system has dramatically changed to allow more private health care."

The Supreme Court of Canada, widely viewed as among the most liberal in the world, nearly two years ago allowed a man in Quebec to buy health care on his own--striking down 30 years of precedent and giving advocates for private health care a major victory. The case is known as the Chaoulli decision, after Dr. Jacques Chaoulli, who took action against the system after a patient was forced to wait nearly one year for a hip replacement.

Chief Justice Beverley McLachlin and Justice John Major wrote in the decision: "The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care."

Currently, only about 1% of Canadian health care is delivered by the private sector. But the times may be a changin':
[A]s a result of the Chaoulli decision, the health care debate turned in favor of private financing. The largest impact of the decision has been to change the consensus on whether or not the health care system is sustainable. "It has changed the consensus on whether it's even just," said Brett Skinner, director of pharmaceutical-policy research at the Fraser Institute, an independent research organization in Canada. "There's an evolutionary change that's under way that will be incremental, year over year — a slow expansion of private options, and the development of private insurance for those things," said Mr. Skinner.

But despite a groundswell for more privatization in Canada, it remains illegal under federal law to pay for health care that is deemed medically necessary by a provincial government.

These are important shifts that could remedy what ails Canada (long waits for surgery and testing, many without a primary care physician, etc.). I remember giving a speech in Canada in which I got a big laugh by stating, "When I am in the USA, everyone says they want a Canadian style health care system. Now, here in Canada, I am hearing everyone wants a USA-type system." That overstates the case, of course, but the future seems clearly to be moving in the direction of nationalized care through a combination of private/public funding both in Canada and the USA. The sooner we find the right mix--which will probably be different in both countries--the better for everyone.



At July 23, 2007 , Blogger Lydia McGrew said...

One hears w.r.t. the British system, "Of _course_ you're allowed to use your own money to buy things you can't get on the national system." But the small amount of research I've put into this about Britain indicates that it's not as simple as that. Apparently the private and public systems are kept strictly separate so that a doctor must maintain his practice on all private-money patients and a given individual cannot combine NHS and private money for the same service. This obviously isn't just a matter of the public purse paying up to X number of dollars and you paying more if you want more or better treatment.

I'd be interested to know what the situation was in Canada about this strict separationism before this court decision, and what it's like now.

I do know that when Hillary was proposing her plan for the U.S., the claim was made that you would be legally treated as trying to "bribe" a doctor if you offered to pay your own money for some treatment not otherwise provided by the National Health Care system.

At July 23, 2007 , Blogger Kate said...

The trouble in Canada is not the system itself, which works more or less like it is supposed to. The trouble is a shortage of doctors, caused, not by the system, but by some very ill advised tinkering in the medical schools some time back when the gov. thought that it was going to have too many doctors for the system to support. So medical programs were limited in how many students they could take, causing an artificial shortage of doctors. That's stupidity, not the system. And time should remedy that, now that those restrictions have been removed.

Once again, remember that despite having very different systems, outcomes are little different between Canada and the US, and Canada's system is cheaper. Even comparing the taxes Canadians pay to the amount typically withheld from an American employees paycheck for insurance that may or may not let him receive needed treatment.

For profit medicine has it's heart in the wrong place - in the pocketbook, rather than with the patient.

That said, I'm sure there are ways to improve on what Canada has, adn there must certainly be ways to improve on what the US has. In your opinion, what is the most effective health system in the world? I've heard tell France, though I'm not sure how theirs is run...

At July 23, 2007 , Blogger Cliff said...

Despite an engineered proliferation of supportive stories for privatization and a great deal of intensive propaganda pushing for it, there is in fact no groundswell of support for privatization in Canada.

Canadians do want improvements to the healthcare system, but despite all the pressure for private 'experiments' from business and media elites the public repeatedly and firmly rejects anything but public solutions. Read the many polls on the subject if you don't believe me.

We don't want two tier healthcare for many reasons - losing doctors from the public system to a more lucrative private practice in effect drastically increasing wait times, the dangerous position it would put us in with NAFTA which acknowledges our national sovereignty over healthcare policy only so far and so long as it stays public and opens the door wider for American Health insurance corporations to control our healthcare choices with every private 'experiment', and most importantly, a nationally held belief that the profit motive has no place in healthcare decisions.

Then there's the negative experiences with 2tier healthcare in Sweden and Australia where the numbers showed a 'perverse incentive' for doctors to concentrate on the easiest most lucrative medical procedures - to the detriment of the more difficult and publicly funded -and therefore less lucrative- cases. There's also ample evidence that the more private profit is allowed into the system the more expensive and bureaucracy ridden it becomes.

Trust your original judgment about a fully public system being the best way to go - and particularly examine the funding and motivations behind those groups impugning it and promoting a two tier intrusion of the profit motive. The Fraser Institute for instance, takes millions from the insurance and pharmaceutical industries to promote their interests.

Here's some more info if you're interested:

At July 23, 2007 , Blogger HellKaiserRyo said...

We all have a putative right not to die at all... if there are some legitimate anti-aging therapies available, everyone should have access to them. If not, this violates our right to life.


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