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.

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