Wednesday, March 15, 2000
The Halifax Herald Limited
Alberta’s health experiment could provide valuable answers
By Brian Lee Crowley
THE DEBATE over Alberta Premier Ralph Klein’s health-care reforms is generating enough heat to keep every hospital in Canada toasty warm through a very cold winter. Unfortunately, you wouldn’t want to try to find your way down a hospital corridor by its light, let alone carry out a delicate operation.
The policy that is being vilified by public-sector unions and alarmist journalists and academics is that the existing private clinics in Alberta be allowed to keep patients overnight, thus enlarging somewhat the services they provide. Those services will continue to be paid for by medicare, under contracts negotiated with local health authorities. No local health authority will be obliged to make such agreements. If they do, it will be because it allows them to offer services more cheaply than through public hospitals, or because the resources of the public system cannot accommodate the demand.
This is a small extension of the public-private partnership that has always been at the heart of medicare. About a quarter of all health-care spending in this country is private, much of it on medically necessary things such as drugs, eyeglasses, dentistry, chiropractic, home care and alternative medicine. The proportion of health-care spending in the private sector is larger here than in many countries, such as Britain, which have systems that welcome private medicine far more than Canada.
Even in services insured by medicare, private provision has existed for years. Shouldice Hospital in Toronto, a private facility, performs thousands of hernia operations a year paid for by medicare. Clinics in several provinces offer eye surgery and other services on an out-patient basis. Every time an abortion is performed in one of Dr. Henry Morgentaler’s clinics, it is paid for by medicare, but carried out in a private business.
Here in Nova Scotia, even medicare itself is not administered by civil servants, but by a private, not-for-profit corporation, MSI, now merging with another private company, Blue Cross, headquartered in Moncton.
Our physicians are, with few exceptions, not civil servants, but private businesspeople carrying out the business of providing health care to their patients.
The opponents of privately provided health care charge that as soon as the profit motive enters into medicine, patient well-being is somehow compromised. Yet your doctor and mine provide health-care services to us for a double motive: to do good and to do well. Dentists, chiropractors and others who operate outside medicare are no less concerned for their patients’ well-being than GPs, and likely no more driven by the “profit motive.” Hospital administrators and Department of Health bureaucrats want to do the best they possibly can for patients, as well as to expand their empire and earn a better living.
Public-sector health providers are not angels, without private interests or motives, just as private health-care providers are not devils who see only dollar signs in human suffering.
Most of the huffing and puffing over Alberta’s modest proposal ignores one key fact: that our medicare system is on an unsustainable course. In spite of the fact that we have never spent more money on health care, and in spite of the fact that both Ottawa and the provinces will spend more again next year, the system is crumbling. There is no evidence that this is due to lack of money. On the contrary, the evidence is that we’re not getting good value for the money we’re already spending. We have to learn to do things better.
Learning means innovating. Alberta has proposed an interesting experiment that will give us a little more information about whether or not private management techniques might let us wring a little more value from our health-care dollars. That is why thoughtful supporters of the public health-care system, such as Michael Decter, who was deputy minister of health under Bob Rae’s NDP government, think that this experiment is worth doing.
If the experiment provides evidence that the private sector cannot provide comparable or better quality health care to that available in the public sector, then we will have learned something extremely valuable. And vice versa. If the opponents of Premier Klein’s proposal were genuinely interested in the health of medicare, they’d want this experiment, especially if they’re sincerely convinced that public-sector provision is more cost-effective. The fact that they want to stop the Klein reform at all costs suggests that they fear not the end of medicare, but the exposure of the vacuousness of their own arguments.
Brian Lee Crowley is president, Atlantic Institute for Market Studies.
Copyright (c) 2000 The Halifax Herald Limited