Health care in Canada is not the same for everyone. Access to care differs based on education and socioeconomic status, for simple problems like acne, for diagnostic and preventive medical services, including investigations for colorectal cancer, and for access to ongoing cardiac care for people who have cardiac disease.
Tommy Douglas dreamed of a world where rich and poor alike had access to worthwhile and high-quality care. Instead, we have a system where rich and poor alike pay the same amount when care is received — nothing — but the care they receive is different.
Canadians suffer and wait for important surgery, and diagnostic tests. Canadians wait for consultations to pain clinics and several other expert medical services. Governments use rationing, by waiting, to constrain costs.
In Nova Scotia, despite the Department of Health initiative “Better Care Sooner” (just not now) hospitals have had their budgets slashed even though too many patients have extraordinarily long waits. What good is insurance that doesn’t cover you when you most need timely care?
Surely, we’d all be better off if those who could afford it paid directly for some of their care. The money government gets from you and spends on your behalf could be better used to support those services that most people can’t afford. We might even use the extra money to support timely care for those who can least afford it.
The Romanow commission suggested that government subsidize catastrophic, but not ordinary, drug costs. Why not the same for other medical expenses? Generating additional revenue by encouraging people to pay for inexpensive services would free resources to support rationed expensive care.
Economists, left, right and centre, agree that monopolies, whether public or private, rarely produce the most effective and efficient results. Economists also agree that price controls lead to rationing, poor quality and black markets. The empty shelves of the Gum department store in Communist Russia and decayed and abandoned housing in the South Bronx showed the pernicious effect of price controls.
In health care, Canadian governments maintain a monopoly and look after themselves by outlawing competition. You have no choice: take what government offers you or buy a ticket to Bangalore or Boston.
Would you like to call your own family doctor or communicate by email? You can’t because your insurer, the provincial government, won’t pay for these services. But government will pay about $60, on average, for an 811 telephone call to someone who doesn’t know you and only $30 when you see your family doctor in person.
Governments, as health insur-ers and administrators of health care, fail when it comes to regulating and evaluating their own performance.
People suffer and die because of an unacceptable number of recurrent preventable health system mistakes. Yet the Nova Scotia government hasn’t even bothered to ask and report whether mistakes are increasing, decreasing or are the same as reported in 2004. Airline safety records are public.
When was the last time you heard a provincial government insist that your hospital has sufficient funds to meet its mandate? Were you or your neighbours ever compensated when a scheduled surgery or diagnostic test was cancelled at the last minute? Airlines regularly reimburse people who are bumped from a scheduled flight.
Credit unions are co-operatives (groups of people who collaborate for mutual benefit) that succeed in areas normally dominated by traditional banks. Health care co-operatives, in Canada and the United States, formed to meet member needs, succeed today in areas normally dominated by insurance companies and government. They enable people to direct their money to services that work best for them, instead of to governments that spend according to political priorities. Low-income people benefit from reduced membership costs or other subsidies.
Patient co-operatives are one way to focus health spending and improve access and quality of care. Co-operatives moderate the pernicious effect of price controls and provide choices for patients. Effective co-operatives succeed, ineffective ones lose members. Co-operatives also free government from the unethical conflict that arises when governments are asked to regulate and evaluate their own performance.
David Zitner, a family physician, is Health Policy Fellow with the Atlantic Institute for Market Studies and a professor in the Dalhousie Faculty of Medicine.