Dated: 23/08/07



Halifax Do Canadians value form over function? In suggesting that governments should be considering expanded opportunities for private delivery of health care in Canada, the Canadian Medical Association has been accused of putting profit for doctors ahead of Canadian values.


In Form over Function, the latest commentary from the Canadian Health Care Consensus Group, author Brian Ferguson Ph.D. explores the debate about Medicare in Canada and concludes that we need to take a step back and consider not only what Canadians really do value, but also what, exactly, is being proposed.


 “Unfortunately, Medicare has become such a shibboleth that no government has dared speak in other than platitudes and vague generalities for years now. The result has been a Tower of Babel effect: a debate in which everybody might be using what sounds like the same words, but in which all of the participants have, in fact, been speaking different languages. Under those circumstances, victory goes to the side which can most skilfully avoid precision in terminology while at the same time investing words with a sense of menace.”


Ferguson reviews reactions to statements by politicians and others who have suggested that all is not well with the current state of our health care system and that there exist practical and affordable solutions which do not depend on further increases in public health budgets.  Ferguson says he finds a disconcerting dichotomy:


The most inflexible adherents to our current system do occasionally receive criticism for putting ideology ahead of the suffering of patients waiting for surgery, for example, but, that sort of criticism has a short half life in Canadian policy debate. On the other hand, accusations of willingness to destroy Medicare can be recycled on a moment’s notice.”


The paper also describes the carelessness with which many terms are thrown around in the debate: the term “private insurance” is incessantly misused as a synonym for the United States system; a core concept in Canadian Medicare – “all medically necessary services” – lacks a definition for the term “necessary”; and “private investment” is portrayed as taking away from the public system rather than being recognized as an injection of additional resources into the public health care system.



Most important, says Ferguson, stifled and inarticulate debate impedes action that is sorely needed.


“It’s time to stop letting the defenders of a 1960s health care system control the policy debate. It’s time to recognize what other countries with publicly funded health care systems have already recognized, that the form of the system has to change if its function is to be preserved. Health technology has changed since the birth of the national Medicare plan. The way we organize the delivery of medical care has to be able to change, and cannot be blocked by people who would put ideology ahead of a well-functioning health care system.”





Members of the CHCCG came together to provide a platform for bold, reasoned and practical plans for genuine reform of the health care system and to demonstrate that there is an emerging consensus among reform-minded observers about the direction that real reform must take. The CHCCG, coordinated by the Atlantic Institute for Market Studies (AIMS), includes medical practitioners, former health ministers, past presidents of the Canadian Medical Association and provincial medical and hospital associations, academics, and health care policy experts, all of whom are signatories to the group’s Statement of Principles.


Form Over Function is one of a series of commentaries prepared for the CHCCG, which are intended to contribute to that new debate. These commentaries do not represent official positions of the Consensus Group, and are not themselves consensus documents, but rather are intended to act as starting points for debate, some of which will occur on the Consensus Group’s website (




For more information, contact:
Charles Cirtwill, AIMS (acting) President
Brian Ferguson Ph. D., AIMS Fellow in Health Care Economics & Professor of Economics, University of Guelph
519-824-4120, ext. 53538