31 March 1997
Freeing the forces of innovation in health care
Hospital closures. Long queues to see specialists and have some procedures done. Doctors leaving for more lucrative practices in the United States. Delisting of services previously insured under Medicare.
These are the stories that really attract public attention to the state of our medical system. But these are only symptoms, not causes, of what’s wrong with medical care in Canada. At least part of the fundamental problem is that government monopoly control is shielding the system from pressure to innovate, to find new ways to provide better quality care more cheaply.

That’s not to say that there haven’t been changes intended to cut costs. But the cuts are directed by bureaucrats, according to bureaucrats’ priorities. We, as consumers of health services, would spend the money differently if we were choosing for ourselves.

In virtually every field where you or I spend our hard earned dollars buying goods or services, the innovation constantly occurring is astounding. That change is driven chiefly by the fact that we demand that prices be competitive and that quality be improving all the time. Otherwise we take our business elsewhere. And because we pay, we make careful decisions about just how much of something we want to buy.

Examples are legion. Many new satellite services in competition with cable are improving television programming choice and picture quality. Retail banking has been changed almost beyond recognition by information technology, the ATM and the call centre. Phone companies compete for your business by offering discounts, added features and new billing options. In the car market, choice ranges from the basic cheap import with no options to the fully-loaded luxury car. In more and more areas we can decide what quality and level of service we want to pay for.

This kind of innovation offers us more choices and helps to keep costs down. That’s why the bulk of increases in the cost of living in recent years has come from government dictated increases in taxes, fees and other charges. The prices of goods and services produced by the private sector is now remarkably stable, helped in part by the open access to our market that freer trade has created. If Canadian companies can’t give me the quality I want at a price I’m willing to pay, I can deal with a German, Korean or American company.

None of these forces for innovation are allowed to work in medical care. Take just one example: the role of the doctor. If we individually were paying the bill for office visits, we would long ago have demanded cheaper alternatives. Many of us wouldn’t want to pay a doctor’s fee for simple procedures. A nurse practitioner, for example, could quite competently stitch up cuts, or prescribe the right medication for a wide range of ailments. In doing so, he would be assisted by a battery of sophisticated diagnostic tools, protocols, and databases.

Technology and better training can and should make it cheaper and every bit as secure to have many medical procedures done by technicians. Rural areas could be served by nurse practitioners connected by video and other electronic links to the best specialists in the world. Fewer doctors could serve a larger population more efficiently.

But you don’t pay, at least not directly, for each visit to your doctor. That changes everything. The government has given us a legal right to health care by a doctor, regardless of cost, so naturally we demand that only doctors look after us. If government tried to introduce nurse practitioners, we would decry it as “cutbacks.” If we were paying as individuals, we would feel better off because we now had more money available to do other things. Or we could decide that we really did want a highly trained medical doctor to devote her entire attention to our aches and pains, and pay accordingly.

In every other industry, we encourage specialization. In medical care, we stuff waiting rooms full of flu sufferers in winter so that their kindly local doctor, with many years of highly sophisticated medical training and experience behind him, can tell them to rest in bed, drink fluids and take aspirin. Lonely people with no real ailments visit this same doctor for a bit of sympathetic attention, courtesy of the taxpayer. There has to be a better way.