Could two-tier health care today lead to greater ills tomorrow?
By KEVIN SPURGAITIS
In the early morning hours last July, Cathy Cormier felt the worst abdominal pain of her life — the result of a large gallstone lodged in her common bile duct. In timely fashion, she received a diagnosis and medical treatment at the Halifax Infirmary site of the Capital District Health Authority. But the real problem began when Cormier, who is a nurse herself, needed something that is in short supply in Canadian hospitals these days: an infirmary bed. For two days, Cormier’s was a gurney pushed against the check-in desk of the emergency ward, where according to the Globe and Mail, she and the others were expected to rest until more hospital beds opened up. “Nobody pays attention to you once you are in the hall,” Cormier, 50, sharply told the newspaper upon her release from the hospital. “You are completely on your own.”
In a more shocking case, a homeless man and double amputee died in September after sitting 34 hours in a Winnipeg emergency room. Brian Sinclair’s death was the cause a preventable bladder and abdominal infection, the Winnipeg Free Press reported. All it would have taken to save the 45-year-old’s life was a simple change of his catheter and, of course, antibiotics. But the staff at Winnipeg’s Health Sciences Centre hospital was unable to treat him and, by the time his body was found in the waiting room, it was already stiff from rigor mortis.
The queues for health care across the country have been a common, alarming sight. Access to family doctors and emergency services has worsened over the years partly due to shortages of doctors and space. As a result, Canadians’ faith in a publicly funded health-care system — best known as medicare —has been rudely shaken, leading some to tout a mixed public-private system.
Boosters of this two-tier system, which already exists due to the upspring of specialty clinics, say that increased competition from the private sector would be a cure-all to wait times and would force the public system to be more efficient. It’s the kind of talk that troubles medicare advocates, who view private, for-profit clinics as a threat to the Canadian health system itself. They argue that the outright privatization of health services would actually draw many of the best doctors out of the public system and drive up the wages of medical professionals. They insist it’s not telling of a Just Society that’s supposed to treat sick people equally. But above all else, they say that the current system is already on the mend — so why even try to dismantle it?
Every year, Canadians make 14 million visits to emergency departments, according to Statistics Canada. They frequently call on their family doctors too. In Pollara’s 10th annual Health Care in Canada study, the most comprehensive survey of Canadians’ attitudes on medicare, only 57 percent of respondents recently said that they were receiving quality health care. More than two-thirds agreed that the health-care system needs major repairs or a complete overhaul. However, the national poll also revealed Canadians’ deep conflict about the role of the private sector in health care.
Like it or not, there are now 89 private, for-profit clinics doing surgery, MRIs and CT scans across the country, particularly in British Columbia and Quebec. These “boutique” physician clinics operate in the face of the Canada Health Act (CHA), which ensures universal coverage for medically necessary hospital and physician services, and prohibits private, for-profit health care practices.
Conservative think tanks, such as the Fraser Institute, clearly like the idea. The organization has dismissed the current system as a “single-payer health insurance monopoly” — one that doesn’t cover many advanced medical treatments. It argues that people should be free to buy private health insurance, as they do in countries such as Sweden and Australia.
In 2005, the Canadian Medical Association (CMA), the country’s main lobby group for physicians, also adopted a motion supporting access to private-sector health services and private medical insurance in circumstances where patients cannot obtain timely access to care through the single-payer system. CMA’s new president, Dr. Robert Ouellet, has prescribed a mixed public and private health-care system. He told the Globe and Mail last summer that “Canadians must wake up to the key role private health care can play in relieving the country’s ailing public system.”
Ouellet, who runs several private radiology clinics in Quebec, argues that the Canadian health-care costs have quadrupled in the last 20 years; the country’s doctor-to-patient ratio has plummeted; and by 2011, the number of Canadians over 80 will have jumped by 43 percent. In the face of a shortage of operating rooms, he questions the banning of surgeons, who provide 90 percent of their services in a hospital, from performing five to 10 percent of their surgeries in a private clinic.
Retired United Church minister Rev. Bill Jay, who is The United Church of Canada’s health expert, acknowledges that two-tier health care is already here but strongly urges “the need to carefully manage it.”
“Look, everyone can see the inefficiencies of the public system; we’ve all been caught in the aggravation of wait times,” says Jay, who between 2000 and 2008, carried out the church’s health-care advocacy through the Canadian Council of Churches’ Ecumenical Health Care Network, which he co-founded. “But the moment people start paying private premiums, they’re going to want to be exempted from paying for public health services. When doctors, nurses and technicians are poached by private clinics, more health-care practitioners will follow. It could have a siphoning effect.”
To boosters of health-care privatization, Jay puts its bluntly: “Look, you’re likely to scream for a social safety net when your parents begin to have health issues related to aging and they need expensive treatments for cancer and osteoporosis, or when, despite your own physical fitness, some unexpected thing like cancer befalls you.”
The United Church Moderator Rt. Rev. David Giuliano, who has spent the last couple of years undergoing cancer treatment, says “the more we move toward endorsing [private] care, it seems to increase the likelihood that those at the bottom end of the care system will get sub-standard treatment.”
It reminds Giuliano of the separate but equal schools for African Americans in the United States. “I don’t think anyone will tell you that those schools were funded in the same way Anglo-Saxon schools were,” he says. “I can’t imagine the Canadian health-care system won’t go in the same route if we insist that people with their pockets full of money can buy their way out of the system that is intended to serve everybody.”
He continues: “There’s no basis for an argument that rich people should be treated better than poor people in Christianity. From a theological starting point, those who are wealthy and have plenty of resources have a special call to those who don’t. True, we no longer live in a culture where that’s the basis of any argument, but as a church, we need to move out of that reality and lend our voice to the national conversation about health care.”
It’s been more than six years since former Saskatchewan premier Roy Romanow spoke out on Canada’s health care with the release of a wide-reaching report. His 47 recommendations — which included reorganizing family doctors into teams, computerizing health records and developing a national pharmacare program — were heralded as a blueprint for the 21st century. But up until now, little has been done to act on the report, critics say. Even Romanow, himself, has questioned what his 18-month, $15-million commission has accomplished. He told the Toronto Star that the CHA is “almost becoming a dead letter of the law.”
A major concern now is the “enforceability of the Canada Health Act,” according to Raisa Deber, a professor of health policy at the University of Toronto. “The law is essentially a floor, not a ceiling,” Deber says. “It says medically necessary services have to be paid for publicly, but it says nothing about how those services need to be delivered.”
She continues: “Your doctor does not work for the government. Your doctor is a small business entrepreneur who only bills the government. . . . When we’re talking about increased privatization of health care, I have doubts about a model that is based on the assumption that people are going to altruistic enough. Think about it, if I’m a venture capitalist in the field of medicine and I have this situation in which people are willing to buy their way to the front of the queue, why would I try to lower the number of people on my wait list?”
While the debate over Canada’ health-care system has carried on, the Conservatives have continued to implement the previous Liberal government’s 10-year $41.3 billion federal-provincial plan to strengthen health care. The federal government’s 2007 budget offered more than $600 million to provinces and territories to encourage them to implement patient wait times guarantees by 2010.
The Health Council of Canada (HCC), created by the 2003 First Ministers’ Accord on Health Care Renewal, has been closely monitoring the country’s progress in health-care reform. HCC interim chief John Abbott says “a number of accords, undoubtedly, are leading to some great things and there are reasons to celebrate.” In October, the council also endorsed the Conference Board of Canada’s report on Canada’s health performance, which gave the country a “B” ranking, placing the country 10th out of 16 countries in health performance. “Sustainability is now the goal to which we believe all of our government stakeholders aspire,” Abbott says. “And it is one that all Canadians will have to work collaboratively to achieve.”
United Church health expert Rev. Bill Jay agrees that much is now being done to reduce wait times for heart and cancer patients, as well as those needing hip and joint surgery, cataract operations or diagnostic tests. Jay continues to represent the church on the board of the Canadian Health Coalition, which aims to safeguard the legacy of the late Tommy Douglas, the Scottish-born Baptist minister who as leader of the Saskatchewan Co-operative Commonwealth Federation (CCF) and premier of Saskatchewan introduced universal public health care to Canada.
“[Today’s medicare] still fulfills the vision of its founders: that it would be there when we need it, irrespective of our ability to pay,” he says. “It’s still performing exceedingly well in terms providing necessary medical treatment across the country. . . . Whether you are paying no taxes as a person with a disability or a CEO of a prosperous firm, you have an equal chance of getting prompt treatment.”
But Jay admits that there is plenty of room for improvement, and that much more can be done to accommodate patients such as Cathy Cormier and Brian Sinclair.
“The prescription for Canada’s ailing health care is to fairly allocate existing resources to make sure that the CHA — and the public system as we know it — do not erode through double-dipping,” he says. “This really is an issue that affects all of us and not just the near-do-wells. It’s like the old adage from the Book of Corinthians, ‘If one member suffers, all members suffer together.’”
Originally published in The United Church Observer, February 2009
