A couple of years ago I commented on the 800 pound gorillas that are in each (provincial) living room in Canada: “health care costs continue to grow inexorably, they eat a greater and greater and greater share of provincial budgets, crowding out e.g. education and infrastructure (road and bridge) maintenance, and, effectively, weakening the economic base for the future of each province and every Canadian. Health care costs keep rising for a number of reasons but one of them is that demand seems endless. And one reason it is endless is that Canadians think that health care is and must be free.” The kicker, of course, is that health care isn’t free ~ doctors and nurses and the people who sweep the hallways in hospitals and clinics and the people who replace broken windows and sterilize instruments, and, and, and, nearly ad infinitum, must all be paid. But it sort of looks and feels free because when one visits a doctor or hospital there is no bill at the end of each visit. It looks and feels free because the first criterion for provinces to receive federal money for health care in Canada, set forth in §8(1)(a) of the Canada Health Act, says that “the health care insurance plan of a province must be administered and operated on a non-profit basis by a public authority appointed or designated by the government of the province.” In other words we must have a “single payer,” 100% public health insurance system and the single payer, of course, is the taxpayer.
I believe that sooner or later the Canada Health Act (1985) will bankrupt Canada’s provinces.
But, I also believe that we need a national health care scheme ~ not just an insurance scheme ~ because I understand that a good, efficient, effective health care system makes a country more productive.
I understand that health care delivery and management is a provincial responsibility. That being agreed, we should have a national system. Three of the five principles put in place almost 35 years ago are suitable for such a plan which should be:
- Comprehensive ~ covering pretty most things, medical and dental and pharmacological ~ from cradle to palliative care;
- Universal ~ almost all Canadians, including Permanent Residents, should have access to the care they need wherever they are; and
- Portable ~ the national insurance should cover Canadians when they move to or just visit another province. It should even have (available, at extra cost) provisions for visiting or even working overseas.
I left off accessible because I do not believe it is practical to promise that. People who live in, e.g. Rankin Inlet are not going to have ready access to the kinds if care that are available to those living in, say, Happy Valley – Goose Bay or Whitehorse, much less Edmonton, Saskatoon or Winnipeg. It might be a highly desirable outcome but it is not going to be realized in anyone’s lifetime.
I also left off administration because:
- It is the current public administration criterion that dooms our current health care system; and
- It is an unjustified and unhelpful intrusion into a province’s political sovereignty.
We need a national health insurance scheme that has two components:
- Public insurance, mainly provincial but with a pan-Canadian national “supplement” that is available to all, at very modest, but always visible cost, and that covers medically necessary medical and dental treatments and prescription drugs so that, as Tommy Douglas wanted, catastrophic medical bills do not send Canadians into bankruptcy. But the principle should be that (almost) everyone pays for (almost) everything, even a trip to the emergency room. The payments need not be direct and immediate but every month (almost) every Canadian should get a statement of his medical insurance telling him and her how much “money” (s)he has in his plan and how much (s)he has to pay to keep the plan “topped up;”
- And a variety of private insurance plans, with a staggering array of benefits, that individuals or groups (employer plans) may join. Almost everyone should have some private insurance. A few people will fall through some cracks ~ some will not be able to manage their universal government insurance; some will not be able to afford any private insurance. Some will simply be unable to manage much of anything for themselves. I don’t know how social agencies will care for them, but the system cannot be built around them, it must be built around the 95±% of the people who are under the “normal” part of the bell curve.
Provinces must be free, politically and constitutionally, to experiment with different funding and management models for health care and services … one size is unlikely ever fit all in Canada, not even, one suspects, in Saskatchewan. For the national government to presume to dictate how health care must be funded is the height of folly.
This is not, I fear, a political winner for any party … but, eventually, a party will have to bite the bullet. I spoke, some years ago, to a provincial politician who admitted that he and his colleagues were well aware that the health care “system” would, eventually, consume an intolerable amount of the provincial budget but, he said, it was a taboo topic because the people “are not ready” to consider the situation … they would not, he felt, be “ready” until there was a crisis and then, he suspected, they might over-react. Perhaps Ontario’s new Progressive Conservative leader and, one hopes) soon to be premier Doug Ford will bring fresh, clear eyes to the situation and discuss it with Justin Trudeau et al in Ottawa and with other provincial premiers. It’s going to take a real leader to “bite the bullet” and not be paralyzed by fear.