So, amidst the bit of fuss, earlier this month, about British Columbians’ pretty firm rejection of the Green/NDP notion of electoral reforms ~ which, to be fair, got a helluva lot further than Justin Trudeau managed to push his promise ~ the BC Auditor General has issued a warning about the growing costs of health care. The article reports that Auditor General Carol Bellringer says that “the purpose of this report is to provide accessible information on the complicated topic of health care spending … [and while] … it was not triggered by concerns about the provincial government’s priorities around health spending but she did add a note of caution … [saying, specifically that] … “Rising health care costs may threaten the provincial government’s ability to provide services and meet financial commitments both now and in the future. This is something we noticed two years ago in our report on monitoring British Columbia’s fiscal sustainability. Between 2013 and 2018, health care expenses are projected to increase by $2.7 billion. This is more than the combined budgets of the 11 smallest ministries or even the budget of the third largest ministry, education.”“
I have been on about this for almost three years; warning, more than once, that there are 800 pound gorillas in each provincial and territorial living room, and in the cabinet rooms, too just waiting to break the fiscal furniture. In Ontario, in 2016/17 40¢ of every $1 spent by government went to health care. Sooner rather than later politicians, bureaucrats and citizens have to wake up to the fact that health care spending threatens everything else that matters: public education, roads, clean water and sewers and public safety may all have to be cut back to pay for our insatiable demand for ‘free’ healthcare.
My prescription remains the same: repeal the Canada Health Act and free the provinces from the chains that it imposes. Provincial politicians are not going to gut the system; they are all working politicians and they know that the public will not stand for that; but there are proposals out there that might have some value … to begin with, we don’t have a health care system, we have a universal health insurance system that successive governments have persuaded Canadians actually works for them and makes us ‘better’ than our American neighbours when study after study show that Canada has very high costs and quite poor outcomes when compared to most other advanced nations.
The fault is not with our doctors and nurses, most of whom are fine and many of whom are excellent, nor is it with pharmacists or X-ray technicians or even hospital administrators; the fault lies with a system that cannot meet an insatiable demand because almost every Canadian believes that health care is both ‘free’ and that (s)he is entitled to whatever (s)he wants whenever (s)he wants it … thanks Pierre Trudeau: that’s not what Tommy Douglas wanted but it’s what you promised and study after study shows that no Canadian province can deliver what you promised using the system you created. What Tommy Douglass wanted was a public insurance system that would guarantee that no-one would have to declare bankruptcy when faced with catastrophic medical bills … and that was not an unreasonable fear in the the 1950s. But he expected that many, even most doctors and hospitals would want to remain private … he just insisted that patients should be able to call on the public, shared, co-operative health insurance system when the big bills came due and that no ill person should ever be turned away from a doctor’s office or a hospital just because they were poor; he wanted the community to help out. In most countries in the world that happens: most people pay for some part of their medical care and some part is covered by private insurance and some part, often a large part, is provided by a public insurance scheme which is compulsory and into which everyone pays something.
As has been noted …
… Canada is the only developed country in the world that uses a single payer health insurance system and tries to disallow private options … and the end result is that Canadians are, already, deciding to opt for private care when they can afford it. The system is broken and we cannot afford to repair it … we need to redesign it using a non-Stalinist approach.
We do not need to take an ax to health care but we do need to take a scalpel to the funding model that is enshrined in the Canada Health Act. Free the provinces; let them experiment either other models and soon best practices will be adopted nation wide.