I have been arguing, since the early days of this blog, February 2016 to be exact, that health care spending is going to destroy Canada. Put simply:
- We cannot afford the system we have;
- The system we have is broken; and
- No one wants to discuss a rational system.
Canadians love their healthcare system. About 18 months ago the Washington Post said that “Canada’s health-care system is a point of national pride … [and] … Canada’s health-care system, known as Medicare, is an unrivaled pillar of Canadian national identity. Nearly 90 percent of Canadians believe that eliminating it would result in a fundamental change to the nature of Canada … [but, that newspaper warned] … Canada’s universal health-care system is in danger of becoming outdated, putting its credibility as a global health leader at risk … [according to a study in a prestigious British medical journal which pointed out that] … The study is also critical of Canada’s long wait times for nonemergency, specialty procedures like knee and hip replacements and non-urgent advanced imaging — higher than those in America — describing them as a “lightning rod issue” that could undermine support for Medicare among Canadians … [and] … Canada’s status as the only country in the developed world with universal health-care that does not cover prescription drugs is panned, too. In almost one-quarter of Canadian households, someone is not taking medications because of an inability to pay, according to the Angus Reid Institute, a polling organization.“
Predictably, in the wake of the ethics commissioner’s report and the blackface scandal, Justin Trudeau promises to fix it. He promises to add $6 Billion to the $253.5 billion, or $ 6,839 per person Canada already spends. A 2.5% increase in spending, spread over four fiscal years is going to fix things? Does anyone really believe that?
Mark Bonokowski uses his own, sad, personal experiences to illustrate the problem in an opinion piece in the Toronto Sun. “The latest fantasy among the Trudeau Liberals,” he says, “is their electoral promise to spend a piddly $6 billion over four years to improve access to a family doctor as well as mental health services … [t’s a fantasy he says because] … It’s truly laughable. It’s as if family doctors could be ordered online and sent wherever needed, and that mental health services just need a few more bucks and sanity would magically prevail …[and, of course]… On cue, Justin Trudeau blamed one of his favourite villains, Ontario Premier Doug Ford, for cuts to the province’s health system, but skipped the part where Ford’s budget invested $1.3 billion more into the system.” That’s right, Doug Ford, who inherited a fiscal nightmare from the McGuinty-Wynne Liberals, still had to increase healthcare spending because Ontarians, being Canadians, expect more and more and more “free” healthcare. That spending comes at the expense of education, law enforcement, transportation, clean water and so on … because its a political imperative.
Kim Campbell famously, perhaps infamously said during the 1993 election campaign that “An election is no time to discuss serious issues,” and one can understand, perhaps, what led her to that conclusion. But healthcare funding is a “serious issue” and this election campaign is when wild, irres[ponsible promises are being thrown about. Eventually, someone has to warn Canadians that the system, put in place by the Canada Health Act of 1985, is going to bankrupt us all. The problem is simple: it is the “public administration” principle ~ which applies to health insurance, not to healthcare delivery ~ ties provinces hands as they look to find ways to meet an ever-growing demand. The only practical control is rationing, and Canadians see that when they cannot get a timely appointment or cannot even find a family doctor and must then wait for four, six or, as Mr Bonokowski relates, for 10 hours to be seen in a hospital emergency room. Of course, there are fully private alternatives in most cities … at considerable cost.
Study, after study after study shows that Canadians pay more for healthcare than do the citizens of almost any OECD country other than the USA but they end up with worse healthcare outcomes (results) than do most others. We spend too much and we get too little in return. The systems which produce better measurable outcomes and spend less per capita are all shared cost systems ~ that is to say: the individual, often through a supplementary, private insurance programme (sometimes provided by her or his employer) pays something, a bit, for each visit to a doctor, for each test, for each procedure. Perhaps the individual doesn’t pay very much and, of course, in every country, there are some individuals who cannot pay anything at all, but most people pay for some of their own health care costs. This appears, to me, to make individuals more responsible health care users and to make the make physicians less likely to order expensive tests for simple problems in order to pacify patient over-expectations.
I am, most assuredly, NOT recommending that we adopt anything like the American health care model; it is even more expensive and produces sub-par results, too. But Australia and several other countries provide better health outcomes for less money than does Canada. Australia, Germany, Norway, the Netherlands and Singapore all provide better health outcomes for less money … why do we insist on retaining our Marxist system?
I do not advocate making this an election issue, but I do hope that the next government will take healthcare more seriously. We cannot ignore the 800-pound gorilla for too much longer: