Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind... Romans 12:2
Better Medicine: Reforming Canadian Health Care
David Gratzer, ed.
ECW Press, 2002
326 pages
Reviewed by Ken Ewert
Age does tend to mellow us. For me, reading the morning paper is not nearly the provocation it once was. Yet there are still things that incite groans and headshakes of disbelief between sips of my morning coffee. Reports on the progress of the Romanow commission on Health Care reform generally provoked both. In the commission's final report released in November, Mr. Romanow, a former NDP Premier of Saskatchewan, let it be known that our health care system needs some clever carburetor adjustments and more gas money, but definitely not an engine overhaul.
During the commission's hearings, Mr. Romanow repeatedly declared that he was waiting to see evidence that allowing increased "for profit" services in health care would improve service or help control costs. He would have done well to include David Gratzer's book, Better Medicine: Reforming Canadian Health Care in his reading. Thanks to a system "characterized by central planning, bureaucratic rule, special interests, and political interference" Canadians face lengthening waiting times and deteriorating service. As with all socialism, the result is people suffer and die.
The above fact is not lost on Canadians who seem increasingly ready to accept changes. A recent poll commissioned by the Federal government found support for a "two-tiered-private-pay competitive system" has increased by 50 percent since 1995. Despite the beginnings of a shift in public opinion, there is stiff resistance from most political leaders (recall Stockwell Day's facile "No Two Tier" sign during the Federal election debate) and from some within the system—such as health care unions—who have strong incentive to preserve the status quo.
Dr. Gratzer is a physician and the author of Code Blue (ECW Press, 1999) which won the Donner Prize for best Canadian public policy book in the year 2000. In Better Medicine he assembles a variety of experts to address many facets of the Canadian Health care system.
As Gratzer notes, there is an "orthodoxy" among our political and cultural leaders which holds to the following: Canada has the best health care system in the world and its relatively minor problems can be solved by better management and more spending. Any change involving free competition would be contrary to Canadian values of compassion and would lead to a disastrous "Americanization" of the system.
This orthodoxy is a vain falsehood. First, if Canada's system is the envy of the world, why is not a single Western nation considering a Canada Health Act of its own? Second, the provinces already dramatically increased spending by an average of 22% between 1998 and 2000, with little visible results. Third, better health management has already been pursued by administrators for three decades. And fourth, despite the above efforts, a recent Fraser Institute study found that the total average waiting time from initial visit to surgical therapy was sixteen weeks, a significant increase over last year's numbers.
Ontario Medical Association President Albert Schumacher describes the situation in his own community: "[In] Windsor, for example, it now takes six months to obtain a hip replacement. Five months to get a CT scan. One of my patients waited more than a year for cardiac surgery. And some of our cancer patients still have to go to the United States for treatment." Forcing peopleoften in significant pain or discomfortto wait for long periods of time is hardly compassionate.
The contrast between cataract surgery and laser eye surgery illustrates the problem of, and solution to, our health care misadventure. There is a waiting list for cataract surgery of up to a year and a half. But there are no lineups for laser eye surgery. Why? The government has effectively claimed the right to be the sole provider of cataract surgery to Canadians, but has not likewise regulated laser eye surgery.
How did we get to this sorry state of affairs? Michael Bliss notes that Canada's Medicare originated in the 1960s consensus that there should be "a social equality" among people and that governments were able to manage things better than the free market. The result was a national insurance scheme implemented by the Pearson government in 1968 and, for a brief time, the golden age of Canadian health care. Soon, however, the costs of health insurance soared due to medical innovations, rising patient expectations, and the elimination of direct payment by users. As a result many physicians opted out of the public system and billed patients directly. In response, the Canada Health Act of 1984 eliminated extra billing by physicians and "effectively outlawed private medical and hospital practice and a legislated monopoly became the order of the day." Our Soviet-style system has supplied predictable results. As Bliss notes, when you "remove an industry from market conditions, replace price signalling with administrative fiat, [and] outlaw competition... you create the classic conditions for inefficiency, declining productivity, and gradually increasing consumer dissatisfaction."
One of the most enlightening chapters is "Myths about US health care." It is popularly reported that 43 million Americans are without health care. In truth, as David Hendersen points out, these people are without health insurance, not health care. Typically these people are without insurance only for a short time, such as when they are between jobs.
Another popular Canadian belief is that American health care is an example of a rugged free market, which has thus caused the explosion of medical costs. Again, as Hendersen shows, this is far from the truth: "The US medical system is one of the most regulated industries in the United States." US tax policies give powerful incentive for employers to purchase health insurance policies on behalf of employees, with the result that employees have little incentive to be price conscious when using these services. Additionally, the US system has a large component of socialized care: Medicare for the elderly and Medicaid for the poor. Under these programs users pay very little out-of-pocket. The result, according to Hendersen, is that "these two programs are the main source of the explosion in US health care costs" growing some 663% (adjusted for inflation) between 1970 and 1999.
This is a well-written and readable book. Canadians interested in their health care will want to read this book. Mr. Romanow, apparently, will not.
Return to Volume 8, Number 2.
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