Monday, September 12, 2011

Pack the trunk of this health-care elephant

By Naomi Lakritz
Calgary Herald
August 24, 2011

Tory leadership candidate Gary Mar has been reading too much F. Scott Fitzgerald lately.

Fitzgerald's 1925 short story, Rich Boy, starts off: "Let me tell you about the very rich. They are different from you and me."

Mar thinks the rich are so different, that they should be able to buy their way back to health, while the rest of us unmonied members of the great unwashed queue up in the public system.

Now, this is nothing new. It's ideological baggage from the Ralph Klein years, which mercifully are past, and it just goes to show that Mar has not evolved in his thinking. Do we really want our next premier to be someone who checks into the legislature still carrying the same worn-out, frayed suitcases he had when he left?

Mar appears to have conveniently forgotten how his confreres had to back away with noticeable and precipitate haste from the Third Way, after Albertans made it clear they didn't want anything to do with it. Now he's back with, quite possibly, the Fourth Way. How about the Highway, Gary?

Ever heard of the Highway? How about taking that path with your recycled schemes to let the rich pay?

Mar says he's not talking about critical care. So if a rich person needs a quadruple bypass, they can't buy their way into their cardiologist's favour. But he puts forth the same fallacious argument that others put forward when promulgating the privatization of health care, and that is, as columnist Graham Thomson wrote recently, that private clinics would take the pressure off the public health system.

There are a finite number of doctors in Alberta. If some of them go over to the private clinics to work, they will remove themselves and their resources from the public system. The public system will be left with fewer doctors, which will create longer queues. It's simple math. Too bad the only math the proponents of schemes like Mar's understand is the increased jingling of profits in someone's pocket.

Dr. Harvey Barkun, whose impressive list of credentials includes 16 years as executive director of the Montreal General Hospital, writing in the McGill Journal of Medicine in 2008, had this to say about why privatization does nothing for the public system, whose fundamental problem is wait times: "You wait to see a family physician; you wait to see a specialist; you wait in emergency rooms; you wait for elective surgery; you wait for laboratory and radiological procedures.

And will an infusion of private money cure these ills? Not at all. These long wait times exist because of a very serious lack of health care personnel ... Proper treatment requires a proper diagnosis. The diagnosis of our current ill is a lack of people, not lack of money.

Privatization is the wrong treatment.

The Ottawa-based Canadian Health Services Research Foundation cites a study that showed "countries with parallel public and private health-care systems have the longest waiting times . . . England and New Zealand, which have parallel private hospital systems, appear to have larger waiting lists and longer waiting times in the public system than countries with a single-payer system, such as Canada . . . Waiting times in England and New Zealand are also longer than in countries such as the Netherlands, where a separate private hospital system exists for the wealthiest citizens, who are not able to use the public system."

As well, "Studies in both Australia and England have found the more care provided in the private sector in a given region, the longer the waiting times for public hospital patients."

The CHSRF cites Manitoba, where, "until 1999, patients paid an additional facility fee or 'tray fee' if they chose to have cataract surgery in a private facility (the surgery itself was still paid for by the provincial health plan). At the time the fee was in place, the Manitoba researchers found that patients whose surgeons worked only in public facilities could expect a median wait of 10 weeks in 1998/99; however, patients whose surgeons worked in both public and private facilities could expect a median wait of 26 weeks."

The CHSRF also says: "Since health-care practitioners can't be in more than one place at the same time, creating a parallel private system simply takes badly needed doctors and nurses out of our public hospitals . . . it's hard to see how removing them from the public system will help alleviate public waits. Since doctors earn more in the private sector, they have what economists call a 'perverse incentive' to keep public waiting lists long, to encourage patients to pay for private care."

Or, as another Tory leadership candidate, Alison Redford, put it at a Herald editorial board meeting this week, allowing privatization does not fix the public system.

Mar calls privatization "the elephant in the room." Well, an elephant in the room poses a danger to humans, who could get trampled by it.

Let's lasso this elephant and hustle it out of that room.

Naomi Lakritz is a Herald columnist.

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