Canada’s never-ending medicare fight

By Thomas Walkom
Toronto Star
Nov 29 2011

The most depressing element of Canada’s on-again, off-again medicare debate is its repetitiveness. The country is forced to fight the same battle again and again. It’s as if our political elites learn nothing.

I was reminded of that this weekend when Reform Party founder Preston Manning showed up on CTV’s Question Period to — again — make his pitch for two-tier health care.

The ostensible reason for his appearance was that Ottawa and the provinces are again talking about how to share medicare costs.

Manning has been pushing two-tier medicine since 2005. That’s when he and former Ontario premier Mike Harris wrote that Canada’s medicare system should be replaced by a narrowly defined scheme focused on catastrophic illness and financed, in part, by user fees. All other health care would be paid for privately.

Few paid much attention to Manning then. The country had just gone through a bruising debate over medicare during which the kind of ideas he was flogging were thoroughly discredited.

Any number of studies have demonstrated that so-called single payer public insurance systems like Canadian medicare are more efficient than two-tier schemes — for the simple reason that they avoid the paperwork costs involved when physicians have to track and bill large numbers of private insurers.

And user fees? Even a Senate committee that had been warm to the idea of charging patients each time they saw a doctor changed its mind when faced with the evidence. By deterring sick patients from getting early treatment, user fees end up costing the health system more.

But the real problem with two-tier medicine, as former Saskatchewan premier Roy Romanow noted on the same CTV show, is that it simply shifts costs.

Private-pay medicine may save governments money. But it provides no net savings to citizens who end up paying out of pocket for the same or worse health care.

Manning made much of the fact that Quebec’s government devotes proportionally less of it provincial budget to health —30 per cent of program spending as opposed to about 40 per cent in Ontario.

He appeared to attribute this to the fact that Quebec, unlike Ontario, allows physicians to opt out of medicare and bill patients privately.

But the real reason why the Quebec government spends less in proportional terms on health care is that it spends more in absolute terms on everything else. Provincial government program spending per capita in Quebec is $11,457. In Ontario, the figure is $9,223.

What’s more, health care spending in total — including both private and public medicine — takes a bigger bite out of the Quebec economy. The Canadian Institute for Health Information calculates that total health spending in Ontario represents 11.9 per cent of the province’s gross domestic product. In Quebec, the comparable figure is 12.4 per cent.

All of these statistics point to the same thing: shifting health care costs from the public to private sphere is no solution. If politicians want to deal seriously with the issue of rising costs, they will have to move beyond this sterile preoccupation

Yes, other countries have two-tier systems. But they don’t necessarily do any better. The Germans, Dutch and French, all of whom are praised by two-tier fans, spend more of their gross domestic product on health care than we do.

Surely it’s more productive to build on what we have — a successful, publicly funded, universal health insurance system that covers doctors and hospitals. It could be improved or even expanded. But it works. That’s why Canadians keep fighting for it. Over and over and over again.