Writing in Sun Media papers, reporter Jonathan Sher covers the release of the Macdonald-Laurier Institute's latest paper, "How markets can put patients first: Economics before politics in Canadian health care delivery", by University of Toronto professor Audrey Laporte. The paper is the latest edition of MLI's series on health care reform, "Medicare's midlife crisis". Sher writes that "Canadian health care will wallow in mediocrity and consume wealth until governments allow private insurers and require patients to pay more cost directly out of pocket to providers, a health economist warns". He interviewed John Church, a political scientist at the University of Alberta, who agrees with Laporte that a competitive insurance system need not be modelled on the US system. Sher writes that according to Church, "Canadians need to reach consensus on values that should drive the system".

Sher breaks down Laporte's recommendations as follows:


As Laporte sees them


  • Pay for care above a base covered by insurance.
  • Insurance for catastrophic costs; tax credits to offset costs for the low-income

Private insurance

  • Privately provided, with minimum core set by government
  • Bought like car insurance, not through work; coverage not affected by job change
  • Premium charged for acute coverage and a second amount to offset future increases for chronic conditions

Market pricing

  • Set by providers, not government
  • Require insurers to cover a bit more than the actual cost of care.
  • Anything beyond paid out-of-pocket by users.
  • Providers compete on price.
  • Remove barriers to enter marketplace to ensure competition

Government as referee

  • Insures quality through inspections/public reporting
  • Provides care in rural/remote areas to ensure standards met
  • Makes sure teaching hospitals fulfill educating roles

Private sector

  • Provides insurance
  • Private hospitals/clinics decide how to set up their practices and compete with public ones.


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