June 29, 2012 - In the National Post today, chairman and CEO of medcan Shaun Francis highlights MLI's report, First, Do No Harm: How the Canada Health Act Obstructs Reform and Innovation, in an op-ed about reforming medicare. The full column is copied below.
By Shaun Francis, National Post, June 29, 2012
This Sunday marks the 50th anniversary of Saskatchewan's Medical Care Insurance Act, which first took effect on July 1, 1962. The legislation, championed by premier Tommy Douglas throughout his 17 years in office, meant the prairie province was the nation's first to provide universal medicare. This was a seminal moment, one that paved the way for every other Canadian province to follow Saskatchewan's lead.
That said, it was not a seminal moment for the world. Such countries as Britain and Germany are among those that beat us to the punch with legislation meant to ensure that all citizens could afford adequate health care.
But let's not undersell the achievement of the act's progenitor. Tommy Douglas was a remarkable man who was an ordained priest, an amateur province-wide boxing champion, and a member of parliament, all before the age of 31. He also was a socialist, and thus was aligned to a political sensibility differing considerably from my own. But had Douglas lived and worked today, and been able to witness firsthand the effects of the legislation intended to safeguard his legacy, then I think we both would have agreed on something: The Canada Health Act (CHA) requires revision.
Few Canadians realize that the universal medicare that Douglas shepherded into law contained key differences from our current system. For example, Douglas's legislation allowed a private, parallel system to exist alongside the government-run one. People could opt out of his provincial system. And Saskatchewan's doctors were able to set their own prices for the services they provided — a practice known as "extra billing."
The stultifying monopoly situation that now exists didn't begin until the advent of the Canada Health Act, which received royal assent on April 1, 1984. By that time, Douglas was living in Ottawa and well into a battle with cancer. A strong man, he held on until Feb. 26, 1986. The Ontario legislation that banned extra billing didn't pass in Queen's Park until June 20 of that year. The point? Tommy Douglas died in a province where monopoly health care hadn't yet taken hold.
Now, as we pass the half-century mark for the advent of universal medicare in Canada, it seems timely to ask what Tommy Douglas would think of the measures we have taken to safeguard his innovation.
The latest indication that we're falling behind is a report released recently by the Macdonald-Laurier Institute, which notes that the Swiss healthcare system spends the same share of the country's GDP as we do. And yet, by numerous measures — physicians per thousand people, CT scanners per capita, most wait times — the Swiss system beats ours. Why? Well, the report notes that, like every other developed universal medicare country but ours, Switzerland allows a parallel private system. The Swiss system allows user fees and allows doctors to extra bill. The report's authors, Jason Clemens and Nadeem Esmail, posit the cause of our lagging: The public-payer monopoly effectively prescribed by the Canada Health Act.
Here's what I think: Tommy Douglas would be in favour of the experimentation that Stephen Harper's government has, to date, halfway encouraged through its "no strings attached" funding. But as Clemens and Esmail point out, to really encourage innovation, the federal government should revise the Canada Health Act. And I think Tommy Douglas would agree with that.
Tommy Douglas wanted decent, guaranteed healthcare for all Canadians. But he also was fine with letting people pay a little extra if they wanted additional care. For example, in his recent biography of Douglas, Vincent Lam describes the way he paid for private nurses to care for his daughter, Shirley, at home, so that she wouldn't have to stay in a public hospital ward during a bout with the measles.
Not only that, as an intensely driven boxing champion and small-time entrepreneur, he understood the motivating value of competition.
Tommy was anything but dogmatic about health care, or any of his policies. He was a pragmatist — one who was open to radical thinking. Lam says Douglas pursued his goals by analyzing policies with three questions: "What do we want to achieve for our citizens? What's the best way to achieve it? And: Are we getting value for our money?" Both he and I would agree we want to achieve a universal, world-class healthcare system; and that the best way to achieve it is not the way we're currently pursuing. And both Tommy Douglas and I would agree we're not getting value for our money.
To mark the half-century anniversary of the universal medicare system he championed, then, let's at least acknowledge this: Given the damage the CHA monopoly has done, and how far we've fallen behind other nations, even Tommy Douglas would acknowledge that our system would benefit from an injection of competitive spirit.
Shaun Francis is chairman and CEO of Medcan, North America's largest preventive health clinic.