June 26, 2012 - MLI's latest report on the Canada Health Act by Jason Clemens and Nadeem Esmail, First, Do No Harm: How the Canada Health Act Obstructs Reform and Innovation, is the subject of a latest editorial in the Ottawa Citizen. In "Enough health-care studies", the editorial accepts and promotes the two main arguments in the MLI paper: (1) Canada needs to look to other universal health care countries, particularly countries like Switzerland, to learn lessons about how to improve our own system, and (2) the Canada Health Act needs to be revised in order to allow such reforms to occur at the provincial level. The full editorial is copied below. Copyright (c) The Ottawa Citizen.
Ottawa Citizen, June 26, 2012
If there is one thing Canadians are good at, it's studying health care. A recent Conference Board of Canada study, itself a study of previous studies, pointed out that there have been 18 major examinations of the subject in the last 15 years.
But that was last month. Since then, more studies have arrived, including an intriguing one from Ottawa's Macdonald-Laurier Institute. This new report looks at the Canada Health Act, the federal legislation that sets out the rules for medicare.
The think tank argues that the federal government needs to reform the act, not to tell the provinces what to do, but to free them to experiment.
It's a suggestion that's in line with the Conservative approach to health care, and the government has taken an important first step by guaranteeing annual health care increases until 2025 with no strings attached. That's not enough, the think tank says. While the government has called on the provinces to innovate, the health act is a barrier to change because it limits or rules out the kinds of reforms already in place elsewhere.
The report proposes a middle ground, not tearing up the health act as some would like, or viewing it as tantamount to the 11th Commandment. Instead, the report suggests that the act be amended to allow changes to how we pay for health care and how it is delivered, while maintaining the universal coverage that is the key element of medicare.
Debates about health care in Canada usually involve unfavourable comparisons to the American system, but the more relevant examples are found in Australia and Europe. Those countries have universal health care but typically have parallel public and private systems, copayments and different insurance options.
There are a lot of ways to deliver universal health care, and they are proven to work. We have a stack of studies that tell us so. Particularly startling is a comparison with Switzerland, which spends the same percentage of its gross domestic product on health care. As the accompanying graphic illustrates, the results Swiss patients get for their money are significantly better than ours.
The Swiss use deductibles, multiple insurers and public-private competition to introduce efficiency and choice. All those options are routinely rejected in Canada on the premise that government must pay for all of our care.
But what happens when government can't afford to keep that promise? In good times, we have health care rationing. In bad times, government struggles to maintain the status quo. In Ontario, health care spending will be severely constrained for several years because the economy is weak and past spending practices have created a substantial structural deficit. Under these circumstances, it will be difficult to maintain the health care we have, much less improve it. That suggests it's time for a different approach.
In Canada, the impediment to change doesn't come just from the health act. As the institute report points out, it would likely allow provinces to create privately-owned hospitals, create a privately-funded health care sector as long as it didn't share costs with the public system, allow physicians to work in both the public and private systems and to create a public health insurance agency to run the health care system.
While the usual assumption is that private care takes away from public health care, that's not necessarily true. The issue is whether the system today is fully utilized. Wait times for certain procedures have been reduced in Ontario because the government directed more money to them, allowing physicians to spend more time in the operating room.
The real challenge is political will. It's difficult to discuss fundamental health care reform without an immediate knee jerk reaction that Canadians want to pay for health care with their health cards, not their credit cards. Of course they do, but are we going to be able to get what we need from government, especially a cash-strapped government like the one in Ontario?
It is fundamentally perverse for government to effectively ban us from contributing directly to most types of health care, on the basis that the care must be provided by government, then fail to deliver the care. Government gets around the problem to some degree by pretending that things like physiotherapy aren't essential health care, so we can pay.
There is no intellectual consistency in the Canadian approach to health care, just a fear of changing the status quo. Until we overcome that fear, we will continue to pile up studies and pay for a health care system that delivers too little for the money we spend.