Solving the health care crisis will take imagination

By Steven Martinovich
web posted August 21, 2000

Old joke: A patient walks into his doctor's office and complains that he feels an unbearable pain every time he swings his arm wildly. The doctor considers the patient for a minute and simply responds, "Stop swinging your arm like that."

As jokes go, it's not much but it tends to accurately summarize the level of discussion over how health care in Canada should be reformed. Everyone agrees that something must be done if the beleaguered - that's the media's favourite word - health care system is to survive, the problem is that few people agree on what that something is. Most, however, agree with what that something isn't.

That something was presented by David Gratzer, author of Code Blue: Reviving Canada's Health Care System, to a panel at the Canadian Medical Association's annual general meeting on August 13. Gratzer argued that Canada should consider implementing a system similar to Singapore's, one that sees citizens pay for their health care out of a special account made up of tax-free contributions until costs reach a certain point. After that, catastrophic insurance takes over. With a health care system that is structurally flawed and rife with abuse from patients, doctors and hospitals, even a system with user fees would alleviate some of the pain and reduce waiting lists.

Although the CMA gave Gratzer a polite hearing, their attitude was best summed up by Michael Decter, former deputy health minister in Ontario, who granted that reforms were needed but there had to be a limit.

"There are those in the country who feel we can't reform our health care system without making patients face a financial consequence and I do not agree with them," said Decter, forgetting the taxes Canadians pay at three different levels of government to fund health care programs could be considered a financial consequence of the current system.

When it comes to reforming the system, Canadians shouldn't be looking at politicians or doctors to lead the way. At a recent meeting, the country's premiers once again demanded that $4.2 billion a year in transfer payments cut more than five years ago be restored plus future increases tied to inflation, population growth, and the introduction of new technologies and drug therapies. As for Health Minister Allan Rock, he believes Canadians "live longer and healthier lives because our social programs distribute health in a manner that benefits us all." Rock must have missed all the wealthy Canadians flying to private American clinics or the preferential treatment that federal politicians and their families receive at hospitals, bypassing the waiting lines that the rest of us endure as our benefit from redistribution policies.

Doctors, who should best know how bad the situation may become thanks to aging Baby Boomers who will demand significant resources starting in 2010, also show a lack of imagination in solving the system's problems. The CMA called upon Ottawa to show "moral authority" and boost long-term funding to the health care system on a "sustainable basis." In essence, more of the same but with a lot more money.

Such attitudes seem in direct contrast to a growing belief among Canadians that the health care system is broken. According to an Angus Reid poll released at the start of the CMA's annual general meeting, 58 per cent of Canadians believe that only core services should be covered under health care, hinting that private health care - at least to some degree -- is growing to be a more acceptable concept.

Given a recent Fraser Institute report that showed provinces which provide higher per capita funding didn't see shorter waiting times - the extra funding generally went to wage and price increases or non-surgical uses - and actually saw fewer surgeries performed, medical savings accounts (MSAs) should be seriously considered as the only rational and efficient way to reform the system.

By bringing the free market and consumer choice into play, MSAs would put a downward pressure on prices and reduce the cost of health care. MSAs would allow Canadians to deduct their medical expenses, including premiums, from their taxes. Surplus money from people who rarely use the health care system would no longer be used to cover those who need extended care, allowing healthier people to leave the current system.

An MSA system would force people to take more personal responsibility for their health care, requiring them to use personal choice and economy in choosing a medical plan and doctors. Such a system would also see accumulated money available to be used in a person's twilight years and allow the current system to be phased out over time. Gradually switching over to an MSA system would serve everyone: youth who would be moved into the new system and those who will rely on the current system.

The argument is often made that health care is so important that only a government mandate can insure that people receive health care, that ordinary people cannot help themselves with such a complex system. The medical industry is no different from any other industry in this nation. It should be subject to the same rules that govern the marketplace and a MSA system would benefit all Canadians. It's time for government and the CMA to stop telling Canadians not to swing their arms like that.

Steven Martinovich is a freelance writer in Sudbury, Ontario and the editor of Enter Stage Right.

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