Health-care myths that won’t die
LEADERS ... SEE MORE DEBATES AS UNNECESSARY RISKS. — MADDEAUX
Last week, Liberal incumbent Chrystia Freeland tweeted a video of Conservative Leader Erin O’toole talking about health care. Freeland warned voters that O’toole had secret plans to “bring private, ‘for-profit’ health care” to Canada.
Twitter promptly slapped a “manipulated media” warning on Freeland’s video, which had been edited to take O’toole’s comments out of context. Freeland’s accusation was clear: O’toole was pledging a dramatic change to the status quo for health care in Canada.
If Freeland had dropped the charge, we could overlook this as a bit of political theatre. Instead, both Freeland and leader Justin Trudeau doubled down on their message. However, their claim cannot survive even the most basic scrutiny.
For starters, it would be impossible for any politician to “bring” for-profit health care to Canada — it’s already here. For decades, medical imaging, laboratory, and diagnostic services have operated as private, for-profit services within Canada’s publicly-funded, universal health care system. Even though the clinical and business aspects of medicine are heavily regulated in Canada, doctors’ medical offices are still almost all privately owned.
Indeed, the fact that many Canadians are completely unaware that these services are already privately provided proves it is possible to incorporate private elements into the system while maintaining universality.
Opponents of “for-profit” health care tend to focus on the United States as the only alternative health-care model on earth. It might be a deliberate tactic. Horror stories about six-figure hospital bills from the states scare the daylights out of people, and can effectively end the debate about privatization for most voters.
But a broader international comparison clearly shows that both Canada and the United States are outliers at opposite ends of the spectrum on health-care design. The U.S. does not have universal access; Canada does. America allows private, for-profit care paid for by patients directly, or with medical insurance; Canada insists that all medically necessary care must be paid for using tax dollars. Virtually every other country with a modern health-care system comes somewhere in between.
It should be noted that despite such strikingly different approaches to health care in our two countries, the U.S. actually covers a surprising amount with public funding and Canada has a surprising amount of private funding in its system. Many Canadians pay privately for such items as drugs out of hospital, counselling services, dental etc., with private payments covering around 31 per cent of health costs in Canada. Meanwhile, in the U.S., the public sector funds up to 45 per cent of health services: for example, Medicaid, Medicare, and veterans’ care.
However, it is by looking beyond comparisons with the U.S. that Canada could find ways to improve. A recent international study of 11 high-income countries ranked Canada 10th overall — including 10th on specific metrics such as equity and health-care outcomes — making it clear that the status quo isn’t working for Canadians. What is also clear is that the highest-performing countries — such as Norway, the Netherlands, Australia and France — all allow for a more robust mix of private sector involvement in medically necessary care, while maintaining the principle of universality. Importantly, they are able to achieve these outcomes with per-capita spending levels that are comparable to Canada’s — and in some cases are even getting better results with less money.
Canada’s federal nature should, in theory, allow provinces to take these international examples, experiment with different models and learn best practices from each other. After all, health care is an area of provincial responsibility, clearly outlined in Section 92 of the Constitution Act. Unfortunately, the federal Canada Health Act effectively puts this provincial power in a federal straitjacket. Federal spending power is used to entice provincial support for boutique federal programs, while threatening reduced transfers for provinces that dare to permit private health care services.
The result is a stagnant health “system” that was groaning under the weight of an aging population long before the pandemic struck.
Contrary to Freeland’s alarmist claims, the real threat to Canadian health care isn’t private sector involvement. It’s politicians who confuse the issues, defend the status quo, and attempt to stifle any debate or attempt at reform. Meanwhile, Canadians suffer the consequences. Dr. Shawn Whatley is a Macdonald-laurier Institute senior fellow and a past President of the Ontario Medical Association. He is the author of When Politics Comes Before Patients — Why and How Canadian Medicare is Failing. Aaron Wudrick is the Director of MLI’S Domestic Policy Program.