Lift the taboo on private health care
It would create the conditions for a new subsector of health care — Doughart
These are turbulent times for health care. Look no further than New Brunswick, where last month’s modest provincial health reforms sparked instant public protest. The official Opposition now wants to swiftly defeat the sitting minority government.
Those reforms centred on closing six rural hospital emergency rooms at midnight, after which time they typically see only a handful of patients and even fewer bona fide emergencies. The changes were, quite frankly, relatively minor in relation to New Brunswick’s challenge of delivering health care to a fast- aging population on the back of the nation’s slowest economy.
And even though Progressive Conservative Premier Blaine Higgs has cancelled his reforms in response to the backlash, it is now quite possible that the budget he’s due to present next week will be defeated as an expression of non-confidence.
If the Opposition Liberals succeed in forcing an early election, they’ll halt a process that’s already underway to restructure New Brunswick’s Rube Goldberg health system. And the Grits will also send a strong warning to future premiers of any party: namely, that pursuing even skin- deep changes will amount to touching a live wire of public angst.
This isn’t an issue specific to New Brunswick, as Atlantic Canada is more of a window to a national problem than a unique case. National health spending has doubled since 2000. Keeping up with rising costs, driven in part by advances in medical technology, is a problem for all provinces, not just the poorest ones or those with older populations.
Atlantic Canadians do like to tell a story that we labour under unique circumstances. And our demographic issue certainly is important. But the root of the problem is the mandated single-payer system.
People who make health planning and policy decisions are lifting a heavy weight with only one arm. That’s because we’ve permitted ourselves to deal with only one side of the economic equation. All solutions are supply- based, and hence expensive, because we have chosen to take demand- focused policies entirely off the table. Except for one: rationing.
This is a fact of life on the East Coast, where governments can’t afford to finance rising health spending, so they make people wait. But unlike sensible regulatory interventions in a market- based model, rationing in a socialized system is a blunt instrument that can’t effectively target assistance. Instead, it causes the most harm to those with chronic health problems who suffer in long queues, over and over again, until their problems get so bad that they become emergencies. This is not civilized.
New Brunswick is a case study in the cost of removing market features — prices, competition, consumer choice — by prohibiting any alternative to government payment. The provincial hospitals crisis, typified by ever- lengthening waits in urban ERS, is not so much a planning error but the knock- on effect of a broken primary care model. The practice of routine, non- urgent medicine is now far removed from an efficient matching of patients to providers; more than 39,000 New Brunswickers are on an official government wait list to see a regular health professional. Others haven’t even bothered to register for the breadline.
In t urn, emergency rooms, which are intended to treat threats to life or limb, have become parallel centres of primary care. This is not their purpose, and governments have overburdened them by failing to improve options for patients before they’re forced to go to an ER.
Al l owing patients to pay for health services as a supplement to the public system would doubtless improve our ability to provide routine, non- urgent services. It would create the conditions for a new subsector of health care, delivered by doctors and other professionals like nurse practitioners, whose services are locked behind the wall of medicare.
It’s not as far a leap as one might think. Plenty of health services fall under the rubric of enhanced medicine or are outside the public model. Drugs provided outside hospitals, dental care and services like massage therapy and physio don’t experience the same problems with shortages. It follows that creating a similar private payment and insurance market for primary care would help solve many of the problems with the public system.
There are certainly many aspects of health policy that are unrelated to payment that also merit change. But the prize is to crack the nut on our culture’s bias against private payments for routine medical visits and advice. Even conservative politicians dare not tread these waters. That may serve them electorally, but it goes nowhere to creating a better health system, or improving outcomes.
People can talk about “third rails” all they like. But the political and even social taboo about criticizing the single- payer system has become dangerous, crowding out the sensible argument that while government can and must pay for health care in many cases and for many people, it does not deserve a monopoly on paying for it for everyone. We are avoiding a debate about how an advanced society with an established welfare state can better use markets — not to exclude anyone from health care, but to provide it to more people in a more timely manner. It’s time to lift the taboo.