Private care not the right answer
After practising medicine in the U.S. for 40 years, I practised in Hamilton for a few years before retiring. I experienced major changes that shook health care in the U.S. I now hear rumblings of those same changes coming to Ontario.
My U.S. patients often were uninsured or underinsured against the costs of needed health care. I sensed their fear of illness heightened by their despair of not affording care that the more affluent did. Whether by lack of choice or desperation, some were saddled with crippling financial burden, or fear of it.
Medical debt is a significant factor in personal bankruptcies in the U.S.
In Ontario, I never heard a patient voice such fears or make the deliberate choice between ruinous health or ruinous debt.
As Canada started its single payer system, the U.S. turned to for-profit managed care programs, such as Health Maintenance Organizations, largely to deflect a governmental single payer system in the U.S. There was the optimism that enlightened self-interest on the part of for-profit health insurers and private medical care conglomerates would lead to better and more accessible health care at lower cost.
That did not happen sufficiently. While the significant Affordable Care Act of 2010 (Obamacare) was promising, it depended on private and forprofit providers of insurance and health care.
Yet in 2022, nine per cent of adults in the U.S are uninsured and nearly 40 per cent are underinsured according to the Commonwealth Fund. Underinsured is defined as out-ofpocket expenses, beyond premiums, that were 10 per cent or more of the household income. The underinsured is particularly egregious as their insurance only looked reassuring.
The situation is very different in Canada.
I, like others, are frustrated by difficulties in health care in Canada. Canada has excellent physicians, nurses, health-care professionals and technical prowess.
The real issue is timely access to care because of limited infrastructure.
Fortunately, in Canada, unlike in the United States there is the prevailing sense that we all share equally to the same level of care, good or bad, regardless of age or complexity of illness. There are issues of the ability to exercise the right to health care in Canada but I have not seen the right to health care challenged.
Some U.S. for-profit insurers did not want equality of access as their profit margin was enhanced by avoiding the complex and chronically ill patients. Health care in Ontario is at an inflection point. It is unacceptable for patients to suffer for years before obtaining knee replacement, spinal surgeries, and other non-emergency care. But privatization will deflect health-care resources.
There is no doubt that private companies can build new buildings and buy new equipment faster and better attract physicians and health-care professionals. But there is already a shortage of physicians and nurses, and deflecting them to private clinics will only make matters worse.
Siphoning off physicians and nurses from other countries risk health care in those countries and will make Canada dependent on an unstable “supply chain” of foreign physicians and health-care professionals.
A great many efficiencies can be made happen in Ontario health care. As one example, I have seen efficiencies as a physician at the Cleveland Clinic Foundation in the U.S. that began by breaking down academic and practice barriers between types of doctors and different types of services.
Patient-centred transdisciplinary approaches organized around service lines created remarkable efficiencies. That is not happening yet in Ontario, at least to the degree it should.
Instead, we find ourselves failing to follow the saying “when you find yourself in a hole, stop digging.” Privatization, as being entertained, will dig the hole in timely access to health care in Ontario even deeper.