A stealthy slide to a new health reality

According to an Ipsos opinion poll released in February, more Canadians than ever are open to the idea of private-sector delivery of publicly-funded health-care service.

Not only did the poll find 59 per cent of respondents support private delivery, 60 per cent supported the idea of private care for those who can afford it.

But wait — just a couple of months earlier half of the respondents to an Angus Reid Institute poll said more private care options would a negative impact on the system, with only 32 per cent believing private options would improve things.

Vagaries of methodology and ideology aside, what’s going on here.

Could both things be true? Neither?

It’s a relevant discussion as Ontario and other provinces look to the private sector to deliver more services, reducing wait times and allowing more people to get needed care. But how much private-sector involvement is too much?

When does the Canada Health Act, the blueprint for universal health care, become more of a suggestion than the rule?

It certainly doesn’t help when governments, in particular the Ontario government, are more interested in promoting their preferred ideological and political outcome than in providing straight answers.

Consider Premier Doug Ford’s promise that Ontarians will always be able to access care with their “health card not a credit card.” Lovely sentiment, but is it true?

There is a lot of private-sector delivery of health services already in the market, so no one can credibly claim private delivery doesn’t work. But increasingly there are some grey areas that should make us worry.

For example, consider the pediatric practice in Toronto that offers same-day virtual access to registered practical nurse services, but only to people willing to pay a monthly subscription and per visit fee.

Yes, sick young patients will be seen regardless, but if you want to be sure of same-day virtual care and in-person consultation within a day or so, you need to pay.

Without casting aspersions, does that really sound like equitable access to care, as described in the Canada Health Act? Or does it sound more like real two-tier care, one tier for those who can afford it, the other for those who cannot?

There are other anecdotal examples, including some where people say they’ve been told they can get access to services and procedures, but it might take a year or more, unless they want to pay in which case they can get access in short order.

Some tiered service has existed for years now, such as in cataract surgery, where patients are offered different options for lenses, one covered by OHIP, others not and available if you can afford them or have insurance coverage.

The point here is not to denigrate services, patients or providers dealing with this changing landscape. It is that the system is evolving, in real time, without much reflection, debate or study.

We’re sliding toward a different health-care universe, and it’s happening largely by stealth. That’s not the he way it should be, nor is it a prescription for success or public buy-in.