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 Beyond The Commons

Aaron Wherry covers all the goings-on in and around Parliament Hill. Follow Aaron on Twitter: @aaronwherry

Categories: Beyond The Commons, Capital Read

The loneliest campaign

by Aaron Wherry on Tuesday, October 26, 2010 1:55pm - 0 Comments

As he has been for more than a decade now—here he is saying so in 1999 and again in 2000 and again last year and again last month—Keith Martin continues to plead for health care reform.

Martin writes that instead of “tinkering” with the system, governments must “modernize” the Canada Health Act to allow patients to “pay for care if they wish, in entirely separate facilities funded solely by the private sector.”

Under such a system, writes Martin, Canadians could go to these centres and pay for the medically necessary treatment out of their own pocket or through private insurance they have purchased. ”By leaving the public system, they will be shortening the queues for those who are waiting. People using private facilities from time to time would also be free to access the public system that their taxes are paying for. Private facilities would act as a release valve and would in effect be subsidizing the public system. Physicians and other medical personnel would work in both systems.”

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  • Mike T.

    Why would any reasonable person voluntarily pay personally for a service they could otherwise receive publicly?

    • guest

      because the publicly provided ones are swamped by customers and have huge wait times.

      • Mike T.

        What are the effects of these wait times, that significant amounts of people will cough up significant amounts of money to leave the system.

        Dr. Martin uses the term "inhumane" to describe wait times. How will he ensure that the public system is kept so inhumane so that these wealthy citizens spend vast sums elsewhere, with no difference in service to the public.

        • guest

          think of it as a toll road. there's a freeway, and there's a toll highway. some people will pay for the toll drive, reducing traffic problems on both.

          • Mike T.

            Toll roads are a small fee for a small convenience – and I doubt that's what we're talking about.

            If the benefit of the private care is roughly the same as the public (and if it's just quicker, with no ill effects to the wait, there simply isn't a benefit), nobody would pay any more than a pittance. If it isn't roughly the same, Mr. Martin has to be quite clear that he wants markedly better services available for cost, and that the system will require public services to have a demonstrable, harmful disadvantage to feed the private system.

          • guest

            people pay thousands of dollars to cross the border and receive medical care there. people pay more than a pittance to avoid the wait.

          • Mike T.

            there may very well be a few people willing to do so. Enough irrationality to support a system of comparative quality? It's unlikely to solve the problem.

          • JustinWordswrth

            The wait-time is part of the quality. Understand that waiting time is not just 18 hours in an Emergency Room, people are waiting months and years for surgery. We effectively have a two-tier system at present, but the people who are purchasing private care are going to the United States and Asia to get it.

            Allowing private health-care providers is just that, allowing them. It does not mean that the government will then purposely reduce the level of care in the public system to make the private options more appealing.

          • Mike T.

            i am quite aware of what waiting time entials.

            Not only is a different level of service NECESSARY for people to opt to pay for something, the government has an incentive to want you to pay for something out of your own pocket,a nd reduce your own personal investment in a provided service.

          • JustinWordswrth

            Paying for something out of your own pocket is a reduction of your personal investment in that service?

            Are you suggesting to me that the government and its all-devouring bureaucracies are just itching to dump control of services into private hands, and it is only the clamouring masses that are stopping it?

          • Mike T.

            Reduction of your personal investment in the public paralell service. Civic investment, if you will. Before, it was something you might need to rely on even if you weren't using. Now, it's a tax you pay for hte benefit of others.

            For instance, let's wok with your assumption that people will eventually pay for a service if, all other things being equal, you are made to wait long enough for it. Let's say the government has credible data that if they can INCREASE the wait by a month, 20% of the population will seek private insurance. That's additionalf people who now don't necessarily care how fast that service is provided – and if they care, it's a very removed concern rather than something that affects them directly. The government can simply stop the funding that would go to that service, throw it into a tax cut, say.

            I'm not saying that every government would make that kind of decision. But what would Mike Harris do?

          • JustinWordswrth

            You keep saying that the government wants to dump the health-care responsibility. Why?

            What you are saying is that a two-tier system must inevitably become a one-tier, private system, because the government will keep decreasing its level of care in an effort to move people into the private system. If the government wants to dump health-care, why does it need the intermediary phase? Why not just put a For Sale sign on the hospitals tomorrow?

          • madeyoulook

            Well, most provincial governments have provided convincing evidence that they are quite incapable of honouring their health-care responsibilities…

            Why not just put a for-sale sign tomorrow? Have you seen most of the infrastructure? Any potential private provider would be well advised to build from scratch.

          • Mike T.

            Indeed. In the 90s it got so bad the Supreme Court said it violated the Charter, and that was when EVERYBODY had a stake.

          • Mike T.

            You keep saying that the government wants to dump the health-care responsibility. Why?

            ***

            math.

          • Mike T.

            I'm amazed people are having such trouble grasping this.

          • JustinWordswrth

            Okay then, show me the math.

          • Peterborough Dave

            Really? It's that simple? Healthcare as a toll road? People will make the same rational decisions about their healthcare as they do about a toll road?

            This is an interesting related essay. Sorry if the hyperlink doesn't work. Copy and paste into your browser will.
            http://worthwhile.typepad.com/worthwhile_canadian…

          • guest

            ok fine. think of it as a grocery store. people need food. people get irrational when they can't get food. if there is a soup kitchen giving out food for free, lots of people will go there. still, other people will prefer to skip the line and go to sobey's instead.

          • Mike T.

            you're digging even deeper, now….

          • Peterborough Dave

            Well, it's better, but still beating down the wrong path.

          • madeyoulook

            Care to explain WHY guest is beating down the wrong path?

            The health care industry is an economic activity, admittedly a peculiar one, in which consumers rely on licensed professionals (mostly) to offer advice about what to consume, for a fee. Consumers seek to maximize benefit to themselves and their loved ones, and to minimize whatever cost may directly accrue to them. All that is left is whether the consumer pays directly or indirectly, who any contracted third-party payer may be, the distortionary role such a third-party player may play, and, vive le Canada, whether the consumer even has the right to any of the above choices in the marketplace.

          • sourstud

            I'd say a better example would be the currently controversial Liberation therapy for MS patients. There is currently an unknown wait time for that procedure in this country, but it can be purchased elsewhere. I think the proof is in the fact that thousands of Canadians are rushing abroad to have this procedure done at their own expense, even though the treatment is still very much unproven.

          • Mike T.

            It's unlikely that greater public access to quackery will help in the long run. or even offering controversial treatment earlier on a private basis – the concern seems to be around paying for proven stuff we're already providing.

    • John W.

      Easy, the private clinics that you pay a premium for will have the best surgeons, technicians, specialists, and equipment. They will be better paid than the bottom of the class types the rest of us will get at the basic level clinics.

  • Emily

    I remember Allen Rock discussing this years ago. He had looked into it especially with other countries that had a 2 tier system, and they warned him not to go that route.

    The best doctors and the best facilities went private, and what remained for everyone else was poor quality.

    • Mike T.

      Plus hte government paying the public service has every incentive to "encourage" people to use the private facilities – I don't think that is understood enough.

      • Emily

        Well you can 'encourage' people all you want, but they may not be able to afford it.

  • WDM

    Everyone would be having a stroke if a Conservative suggested this. Kind of interesting how brands and affiliations play such an important role. I would imagine that the Conservatives won't pick up a seat in downtown Toronto, nor will the Liberals in Calgary, next time out, but look who both those cities elected as Mayor.

    • Emily

      Yeah, but muni politics are so different from the other two levels….local stuff, potholes and street lights etc….no vision thing.

      And in Ontario at least, there are no municipal parties, so it doesn't matter who the mayor is as he only has one vote.

      • WDM

        While I can't speak to what happened in Calgary, it seems to me that Rob Ford's message would not be out of place in any federal or provincial election either.

        • Emily

          In Ontario it would.

          Toronto just has a penchant for picking oddball mayors. I thought they would have learned from the Mel Lastman experience, but apparently not.

          • WDM

            They elected Mike Harris twice while they were electing 100 Liberals federally. Yes, the split on the right played a role, but Harris' message also worked.

          • Emily

            At the time people mistook Harris for a PC…as he advertised himself. It was only later they realized he was a neo-con, but by then the damage was done.

            It wasn't his 'message' per se, it was a 'return' to the PCs after those horrible years under the NDP. The Liberals were having their own difficulties, and we'd had steady bland govt for 30 years with PCs….so they seemed like a safe bet. We paid dearly for it.

          • WDM

            Then people weren't paying attention at all. The union busting/welfare cheat narrative was part of Harris' narrative from the start. At certain points, populist rhetoric becomes incredibly appealing to a frustrated electorate. I do agree though, that his message came at a time where people were livid with the NDP and uninspired by the Liberals.

          • Emily

            Most people don't, you know? And in any case, union busting and welfare cheats are always a popular mantra when finances are in a mess.

            They just didn't expect all the rest of it.

    • Mike T.

      People aren't thrilled about it anyway. Probably why it hasn't been adopted.

  • Orson Bean

    Well, he was once a member of the Reform Party. That does make him a potential Thought Criminal.

    • Mike T.

      It does speak to a lack of judgment generally – in this specificity displayed quite plainly.

    • burlivespipe

      At least in the Liberal party he's allowed to meander down that road if he wants. The silence on Harper's side should create some suspicion, if not more, of what he's got planned…

      • Orson Bean

        The Evil Hidden Agenda, of course . . .

  • wsam

    I don’t think Mr Martin understands the economics of health care. The problem the Canadian system faces is cost. A major reason why the US system is so much more expensive (and inefficient) than Canada is the overlapping bureaucracies needed to administer multiple private, state and federal health care systems.

    To curtail costs all European countries tightly regulate their health care markets. Public and private. One result is doctors on average get paid much less. In Finland, doctors make a little bit over 3,000 a month. In the US the figure is 8,000. In Spain and France most GPs make about as much as a school teacher.

    In Spain, most categories of physician are forbidden from operating in both the private and public systems. They have to choose. This is because doctors who operated in both systems were gaming the public system to encourage people to patronize the private clinics they ran on the side, in some cases inflating waiting times.

    • http://ragingranter.blogspot.com Raging_Ranter

      So then, lets look at what the Europeans are doing and maybe do some of it here.

  • Mike T.

    He's their Bernier!

  • Loraine Lamontagne

    I am probably wrong about this but I've always thought that the law doesn't stop Canadians from paying "for care if they wish, in entirely separate facilities funded solely by the private sector.”

    As long as one is a member of the regulatory college for medicine in one's province one can practice medicine. My understanding is that doctors cannot operate in both the private and public system but they can operate in the private sector if they wish, and if they can make a living out of it, which is an entirely different issue.

    So please correct me here if doctors in Canada are not allowed by law to practice private medicine.

    • Geiseric

      Gotta say I DO remember way back when the whole thing started doctors putting up posters saying if they were opting in to the public system or not so I can't blame you for thinking it might still be an option.

    • Stewart_Smith

      My understanding is the same as yours, and the two systems do work in parallel for some treatments like physiotherapy.

      • Mike R

        They also operate in parallel in other areas. Most Workers Compensation Boards rely on private medical clinics to provide services to their workers. An injured worker, under WCB, has access to an MRI, for example, much more rapidly than a patient on medicare – days in most cases rather than months. The same applies to most orthopaedic surgeries. In BC the provincial insurance company, ICBC also sends its clients to private clinics and hospitals, on the theory that getting people treated faster is cheaper in the long run.

        • Mike T.

          I am assuming you mean faster for a comparable injury, right? Public MRIs can be very very fast if they need to know if they need to operate tonight, much slower if the wait won't have any ill effects.

          • Mike R

            Yes, the public system generally responds well if you are in crisis. Its the more chronic issues – such as knee hip and back problems that are not life-threatening, but still disabling, for which the greatest disparity arises. Most people find the system works well in a real emergency – it is the longer-term "elective" types of treatment (a hip replacement being elective only from the point of view that you won't die without it) that cause the greatest delays and frustrations. And that is where private clinics have shown the ability to respond in a way that the public system doesn't.

          • Mike T.

            And even with joint replacement, those who need them most get them sooner. The more pain you are in and less mobility you otherwise have, the closer to the short end of the wait list you will be.

    • Emily

      Depends on what it's for….standard medical care is public. If you want 'plastic surgery', you pay for it yourself. There are things like mental health, therapy and so on that get govt help I believe….but are more private

      And of course things like dental care, glasses, drug costs etc are usually private….companies often offer these in a benefit package.

      System needs an overhaul, no doubt about it….but as long as the choice is either/or……or two tier….the subject is toxic and off limits.

    • madeyoulook

      Loraine, you are correct. What has been illegal (until Chaoulli v. Quebec) has been the ability to purchase insurance to pay for private medical care in Canada. Which has pretty much guaranteed that very little of the "big stuff" can be done, since there is no risk pool to share the costs among willing participants, because Canada really likes being lumped in with North Korea and Cuba on this point. Or something.

      • Loraine Lamontagne

        Again correct me if I'm wrong, but Chaoulli v Quebec is founded on the Loi sur l’assurance maladie and the Loi sur l’assurance-hospitalisation, both provincial statutes. I just don't think that the Canada Health Act or other federal statutes prevent Canadians from obtaining private health care (or buying insurance to obtain private health care??). Provincial legislation is broader and gets into that kind of rules.

        The reason why I bring this up is that I, as an older person, remember very well when universal health care came along in Quebec, where I lived at the time. If there were a group of people overwhelmingly happy to see this become a reality it was the doctors. They used to have a terrible time getting paid.

        I think this has more to do with economics than federal legislation.

        • madeyoulook

          I am pretty sure a funding condition inherent in the Canada Health Act stipulates (or stipulated, until the SCOC reminded everyone we Canadians have rights) that the sale of private insurance policies to cover services offered in the public system is (was) forbidden. And, furthermore, such stipulation remains in place in all provinces except for a very limited number of specific services in Quebec identified by the SCOC as being so woefully inadequately offered in the public system that human rights compelled the justices to let rich Canadians buy insurance for this coverage, in Canada. Well, no, it suspended its judgment for a year (we Canadians have apparently disposable human rights) so that maybe Quebec could get its act together and improve its wait times to a level of sufficient mediocrity as to satisfy the robed crew in Ottawa that our rights were now safeguarded because the wait time was only six months instead of eighteen. Or something.
          Cont'd…

          • madeyoulook

            …cont'd

            So you have to sue up the chain of Canada's legal system in order to have the right to buy insurance to get you off the going-nowhere wait list at your public hospital. Except now you are on the judicial wait list before you can get off the medical wait list, and by then your condition has worsened so much you are now uninsurable under any private plan anyways. It's brilliant!

          • Loraine Lamontagne

            Funny thing is that I have a private insurance, a top-up, group insurance, a benefit of employment, which allows me to see a doctor in a private clinic, for my annual check-up for example. In fact, when I need a doctor, I usually go to the private clinic which my private insurance pays for. However, if I were to require surgery, I don't think they'd do that, they don't operate a hospital. But if I have a bad chest cold which I think may or may have developped into bronchitis, I see my private doctor in a private clinic paid for by my employer's private insurance plan, and he gives me a prescription for an antibiotic.I live in Ontario.

            I could do that in the public healthcare system, no?

            Anyway, thanks for your opinions. I can see that you and I both need to read the Canada Health Act.

          • madeyoulook

            Are you sure the doctor's fee is paid for by a private insurance plan, and not OHIP?

            All the other stuff (prescriptions, lab tests, "facility fee," whatever), I see being covered by your "top-up" group plan. But I would take "top-up" to mean "the stuff OHIP won't pay for." And the doc's fee, seems to me, doesn't fit in there.

  • MostlyCivil

    And we're back to the same canard about two systems running side by side somehow miraculously multiplies the number of hospital beds, surgeries and making things better for everybody.

    Or, we can have realistic conversations about changing the way we fund doctors and hospitals, like what BC and Ontario are already doing. Fee for service, not chunck funding. Incentives for hospitals with better outcomes. The "adult conversations" that Mr. Mulroney seems to have overlooked.

  • BGLong

    The zombies keep coming. And our loyal media keep describing them as new fresh meat.

    • D-R

      lol…good one.

      I'm so frakking sick of the pols and media framing the medicare debate as the silly little Canadians who can't see the merits of the holy privatization and the blessed two-tier. They've been poisoning our political debate for a dozen years or more.

      Now that McGuinty have exposed the overcharging and kickbacks that cause the problems in the most out of control aspect of health spending. (drugs) I really don't see how this crap has any credibility left.

  • BGLong

    Just to head off a couple of hoary old myths before they are disinterred …
    http://theincidentaleconomist.com/wordpress/phant…

    and …
    http://theincidentaleconomist.com/wordpress/phant…

  • JustinWordswrth

    If funding to the public system remains the same and private systems are permitted to come into existence, supply wouldn't be decreasing, it would be increasing.

  • sourstud

    When has the price of something increasing ever caused supply to go down? I seem to recall from Econ 101 that when the price of a good goes up, the incentive to produce said good increases.

  • madeyoulook

    Martin is assuming offloading demand doesn't diminish current supply but that defies reason.

    Only because provincial governments have been screwing around with supply for years, too, by turning the screws on training positions, in whichever direction the bi-annual five-year-plan tells them to.

  • http://nottawa.blogspot.com Mark

    Shame on Keith Martin for suggesting that other Canadians be offered the same health care choices as Danny Williams.

  • Geiseric

    They already do.

  • Peterborough Dave

    Thank you. There already is a parallel private system available to Canadians- it's called the US, and it's expensive, inefficient, and pretty much guarantees the same outcomes as our own health care system.

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