Wednesday, October 30, 2019

Brian Giesbrecht: Reforming Canada’s Failing Health Care System

Most Canadians think that our healthcare system is a national treasure. One much superior to the system to the south where poor people often don’t get the treatments they need, and the costs can be catastrophic. Instead of focusing on how Canada’s health care system compares to America’s, we should be looking at European systems that offer both better health outcomes and cost effectiveness. 

We have modern hospitals, competent doctors and nurses, and once you are in the system, the care given is usually first class. However, if you are on one of the many long medical waiting lists, then our system fails. You can wait a year or more to see certain specialists. And, if you are held waiting well over a year for a hip or knee transplant – or for a life-saving heart or cancer treatment – our Canadian system is far from first class.

Long waiting lists alone relegates Canada’s medical system to second tier status. Even Cubans don’t wait as long as Canadians do for certain essential medical services.

Increasingly, desperate Canadians travel to other countries (United States, Mexico, India) paying big bucks to get their hip or knee replacements and back surgery that they desperately need but cannot get done within a reasonable time here. Some others travel to patient-pay private clinics in another province.

Approximately 400,000 Canadians and their spouses travel outside Canada for necessary health services every year – spending overall $2 M per day. As for our politicians needing health services, you won’t find them all waiting in lines – some jump on a jet and head south.

It is particularly our older citizens who can’t afford to hop on a plane who bear the brunt of these unconscionable waiting lists. They can endure many months of pain waiting to enjoy quality of life. Some live in terror that their pace-maker, valve replacement or hip replacement that they need will not be provided before they die.

Canada’s medical waiting lists are a national disgrace.

We should be able to look to our provinces to fix the problem, but the provinces generally lack the revenue necessary to provide proper medical services within reasonable time limits. Instead, they resort to using what can only be described as cruel waiting lists as a method of rationing services to hold budgets done.

So, why do the provinces lack the funds to provide timely medical services.

At the time of Confederation, powers were divided up between the federal and provincial governments. Then the federal government had the most expensive obligations – the military, control of national borders, Indigenous relations. As such, it received the main revenue sources. The revenue source for the federal government was greatly augmented when income tax (introduced in 1917, then as a temporary measure to pay for our First World War debts). Health care was left for the provinces to administer.

In those early decades, healthcare was much less expensive than it is today, partly because it was at such a primitive state that there was much less of it. Religious orders were active in healthcare, and funds flowing to their hospitals was augmented by fees and donations.

Then, people did not live the long lives that we now do. Most people died before needing the hip replacements and the steadily expanding list of other procedures that now are to improve their quality of life in their senior years. As medical science improved dramatically, lives are now 60% as long as they then were. Medicare came almost sixty years ago, and for all hospital and physician services, the provinces became the sole payor.

Costs increased dramatically as the technology of healthcare increased over the decades. But, the revenue sharing arrangement has not changed, leaving the federal government with a vastly superior ability to extract tax revenue than the provinces. The provinces are permanently failing, to catch-up with the waiting lists. As soon as they shorten one list, the demand for new

procedures made possible by enhancements to medical science creates another.

As Canada’s system remains as it is, one payer, the federal government is the only agency that could provide a proper funding arrangement to eliminate the disgraceful waiting lists. However, so far, the feds prefer spending much of ‘its’ money largely on its own pet items – often using its revenue base to intervene into areas of provincial jurisdiction.

What is certain from the lack of adequate healthcare funding is that thousands upon thousands of mainly elderly Canadians are waiting – in pain and fear – for necessary medical services. Canadians who have faithfully paid their taxes all their lives are left to sit and wait.

If the federal government continues to choose to under-fund the provinces for Medicare, the design of the system should be reassessed. The federal government should either step-up the level of transfers to the provinces (to acknowledge the current approach is resulting in indefensible waiting lists) or cede tax points from it to the provinces.

European countries, like France, Holland and the Scandinavian countries, have better health outcomes while combining public funding with user fees and premiums. Our politicians should acknowledge our system’s failures and begin honest discussions about bringing in some of the proven European practices.

Now, we waste energy focusing on how the flawed American model compares with our flawed Medicare model. It is sad how Canadians hold the American system up as everything we don’t want ours to become, while the Americans do the same with our system. Instead of fixating on an irrelevant comparison, we should focus on superior European healthcare models.

It is time to introduce reforms to enable the provinces to properly fund our healthcare system and end unacceptable waiting lists. This will first require an honest look at our failed system.

Brian Giesbrecht, a retired Manitoba Judge, is Senior Fellow at the Frontier Centre for Public Policy HERE.

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