| Imagine your doctor just told you that you will need cataract surgery. “No big problem,” you think to yourself, “It’s only a 45-minute surgery – I’ll be good as new in no time.” You then find out that there is an 18-month waiting list to get the surgery. The good news is you don’t need the surgery; the bad news is you’ll be blind if you don't get it. This is just one chilling story told by the actual patient in Stuart Browning and Blaine Greenberg’s documentary on Canada’s healthcare system, “Dead Meat”. Why is there such a long wait for a simple and quick procedure? Because Canada refuses to adopt a two-tier healthcare system where an optical surgeon can open his own private practice with a specialized operating room and specialized equipment. Canada is one of three countries who prevents their citizens from paying directly for healthcare, the other two being Cuba and North Korea. We don’t have to look far for a healthcare system that works (as much as Michael Moore will tell you otherwise). Our neighbours to the south have a system that is clearly superior to our own. Let’s look at the facts. In a survey of American and Canadian hospitals 21% of Canadian hospital administrators admitted it would take longer than three weeks to administer a biopsy to test for breast cancer, while less than one percent of their American counterparts claimed it would take that long. Over 50% of Canadian hospitals said seniors would be required to wait over six months for hip replacement surgery, whereas nowhere in the surveyed areas of the United States would it take this long. The average physician in Canada sees 3143 patients a year whereas an average American physician would only see 2222. This means patients can spend more time with their doctors and get a more in-depth analysis and a better diagnosis. The same study said that 30% of Americans spend longer than 20 minutes with their doctor, whereas only 20% of Canadians do. The benefits don’t just take place in the doctor’s office: The average length of stay in an American hospital is 5.4 days while in Canada it is 7.1. This means the patients can go home and recover while their bed is opened for more patients who need it. Going home once you are well enough has the added benefit of being in familiar surroundings, which will help in the recovery process. In a survey of American and Canadian seniors, Americans were generally more satisfied with their healthcare system. It is not only the Americans that put us to shame. In June 2005, the National Post reported that the Supreme Court ruled that Sweden, Germany, and the UK all have two-tier systems and provide services that are superior and more affordable than Canada. Universal healthcare does not mean more amenities either, as Canada has 4.5 MRI machines per million people while the average of other first world countries is 7.9. One of the most important reasons for allowing a two-tier healthcare system is that it will allow doctors to open private practices which will mean a bigger paycheque for them as we pay them directly and not the government who in turn lets it trickle down to them. This will keep more doctors in Canada. The Canadian Medical Journal Association published a study that one in nine doctors leave Canada for the US directly after graduation; this is equivalent to two of our medical schools training only American doctors. Statistics Canada reports that in 2003, 1.2 million Canadians did not have a family physician. Think of how much smaller this number would be with two more graduating classes of doctors each year. In general, Canadians want to pay for their healthcare. Ekos Research Associates reported in a 2002 survey that if given the chance, 70% of people would pay $1000 to have a family member jump to the top of the list for heart bypass surgery. Companies such as Surgical Tourism Canada provide packages where in a matter of weeks you can be under the knife in a state-of-the-art hospital and get up to four weeks of recovery time in a five star hotel. We already have one form of private healthcare in Canada, but unfortunately you need four legs to be a patient. We would have to wait over a month for CT scans, three months for an MRI, and three weeks for an ultrasound, whereas the waiting list for a veterinarian’s MRI machine is only three days long. Veterinarians also provide other services that come with private healthcare such as low prices, extended hours, and specialties. In 2004 the median wait time for a Canadian just to be referred to a specialist was almost 18 weeks. Some people fear that private healthcare would bring higher costs. This is not the case however. Many companies provide health insurance, which is a lot better as they often include limited coverage on routine eye exams, prescription drugs, and dental work, three very basic services that OHIP does not cover. In fact, a two-tier system would lower the cost of healthcare, as it would bring in competition, which results in lower prices. It would also make hospitals much more profitable as private companies are usually run better than crown corporations. Of course, even if you can’t afford private healthcare, there are free clinics, or you may have to wait a bit longer than others, but seeing as we already have wait times that are beyond ridiculous, two-tier healthcare deserves a shot. | Universal single-tier health care is not only a Canadian institution, but also the most efficient and ethical system of health care available to us. A two-tier system would be costly to implement, and raises the danger of a deteriorating public health care system and an unethical gap in basic human rights between the rich and the poor. In any discussion of the possibility of two-tier health care, one issue must always be addressed: Is a two-tier system morally acceptable to Canadians? As polls have consistently shown, the answer is no. The right to medical treatment, based on need rather than financial situation, lies at the heart of the argument. A two-tier system would mean that two people facing the same health-related emergency would have a difference in level of care, defined primarily by their ability to afford private care. A capitalist economy ideally rewards those who generate wealth with an increase in opportunities. The question in this case is whether improved health care belongs in that category of opportunities (i.e., is health care equivalent to a new car, or the ability to travel?). Health care, however, is not a reward; health care is a right. And while wealthy individuals may deserve to be rewarded in many ways, they do not deserve a longer life than the rest of the population. A proponent of the two-tier system may argue that it would have no negative effect on the quality of public health care, but rather would reduce the burden on the system. However, establishing a private system would remove one of the greatest assets of our health care system: the wealthy. High-income earners are the group best equipped to deal with the problems they see in society, simply due to their greater pool of resources and clout within the political system. If there is a problem with wait times at the local hospital, a well-off individual is more likely to have the local MP’s ear (or be the local MP). A blue-collar worker, on the other hand, is unlikely to have the time to launch a grassroots campaign. Creating two separate health care systems would leave the public system without this vital feedback loop. Of course, this is all just speculation. To know how two-tier health care would really affect Canada, there needs to be a case study. Australia is a perfect opportunity: It has a similar health care system to our own, with the distinction of allowing private care. Citizens are encouraged to obtain private insurance, rather than rely on government-funded Medicare (individuals making more than a set income who do not have private insurance are taxed more heavily). What are the results? They aren’t pretty. Instead of saving the taxpayers’ money, the government has had to bail out the private system in order to keep it going, at a cost of $2.2 billion a year. Wait times, a common complaint in the Canadian system, were not helped by the private tier. In fact, wait times in Australia actually increased as a result of private insurance. Studies there have shown that, as more care is provided by the private sector in a region, wait times for patients in the public system increase. The same effect was observed in England and New Zealand, which have similar multi-tiered models; both countries appear to have longer wait times than in Canada. These findings support the hypothesis that a parallel private health care system will damage the public system by diverting resources and professionals from the public system. A private system will decrease wait times for those who can afford private insurance, but it will do so only at the expense of those who cannot afford this luxury. This agrees with a study completed here, in Manitoba. Until 1996, patients waiting for cataract surgery in Manitoba could choose to have the surgery in a private facility for an additional fee (although the surgery cost was still covered by the provincial health plan). Researchers at the University of Manitoba compared wait times between three groups of patients: those paying for the private facilities, those using the public facilities whose surgeons worked only in public facilities, and those using public facilities whose surgeons divided their time between public and private facilities. They found that the median wait time for private care patients was four weeks; for public care patients, the wait was ten weeks for patients with public-only surgeons, and 28 weeks for patients whose surgeons worked in both systems. Thus, the introduction of the second tier had a direct and negative effect on patients in the public system, as it did in Australia, the United Kingdom, and New Zealand. A recent Supreme Court of Canada ruling struck down a ban on private health care in Quebec, agreeing with a patient (who was on a year-long waiting list for a hip replacement) that the ban infringed on his right to life, liberty, and security. Based on the facts, one has to wonder whether the Court considered the rights of citizens in the public system, who will be forced to endure longer wait lists in order to meet the needs of those who can afford private care. Are there other successful single-tier health care systems? Interestingly enough, Cuba provides an example. Like Canada, it has chosen to ban all private health care. Despite the fact that the country is often an economic and political disaster, and spends only $251 per capita on health care (compared to Canada's $2669 and
America's staggering $5711), the health care system was ranked by the World Health Organization as 39th best in the world, comparable to the U.S. (37th), Australia (32nd), and Canada (30th). That a country in such a poor financial situation is able to pull off public health care successfully suggests that any problems with our own system may not be based in the model, but rather in the details of how we implement it. Introducing a parallel private system to our health care model is simply a bad idea. There are, undoubtedly, issues with our health care system that need to be addressed. However, assuming that a private system will make these issues disappear is purely wishful thinking. Instead, it will exacerbate many of them, and introduce problems we didn’t have in the first place. Worse yet, it will mean that the Canadians have concluded that the rich deserve better treatment than the poor. That's one pill we're not
ready to swallow. |
