Saturday, October 4, 2008

Health Care Debate Overshadowed by the Economy

In both the United States and Canada debates were held on Oct 2, 2008. I was torn as to whether to watch the Biden/Pallin debate or the Canadian Leaders debate. With the train wreck of an interview Pallin gave to Katie Couric wetting my appetite I wanted to watch the most public I.Q. test ever given.

Alas, my civic duty overshadowed my voyeuristic streak and I watched 5 Canadian Leaders duke it out on National T.V. The video below (in 2 parts) is the health care portion. For international readers, here’s a quick civics lesson.

Canada has a parliament with the Prime Minister being the leader of the majority party. Currently that’s Stephen Harper of the Conservative Party of Canada who, prior to elected office, had been a staunch advocate of privatization of Canada’s health system. The other parties are the Liberals, Green Party, Bloc Quebecois and the NPD. The Bloc is a separatist party from Quebec so they argue most issue’s with Quebec’s interest in mind exclusively where they allow private clinics. The other 3 parties (Liberals, Green and NPD) have come out against private health care.

The Liberals, Green and NPD came out swinging against Harper. Accusations were made that the Conservative's main intent is to allow big businss into health care. There were a couple verbal punches thrown but in the end this is how I saw the facts. All the parties seemed to agree that:
1. excessive wait times and scarce resources are a genuine problem in Canadian health care and not just another political scare tactic
2. many of the problems stem from when the system was underfunded in the mid 1990’s which cut doctors, nurses and hospitals
3. some provinces allow private clinics more than others so there are regional differences in access to care
4. lowering wait times, adding pharmacare and improving access to doctors cannot be accomplished without increasing the health care budget

The Liberals, Green Party and NPD seem to stand united on this issue in their health care platforms. They believe that universal health care means not only a public purse for health care but restrictions on private care to maintain uniform access.

To solve the problem, the Liberals and NPD want to increase funding. The Green Party is looking for cheaper alternatives (e.g. restructuring health care education, expanding multidisciplinary teams, increasing community health, etc…). The Conservatives have slowly increased funding and transfers to the provinces. The have also taken on a few initiatives such as wait times funding, increased electronic health record funding, cancer care and increased spaces for new doctor training as was agreed in the 2003 Health Accord between the Federeal and Provincial governments (not all of the agreements have been met leading to accusations of broken promises).

The 1,000 pound gorilla of course is how and where privatization will creep into the system under Conservative leadership. Both Harper and his Minister of Health Tony Clement have been previous proponents of it and the Canadian Medical Association has just elected a president that runs several private MRI/CT centres in Quebec. Obviously a change is in the wind.

My take on this is that the current situation cannot go unchanged and no-one has the stomach to increase taxes. I believe Harpers' intent is altruistic in that he wants to improve our health care system, even if it does include private care. The Liberals, Green Party and NPD have given scant evidence to the manner in which they will fund health care. During the debate, Elizabeth May of the Green Party seemed to suggest that simply enforcing the Canada Health Act would solve the problems; if it were so simple.

The only alternative left is to allow some privatizations’ (or user fees, which no-one supports) so that people can choose to direct more of their own money to health care. The down side could be that care may become more expensive* as stake holders take their share of the revenue. Another potential downside, could be loss of control over the degree to which we privatize. As a recent NAFTA law suite has shown, opening the door to privatization may also open a can or worms for US health care companies looking to profit in Canada.

Conservatives, at least, have made slow, plodding decisions to improve care and access and I cannot argue with the method so far. I would ask Mr. Harper to apply this litmus test to any change. If a mother is deciding whether or not to take a sick child to the doctor she should not have to consider whether or not the family can afford it.**

*even though there is greater distribution of the revenue in a private system my estimate is that private is roughly twice as efficient as public.
**interestingly mothers make the choice every day now because access is so limited it means a lost day at work almost every time as they wait in clinics.

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