Canadians generally like their heathcare system, and rightly
so. It guarantees basic physician care and hospital care (insofar as such
things can be practicably guaranteed, given our geography and diversity), so that we can get on with
our lives, and cope with catastrophic illness when that happens, without having
to also worry that it will wipe out our savings or saddle us with huge debts.
Most of the world’s leading health economists and health policy experts
generally approve of universal care and single payer not just on the grounds of
equity and general health outcomes, but
on the grounds of efficiency and cost containment as well: it pools risk,
spreads cost, and provides patients generally with bargaining power vis a vis
health care providers and drug companies.
From a comparative perspective, the cost of Canada’s health care system is best
described as middle of the pack-- in 2017 we spent about 10.5% of our GDP on
health care (7.4% publicly and 3.1% privately), compared to an average among
the ten most comparable OECD countries of
10.6%, (7.9% publicly and 2.7% privately), #11 in spending in the OECD. (The United
States, at about 17.3% of GDP, is far
and away the biggest spender.) The
problem is that many of these countries include a broader basket of health services on a universal basis than we do.
Canadian medicare coverage has been described as being stuck
in a rut that is "deep but narrow". The narrowness comes from our
difficulty imagining our dentists, home care workers, pharmacists, optometrists and physiotherapists, etc.
billing the government like our doctors and hospitals do. It also comes from
our difficulty imagining a doubling of transfer payments from the federal
government to the provinces in order to help pay for the expansion of coverage.
Notice that the problem does NOT stem from our single-payer model per se, but
from how it articulates with fee-for-service private payment schemes and our system of fiscal federalism.
Alberta's practice of allowing a small number of visits to
physiotherapists to be paid for under Alberta Health (I believe the
number is six visits), has a general preventive benefit in terms of
encouraging early treatment, as well as enabling workers to gauge the
value of physio in managing pain, etc so that they can make an informed decision about whether to pay for further treatment. Similar benefits on a larger scale could be expected from having a basic public dental plan. I have never studied the economics of dental care
specifically, but it seems to me that basic dental care (annual check up and
treatment up to $1000, for example) would not only catch many problems early
and thereby improve the general health and productivity of the population, but
would also act as a payroll tax cut--since our company plans (such as my own)
would no longer have to pay for the basic care. In other words, it should not
be regarded as a deadweight loss of $1000 to the treasury, or to the economy as
a whole. And just think of all the nursing costs and drug costs that could be reduced if we could just remove them from the aegis of hospital and physician care, viz. the most expensive venues imaginable. A lot of seniors have been housed (at enormous expense) in hospitals because of the lack of space in seniors centres, or the lack of publicly-funded home care. Or kept in a hospital so that their drugs could be paid for. These practices are humane and quintessentially Canadian; but they are also wasteful.If people could access drug treatments and senior care outside of hospitals, we could help more people for the same amount of money.
So the issue is whether we can introduce a broader range of
services into our provincial health plans, while still remaining a median
country in terms of overall health expenditure.
In Canada , we probably spend too
much of our health care budget in areas
(physician and hospital acute care) that are expensive, and made more expensive
than necessary by the fee-for -service system . We should therefore focus on reducing and modifying
fee-for-service, improving the blurred accountability created by federal
transfers, and confining any experiments in "new" models of
co-payment to the presently uncovered areas of homecare, pharmacare and eye and
dental care. In other words, let’s try
not to throw out the single-payer baby with the bath-water.
