Wednesday, August 04, 2010

Initial Reaction to the CMA Report: A Welcome Step in the Right Direction

The CMA Report released yesterday, "Health Care Transformation in Canada" , is receiving some mixed reviews of the eyeball-rolling "not another report" variety; for example, Norman Spector accuses the CMA of "speaking with a forked tongue" --i.e. advocating more comprehensive coverage and a single payer system while at the same time approving of Quebec's movement toward deductibles and medicare premiums. While recognizing Spector's point, I have a slightly more positive reaction. I have been waiting for an analysis that cuts across the three silos of Romanow, Kirby and Mazankowski, i.e. recognizing the gravity of the cost situation without exaggerating it; confronting the problem of health costs crowding out other policy priorities; distinguishing between public financing and public delivery, without fetishizing that distinction; and taking into account the best comparative work, such as the that of  Ted Marmor and the Devereaux Study.

"Forked" or not, the CMA is speaking more sense than it has in years. Unlike Brian Day and other likeminded political leaders in this professional association, the current report does not leap to the conclusion that we should open the doors not only to private for-profit delivery but private financing as well. (For example, France is a notoriously centralized unitary state in which 60 million people are squeezed into an area slightly larger than Saskatchewan, yet some people want to leap to the conclusion that its success stems from its fees at point of service, or "depassements". What little truth there may be to that judgement is itself grounded in that particular European context.)

Instead, the CMA recognizes that many of the biggest cost-drivers emanate from the 30% of the system that is still privately financed. Extending the scope of our relatively efficient single payer system to include more drug and home care is perfectly sensible--just as is the greater empowerment of physicians and patients to tailor health care to individuals' needs. Combining these two directions is a difficult balancing act, but not a full-blown contradiction. Ideally, we would each pay a medical premium that would carefully distinguish between the behaviours that we have some control over and the conditions that we do not control; incentivizing the former while co-insuring the latter all the while taking into account ability to pay. Such a perfect system does not as yet exist, and would be vulnerable to corruption by economic interests. But overall I would say that the CMA has taken a step in the right direction.
I will have more to say when I have reflected on each of the CMA's five recommendations in the light of the above-mentioned literature.

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