Set aside ideology and take real look at European health care
Professor Colleen Flood’s recent column in Globe Debate (Canada should look to Europe on health care, not the U.S) got the title right – but just about everything else wrong. Canadians would indeed benefit from a look at Europe for lessons on healthcare reform. What they should not do is fall for Ms. Flood’s erroneous jumbling of statistics that muddle reality and results in false conclusions.
Recently, as she notes, the Commonwealth Fund ranked Canada second to last (ahead of only the U.S.) in an 11 country comparison. While Ms. Flood doesn’t seem to dispute the result, she warns readers that “those bent on further privatizing health care” will use it to advocate for change. We’re certainly not “bent” on privatizing anything for the sake of it – but it’s really hard to ignore the fact that those European countries ranked highest in the study all have some combination of private competition in the financing and delivery of core medical services, and most require cost sharing for patients (with limits and exemptions for lower-income patients among others).
Of course, Ms. Flood forgets to mention any of this. In fact, she actually goes on to lament the fact that “we already have a mix of public and private care.” But this statement is entirely misleading because it’s only really true for healthcare services that are not considered “medically necessary” under the Canada Health Act. Canada has nothing even close to the European-style mix of options about who will fund and who will pay for medically necessary care, including physician and hospital services.
In reality, Canada is alone among developed nations in its stubborn “commitment to restrict private finance for medically necessary hospital and physician care.” It is also alone among developed nations with universal access insurance systems in disallowing physicians from serving both publicly funded and privately funded patients.
The so-called “jewel of Canada’s health system” is, in fact, exactly what sets us apart from the top-performing universal access health care systems across the developed world. Freeing patients to seek care on their own terms with their own resources actually more closely follows the European approach to health care where universally insured residents of countries like Sweden, Switzerland, Germany, the UK, and others have always had the option to choose private parallel care.
Ms. Flood is, however, correct about the fact that (unlike Canada) most European countries include coverage for pharmaceuticals in the universal scheme. However, what she fails to mention is that several of them (including Germany, Switzerland, and the Netherlands) provide that coverage through competing private (and even for-profit) insurers who also cover medically necessary services.
And what of the “spend money now to save money later” suggestion? A look at reality shows we’re already spending plenty: Canada’s health care system ranks among the most expensive universal access health care systems in the developed world. The problem is we don’t get the sort of health care we’re paying for. Despite that high spending, Canadians endure relatively poor access to physicians and medical technologies and some of the longest waits for access to health care in the developed world.
At the same time, systems with a far larger role for the private sector in financing and delivery like Germany, Japan, the Netherlands, Switzerland, Australia, and Sweden manage to provide higher quality and more timely access to services than Canada for similar or even substantially lower outlays.
Ms. Flood’s commentary does a spectacular job of pointing toward the correct destination in the title, and then telling everyone to travel in the opposite direction in order to get there. It also manages to entirely mischaracterize the ongoing BC court challenge and drag up the tired old comparisons with the United States in a desperate bid to scare Canadians.
It’s time for Canadians to set ideology and fear-mongering aside, and focus on the facts: the developed world’s top performing universal access health care systems all include a far greater role for the private sector in financing and delivering medically necessary care than Canada and they are better for it.
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