Who’s Next in Line?

The idea that some Albertans might be getting their health care more rapidly than others, because of who they happen to be, or who they know, seems to have generated a fair amount of rage among opposition politicians and the public. Yet many of those who decry such queue jumping by elites and the politically connected are supporters of the current public monopoly in health care insurance and hospital care delivery, and it is this very structure, and the rationing by waiting it entails, that is to blame for the situation.

Let’s be clear about queue jumping in Alberta: it happens. A belief that those with political clout or personal connections don’t get preferential access to health care in Alberta is simply incorrect.

Consider that in 2010, the average Albertan could expect to wait 22.1 weeks from GP referral to treatment by a specialist. That was the longest wait time Albertans have experienced since the measurement of wait times began in 1993. In 2009, when Stephen Duckett became the head of Alberta Health Services, the wait time was 19.6 weeks, which is the second longest wait time Albertans have experienced since 1993.

Looking more closely, among medical specialties in 2010, wait times ranged from 4.0 weeks for medical oncology (chemotherapy for cancer) to 48.6 weeks for orthopedic surgery.

If you had the opportunity to reduce the substantial wait for medically necessary treatment for a friend, or loved one, or even yourself, would you not take it? Would you not try everything in your power to help yourself or your friend or wife or child or parent obtain health care without the untenable, if not inhumane, delays Albertans are normally required to wait? Should we be surprised that some Albertans have done so?

In fact, the evidence on waiting lists indicates that rationing by waiting is often a façade for a system of personal privilege, where those with personal prominence or political connections do not wait as long as those without.

But there is another, much more important reality that many seem to have overlooked in the arguments over queue jumping: Queue jumping is not the problem. The queues are.

Focusing on the privileged few who may have used their political clout or personal connections to get speedier care does a disservice to all of the other Albertans who languish and suffer on the province’s waiting lists. Queue jumping is an unavoidable consequence of long waiting lists. The solution is not an inquiry or expose. The solution is to eliminate queuing.

If you think eliminating long wait lists is some sort of pipe dream, consider that Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the Netherlands all maintain universal access health care systems that provide care without systemic delay (queues). Yes, you read that correctly: without long waiting lists for treatment. Consider also that none of these nations spends more on their universal access health care system than Canada on an age-adjusted basis (and that Alberta maintains the most expensive publicly funded health care system in the country on an age- and sex-adjusted basis).

So how do citizens of these eight nations get queue-free access to health care while spending the same or less than Canadians do? Notably, the governments of all eight nations subscribe to the same set of health care policies: private hospitals competing to supply universally accessible care, cost sharing for patients accessing the health care system, and a private parallel health care insurance sector offering another option for the financing of health care.  Put another way, these eight nations do things differently than we do.

The simple reality is that Alberta’s public monopoly in health care insurance, Alberta’s lack of cost sharing for medically necessary health care services, and Alberta’s reliance on monopolistic public hospitals has created a very expensive health care system that requires Albertans to endure some of the longest queues for health care in the developed world. And those long queues create a situation where queue jumping is inevitable. Defending Alberta’s monopolistic, government-run approach to health care policy while condemning queue jumping is simply inconsistent.

As long as we have long queues for health care, some Albertans will have better access to health care than others because of who they are or who they know. The answer to this problem is not to undertake the impossible task of stopping queue jumping; it is to undertake the entirely possible task of reforming health care policies to emulate those nations who deliver health care to all without systemic delay.