Government Health Care: Not the 11th Commandment

Whenever talk of health care reform arises—and praise for European countries that combine universal coverage with more private sector involvement—a reflex inevitably kicks in. For some, it seems more privately-delivered or privately-insured health care is a policy choice akin to religious heresy. It’s almost as if government delivery and government insurance were an 11th Commandment: Thou Shalt Only Provide Health Care via Taxes and the Public Sector.

But wherever the reflex originates, consider a few basic facts. As a percentage of the economy, Canada has one of the world’s most expensive health insurance systems. Yet, relative to comparable developed countries, we get poor value for our money spent.

For example, in 2007, and with a comparison to between 22 and 26 countries depending on the indicator, Canada was 17th for the number of CT scanners and 17th for MRI units per million people. It was tied at 19th place for the number of curative care beds and tied at 20th for the number of practising physicians per 1,000 people.

Unlike Canada, most of Europe ranks higher in the availability of medical goods and services. This is because in Europe, no purchaser of health care (government, non-profit or private) is held hostage to one service provider, either on insurance or delivery. This is true regardless of the exact private/public share of total health care spending. It helps explain why most European countries have short or non-existent patient waiting lists.

In much of Europe, patients can choose between several insurers and health care providers. Even in countries that mandate basic health insurance (like Switzerland), patients select insurance which best suits their personal needs; they can switch insurers if unsatisfied with their service. Likewise, in most developed countries, patients can choose between public and private hospitals.

Does this matter? Of course. In British Columbia in 2004, the Hospital Employees Union (HEU), the main provider of support services in BC’s hospitals went on an illegal strike. They did so despite the fact their wages were above (and their weekly hours below) the national average. They struck despite generous vacation benefits (five weeks after 10 years of service and up to nine weeks beyond 25 years of employment).  But the HEU was in a monopolistic position vis-à-vis hospitals, so patients suffered.

In just the first four days of the illegal strike, thousands of diagnostic tests were cancelled including 514 MRI scans, 1,852 CT scans and at least 11,500 lab tests. More than 11,000 ambulatory care procedures were cancelled including diabetes education, cast clinics to remove casts, wound care, epilepsy management clinics, and occupational and physical therapy sessions. On a daily basis, the provincial government estimated 450 to 650 screening mammograms for breast cancer were cancelled.

Surgery cancellations over four days included: A nine-year-old Campbell River boy for heart surgery; two Kelowna women who needed breast cancer surgery; a three-year-old boy who already waited months to have a growth removed; and a baby in need of a cochlear implant. In just four days, 79 children’s surgeries were cancelled at BC Children’s Hospital in Vancouver.

Thus, it is here that those attached to government-run and government-insured health care misconstrue another important factor: human nature and its relationship to power and money. Some argue that if more health care was delivered or insured by the private sector, the profit motive would harm health care.

However, human nature does not magically change because one gets a paycheque from government or from a private company. Self-interest will still be in play, whether the “currency” is power or money, and both influence government unions and private companies alike. Sometimes the self-interest is reasonable—everyone likes a raise; sometimes it morphs into greed, but that exists regardless of the sector.

To avoid gouging by unions or companies, and also to avoid the constant politicization of health care that now exists, what’s necessary is a break-up of any particular concentration of power and influence. That requires competition, and is just as necessary in health care as in any sector that involves human beings and thus human nature, from groceries to telecom services.

In the case of health care, requiring multiple providers for services and financing must also be wrapped in universal access, this so no one goes broke or, as is too often the case in Canada and our present quasi-monopolistic system, has pain-saving or life-saving treatment delayed.