Why it's time government called 'time out' on the Canada Health Act

When it comes to Canadian health care, everyone seems to agree our system has problems and needs to be improved. But the discussion always seems to end there, with any new idea for reform immediately discarded by vote-sensitive politicians and vested special interest groups.

Witness the case of Maxime Bernier, who found himself under heavy criticism last month when he suggested the feds do away with the Canada Health Transfer and instead free up provincial tax room so that provinces could manage their own health care systems as they see fit. Bernier was accused of trying to dismantle the Canada Health Act and any further consideration of his proposal was effectively halted.

This week the Fraser Institute published a study with a policy recommendation that we felt federal and provincial governments should consider because it would be easier to introduce: a five-year population-wide moratorium of the Canada Health Act, essentially taking a 'time out' from the Act. This would allow governments to try out any number of new policies that are currently limited or even prohibited in Canada, but which are in place in the majority of industrialized countries.

But as has become all too common in the health care debate, the National Post was soon reporting that federal Health Minister Leona Aglukkaq and Dr. Jeffrey Turnbull, president of the Canadian Medical Association, had rejected the idea out of hand.

Now I don't know if either the good minister or doctor has read the report on which we based our recommendation. If they haven't, here's what they are missing and why a temporary break on enforcing the Canada Health Act makes sense.

According to 2007 data from the Oganization of Economic Cooperation and Development (OECD), Canada's health insurance system was the sixth most expensive among 28 OECD nations, but failed to match the majority of these nations in terms of providing medical resources and services to the country's citizens. Canada fell below the OECD average and ranked sub-par in 12 of 18 indicators used to compare the availability of medical services and resources. Importantly, on 16 of the 18 indicators of medical output, Canada finished below its own sixth place rank for health spending: meaning we tend to spend more and get less in return.

But what's most troubling is the fact that almost every country in the industrialized world with a better performing health insurance system than Canada, also has public policies in place that are either prohibited or limited under the Canada Health Act. For instance, Canada is one of only four countries that ban patient cost sharing for the use of publicly funded hospital care, general practitioner care, and/or specialist care. Canada is also the only country that effectively prohibits private health insurance for hospital and physician services. Although private medical insurance is not banned specifically by the Canada Health Act, federal and provincial governments have historically interpreted the Act as intending to ban private insurance. While only six provinces legally prohibit private medical insurance for medically necessary services, all provinces have other policies in place that penalize providers who choose to bill privately for services. In practice, private insurance is generally only permitted to cover goods and services that are not covered by our universal government-run health insurance plan, mainly dental services and prescription drugs.

Under the stipulations set out in the Canada Health Act, provincial governments risk losing a share of their Canada Health Transfer if these conditions are not followed. This means provinces have a significant disincentive to experiment with alternative methods of financing health care services. Consequently, as long as we retain the status quo, Canadians will continue to experience increased rationing of medical services, longer waits for medical treatments, and limited availability of the latest medical technologies.

Alternatively, if provinces had more flexibility for determining how provincial health services are financed, significant improvements could be realized. A simple assessment of similar jurisdictions throughout Europe shows that alternative financing schemes could lead to better value for money. Yet the primary reason that provincial governments cannot experiment is because of conditions set out in the Canada Health Act.

Therefore, in order to determine empirically whether Canada's health insurance system would improve if policies similar to those in the rest of the world were implemented, the federal government should temporarily suspend enforcement of the Canada Health Act.

A five-year moratorium would give provinces freedom and encourage experimentation with alternative financing schemes. It would encourage innovation and just as importantly, if some of the ideas did not lead to improved access to care, provinces could always revert to the current system.

It's obvious the status quo is not working, so why are governments afraid to try policies that have been shown to work elsewhere?