November 20, 2003
Health care in Canada is dying. Those who would save it misdiagnose its terminal illness. Using the paradigm of "feed a fever, starve a cold", those wishing to save health care in Canada treat it like it has a fever. They want to feed it, give it copious quantities of money in hopes that it will regain its strength and return to its former glory. The trouble is they’re wrong. No amount of money alone will ever return the Canadian health care system to its former self.
There are three major reasons why Canadian health care in its current form is terminal. The first is that it’s free. Anything that is free is also of no value and can thus be misused or otherwise abused. Have you ever been to a function where there was an open bar? Have you noticed all the half-empty glasses standing around, as people who lose track of their drinks merely go back to the bar for a new one? Compare this with a cash bar and you will see the difference right away. When people are paying for their drinks, they tend to keep track of them and finish them off to the last drop.
So it is with health care. It’s an open bar where no one is expected to keep up with their drinks and if one person has three or four drinks on the go, that’s okay because, after all the tab is being picked up by someone else. Hence you see people going to the doctor for every triviality one can imagine. A common cold, a headache, a vague feeling of discontent and we’re calling our family doctor in hopes that he will fix us up. Besides, it’s free, so it doesn’t matter. Have a cut finger or twisted ankle? Go to your local emergency room, as no one there has the mandate to call you a "Gomer" (that’s doctor talk for ‘get out of my emergency room’) and tell you to get lost. Under our free system they are all obligated to treat us equally, from the most serious myocardial infarction to the most trivial hypochondriasis.
It’s all free, so don’t be shy, belly up to the bar and help yourself to as much healthcare as you can stand. And because it’s free (paid for by the government) it will never run out no matter how much you use (or abuse) it.
The second reason that health care in Canada is dying is closely related to the first, in that in the days when everyone contributed to the health care coffers, either directly or through a payroll plan, the system was properly funded. Funding the system through hidden taxes and from the general government coffers achieves two things. It re-enforces the concept that it’s free and therefore worthless because users do not have to pay anything, and it does not provide sufficient funding to feed an ever more ravenous system.
If we had some user charges in our health care system, it would instill a sense of value for this service among the users and maybe cause them to think twice prior to making use of the system. As Canadians tend to be notorious cheapskates, they will use the healthcare system for any reason, so long as it remains free of charge. If you take issue with this statement, you merely have to look at Ontario’s Highway 407, the toll road, during rush hour and compare it with Highway 401, which is free. The 407 is moving along freely at a good clip, while the 401 is down to a crawl due to congestion. The reason is that the 401 is free.
By returning our health care system to a service that is not free, but is paid for through direct payments by the users, the system would ultimately have more money and less demand by users.
The last and perhaps most important reason health care is dying is in that the absence of any competition, there is no need to keep costs in check, as it’s the only game in town. Where else are you going to go to get health care? Many Canadians, myself included, have surreptitiously sneaked south to take advantage of readily available health care and have been happy to pay the fees because we did not want to suffer pain for six months while waiting in line for an MRI. And besides, every time someone goes south for a paid medical procedure, it frees up a spot for someone in Canada who cannot afford to do the same.
That’s why having private for profit corporations providing some of these services makes sense. Let’s not fool ourselves. Healthcare as we know it today is for profit. Period. Corporations such as MDS who provide laboratory services through OHIP are privately owned and thus are providing this service in order to make a profit. Doctors are paid through billings to the provincial health plans and they are also in it to make a good living. Ditto nurses and other health care providers. Looking for savings by contracting out some of the medical services to the private sector only makes sense, particularly if private, for profit organizations are capable of providing quality service at a lower price. But many, if not most Canadians, are opposed to anyone making a profit on anything, much less on the provision of health care.
It’s one of the factors that has caused so many of our top physicians to flee south. There they can at least take a stab at actualizing their full financial potential and they will not become servants of a rigid, unfeeling civil bureaucracy.
Those of us who still believe we can save health care in Canada need to get a reality check. The patient is failing fast and there is no chance of recovery, so long as the same old tired remedy is continuing to be shoved down his throat.