The Commission on the Future of Health Care in Canada – a
critical test of what kind of society Canada wants to become,
with. special
concern for British Columbia.
Heralded under
the banner of ‘worthy causes’ the forming of ‘politically
visible’ commissions or committees is an old political method of
avoiding controversial decisions and accountability. Members
of the community volunteer time and effort to advise paid
politicians, bureaucrats and consultants on what they should
already have known and should have done many years ago. It is a
good way to ensure that nobody is accountable.
Will the Commission
on the Future of Health Care in Canada be any
different? Will the community embrace the commission, and will
that allow everyone to dodge accountability?
Canadian society
in good democratic order decided that healthcare should be
excluded from the private sector and pricing mechanism, and should
be provided by government and financed through taxation. The
decision is legislated in the Canada Health Act, that states: the
primary objective is to protect, promote and restore the
physical and mental well being of the residents of Canada and to
facilitate reasonable access to healthcare without financial and
other barriers.
The decision was
right. The Canadian Health Act has contributed immensely to
improve the social conditions in Canada. Not only by ensuring
access to health services but by supporting good public health
which is a key element to building a more productive and
competitive nation. A population with a high degree of poor
nutrition and debilitating diseases such as tuberculosis,
diabetes, emphysema, birth defects, or cancer is less productive
and less competitive than a healthier population.
It has been known
for decades that these types of problems are more prevalent among
our first nation communities. So how could that be a surprise for
the health Commission in
their recent consultation visit to Nunavut?
The problem is,
whether in Nunavut, South Africa, Tennessee or elsewhere in the
world, healthcare systems by themselves do not promote and restore
the physical and mental well being of a country. Quality of
life and good mental and somatic health also depend on investment
in economic production in business and the distribution of real
income in the community via employment. Economic production is
also the only way to provide the tax revenues that finance
healthcare and other essential public services.
It is simply
impossible to improve public health without solving the underlying
interrelated socio psychological and socioeconomic issues.
The
problem is that resources and investment used in one direction
cannot be used for other needs in the community.
Investment in the healthcare sector, social services, etc.,
can only be at the expense of investment in the factors that
create economic production, such as education, training, research
and investment in business.
Rising costs and
excessive consumption of healthcare come at the expense of
investment in economic production in the forest, IT, or any other
sector that distributes real income in the community.
Unsolved that creates a vicious circle. Lack of investment
in the factors that create economic production and distribution of
real income inevitably erodes social conditions and living
standards; having a negative impact on the physical and mental
well being of society. That
in turn increases consumption of healthcare and calls for the
allocation of more resources. Ask any GP what happens when the
local factory or mill closes.
A country that
can recognize the cross-disciplinary nature of good healthcare
will invest in solving the socioeconomic issues that hamper
investment in the economic production needed to promote good
health. That country will be far more competitive in the world
marketplace than a country that allocates more and more resources
to treat the symptoms instead of curing the disease.
An
aging population (including doctors and nurses), gains in science,
technology, and how we prevent and cure disease, and the
organizational issues and ever-rising costs are not happening
‘out of the blue’. The issues have been known for the past
twenty years. Unsolved, the issues have been allowed to escalate,
eroding economic production and causing irreparable harm to
society, and even blackmailing society as demonstrated in BC.
This
is not one government’s fault. Federal and Provincial
governments have been failing in their monitoring and intervening
role for decades.
Government’s
most important role in a democratic governed mixed economy, such
as Canada’s, is to correct the allocation problems before
the problems cause adversity. That is not something that the
private sector can, or will ever be able to do.
If the cost
burden of the healthcare system erodes the factors that protect,
promote and restore the physical and mental well being of
Canadians, one could raise the hypothesis that the government is
failing to meet the standard set out in the Canadian Health Act.
If policies and
government intervention - including outsourcing and privatization
- increases ‘disparity in opportunities’ for Canadians, that
would breach Canada’s constitution.
The question is,
will the health commission recognize the culprits, address the
underlying causes, and press for solutions, or will the commission
simply bolster the lack of accountability.
The latter seems
to be what the Chair of the Canadian Senate committee on social
affairs, science and technology supports.
A recent report
from the committee is another repetition of what has been known
for the past decade. Instead of addressing the underlying issues
that are causing excess consumption of healthcare at the expense
of the factors that secure good health, their preference seems to
be to embrace a private healthcare delivery system.
In reality, it is a politically packaged privatization and
implementation of a multi tier system.
There is no
evidence that private managed delivery of healthcare is less
expensive and better, or would contribute to solving the
allocation problems. There is however, lots of evidence to the
contrary, that shifts to private delivery will increase the
consumption and cost of healthcare in Canada, and inevitably erode
economic production and the factors that create good health.
The risk is that
the community will fall victim to misleading assumptions that lack
prudent analysis and wishful thinking that privatization will
lower costs, improve service and public health.
That can only
negatively affect Canada’s comparable advantages and hamper
investment in economic production in business and jobs. That will
damage Canada’s competitiveness in the global economy.
Small and midsize
business and the lower and middle-income bracket will carry the
brunt, not the political and social establishment that makes the
decisions.
The
boosters of privatization seem to overlook that the US mixed
public and private insurance system has the highest healthcare
cost per capita in the world, which is a serious drawback for US
business. It is a system that is the best in the world - if you
can pay for it. The
drawback is that approximately 44 million people in the US lack
health insurance and access to adequate healthcare. Applied to
Canada, that would amount to roughly 3-4 million Canadians without
access to adequate healthcare, which would reduce the quality of
life for all.
The driving force
is of course that money can be made from P-3 privatization of
healthcare. It would
rally the stock exchanges and make fortunes for some, but would
offer little for most Canadians, small and midsize businesses,
jobs, and quality of life in the local community.
Privatization does not require much intelligence. It is an
easy way out; like saving the patient by amputation rather than by
skilled surgery.
Modernizing and
securing the public healthcare system will require new thinking,
and more strategic cross-disciplinary considerations.
The
British Columbia Government is facing the acute stage of decades
of unsolved issues, not only in the forest sector and healthcare,
but in virtually every corner of the economy. Reorganization of
the healthcare system and controlling spending is vital for BC’s
overall economy. The issue here is, there is no reason why the
Canadian public healthcare system cannot be successfully
reorganized; reducing consumption and simultaneously improving
quality. Cost cutting in itself will not achieve that.
Reorganizing
healthcare with the goal to secure the best and most
cost-effective integrated public healthcare system in the world
would immensely promote and improve Canada’s comparable
advantages, attract and stimulate investment in economic
production in business, and distribute real income via employment
in the community. That would in turn fuel the stock market and
create social satisfaction for all, while meeting the standards in
our constitution.
BC
does have a choice to take a lead in Canada with an intelligent
reorganization of healthcare within the broader context of our
overall socio-economic conditions.
As Albert
Einstein said, the problems we face cannot be solved at the same
level of thinking we were at when we created them.
Will the Commission allow new thinking into the commission,
and ensure prudent analysis, logical truth and ethical action is
applied to solving the issues?
Or will the
commission continue the same thinking that created the problems in
the first place? Ultimately will the members of the community and
the taxpayer accept that?
Respectfully
submitted to the Commission
on the Future of Health Care in Canada, and the Premier of British
Columbia.
Okanagan
Institute for Strategic Development
May
2002
