Arguments both for and against the privatisation of Canada’s health care are plentiful. There is evidence by looking at any Canadian newspaper, television news program, or news oriented website on the Internet. Election polls consistently rank health care as Canadian voter’s number one concern (Wickens, 2000, 26).
Reasons for supporting a two-tier system include reducing line-ups in the so called “cash? strapped” system (Fennell, 1996, 54), and to allow Canadian doctors a financially viable alternative to the United States by presenting the option to set your own wages as well as the luxury of more flexible working hours.
Supporters of the blended private? public system insist that privatisation is required to advance technology and decline government budgets (Vanagas, 1995, 24). However, those worried about a change in the way this country delivers its health care feel a two-tier system would be “unCanadian” (26). In this paper I will attempt to discover for the positives and negatives of an implementation of a two? tier health care system in my home province of New Brunswick as well as the rest of Canada.
Two? tier health care can be simply defined as a health care plan that will allow for a private or for?
profit system to operate along side Medicare (Marshall, 200, 48). The system will allow the opportunity for those people who are willing to pay for health care to do just that. Ideally, it will take pressure off the current Medicare system by shortening waiting lists and generating revenue. The form of two-tier being proposed in New Brunswick involves a private system that will operate parallel to the current public system and will allow people to purchase private insurance if so desired (Deber et al, 1999, 539? 43).
Some politicians like to define two?
tier health care in different terms. BC Health Minister Paul Ramsey says, “I cannot think of a clearer definition of a two? tier health system than having one set of services available to those who have large bank accounts and can afford to just go to it and another public system for the rest of us. ” This politician is obviously voicing his negative opinion of the proposed system by constructing this biased definition. I believe politicians try to appeal to voters by voicing emotional tirades about proposed alternatives to Medicare.
Dr. Edwin Coffey, a past president of the Quebec Medical Association and a well-known supporter of two tier health care explains the system in this way, “In a parallel, non-competitive health insurance system, everyone pays into the universal public system also has the option of paying for private health insurance. ” Before presenting the arguments that push for the implementation of a two-tier system, there is evidence that two-tier health care already exists in this country. Dr.
Coffey brings to our attention that, “thanks to money, connections, influence, geographic location, level of intelligence, and availability of highly trained physicians and up-to-date technology, (some) get served first or better. ” A good example of this already existing two-tier health care is the ironic case of Allan Rock, the present Federal Minister of Health. It is suspected that Rock was able to use his influence, whether directly or indirectly, to speed his wait to receive treatment.
Another example supporting this theory is how our health system takes full advantage of a private system by paying and insuring “medically necessary” services such as physiotherapy, MRI tests, massage therapy, etc. (Deber et al, 1999, 539). Why is there so much controversy hovering around this issue now? Is there an alarming trend that is occurring that is making our government nervous about the integrity and stability of our health care system? Or are people beginning to notice a subtle emerge of private health care into our system? There is evidence to suggest both hypotheses.
To support the latter you have to look no further than Bill 11. The controversial bill was passed in May 2000 in the province of Alberta to set new standards for private clinics by allowing publicly funded minor surgeries to be contracted to them (Palmer, The Edmonton Sun, 2001). With a passing of a bill like this I can see why some people might suspect that a trend toward two-tier is beginning. Actually, since 1975, health care purchased privately has reached above 28 per cent from less than 24 per cent (Fennell 54). You do not have to research for very long to realize that our system is riddled with problems.
Our government is struggling to save money that is being spent on Medicare. Since 1993, 6,000 hospital beds have been closed across the country (54). In Ontario, health care funding has been cut from $707 million to $407 million (Turner, 1999, 13). There is also the problem regarding a doctor shortage. A recent college paper has indicated the decline of family physicians (FP’s) in the province of Ontario (Sibbald, 1999, 561). The report explains that in 1980, about one thousand doctors became FP’s in the province of Ontario, in 1997, only 187 moved into this field.
I believe a private system would make it more appealing to a young medical student to practice in Canada where they will be able to set their own wages, their own hours, and other benefits seen in private clinics. Finally, there is growing concern among the people of this country about the stability and integrity of our health care system. This was clear in a 2000 MacLean’s conducted poll, which revealed for the second year in a row that the issue of health care is the main concern of Canadians (Marshall, 2000, 48).
An article in the British Medical Journal revealed that the percentage of Canadians satisfied with the health care system dropped from 56 per cent to 20 per cent between 1987 and 1997(Spurgeon, 2000, 1295). There are many problems plaguing our current health care system among them waiting lists seem to be a major concern among Canadians. A survey reported in an article in the Canadian Medical Association Journal (Sanmartin et al, 2000, 1305), claimed that almost two-thirds of those surveyed felt that waiting times for surgery had grown over the previous 12 months, and half felt that access to specialists had become more difficult.
Daniel Doyle, a cardiovascular surgeon from Laval University described how patients are dying while on waiting lists for bypass surgery. This was reiterated by an article in Canadian Business (Turner, 1999, 13), which described the unfortunate death of a 59-year-old Toronto machinist who died of a heart attack while waiting for an angiogram. An angiogram is a test done to determine if a heart condition is present. Also in this article it is apparent that doctor’s concerns are rising dramatically. I feel that waiting lists will be reduced if people have an alternate parallel system to seek their health care.
There is also some concern among doctors that their ability to provide quality health care in this country is reduced because of our system. This was demonstrated in the case of Dr. Jacques Chaoulli, a FP in the province of Quebec. His case was reported in a 1999 article in the Canadian Medical Association Journal by Susan Pinker. He has created a mobile emergency room in a van that is equipped with an X-ray machine, a darkroom, a portable electrocardiograph, intravenous equipment as well as other medical equipment. His plan was to charge people for his emergency medical care.
However, under the Quebec Health Care Act, it is illegal for him to sell his private medical service. In pure Hippocratic Oath style, Chaoulli has retorted, “I have a duty to provide a good service to my patients. No one should interfere. No one should block me when I want to help my patients and alleviate their pain. ” Embedded in the Hippocratic Tradition is Percival’s Code of 1803 which describes the duty a physician must fulfil to benefit the patient (Veatch, 2000, 6). It seems that because of the current health care system, Chaoulli feels that he is being prevented to completely fulfil his duty to benefit the patient.
By allowing the doctors the option to work in a private health care setting, we are allowing them more of an option to fully benefit their patients by removing the confines of long waiting lists and legal issues about the degree of health care they can provide (I. E. , providing a medical emergency van which would be extremely useful to those people confined to their homes). There is evidence that private health care already exists to some extent in this country. Former president of the Canadian Medical Association, Judith Kazimirski explains, “We are allowing passive private medicine to move in .
. . in an unregulated and unplanned way. ” This statement was made in 1996, and only Bill 11 passed in Alberta is all the significant action that has taken place. I believe that if something is introduced into society laws and regulations must be placed on it. For example a new drug finds its way into our society, it has healing powers but if used in alternate ways, it is a very appealing recreational drug. It would be expected that laws would be put into place to help regulate its use. The above mentions notions are ones that paint the possibility of a Two-Tiered system in a positive light.
There are however, many countervailing arguments on this topic. Firstly it is the argument of whether or not we are morally obligated to prevent the transition of health into a buyable commodity. People feel that it is unfair to profit from vulnerable families or individuals when they are ill (Weir, The Telegraph Journal, 2001). People also see the danger in health care becoming a commodity with risk of costs going up and up just to see what the market will stand. Another argument is one, which is bounded in the legalities of the Canada Health Act (1984).
The claim is, the Act was explicitly designed to prevent the birth of a two-tier system (Shortt, 2000, 1291). The Canada Health Act (1984) is based on five words: pubically administrated, comprehensiveness, universality, equality, and portability (Kluge, 1999, 48). Kluge argues that part of the foundation of the Act is prevention of the ability to pay to improve your access to health care. The argument exists that private clinics by symbolizing inequality are not following the principle of universality in the Canada Health Act (1984), (Vanagas, 1995, 24).
However, arguments to help defend against this stand are quite present. Most notably, an article included in the Kluge text written by John K. Iglehart. He makes comparisons between the Canadian health care system and systems used in the US and UK. Firstly what needs to be acknowledged here is the tremendous pride many Canadians take in our health care system. Al Yarr, a retired physical education professor in Halifax says that, “Our health care system is one of the things that make Canada great”. Iglehart
replies to this “romantic” idea of a health care system making your country great by explaining how the system is outdated and is not able to cope with rising costs. He points out that: In the face of a large deficit, the national government continues to reduce its financial commitment to the plans; patients and practitioners are demanding access to the latest forms of medical technology; the supply of physicians continues to increase at a rate out-stripping the growth of the population; and doctors are restive as provinces work more aggressively to stem the rise in health expenditures.
Another countervailing argument that has been documented is the inability of a two-tier system to reduce waiting lists. As well, the question of whether there really is a waiting list problem in our country. Studies published between 1996 and 1998 reported no significant increase in waiting time for most surgical procedures (Spurgeon, 2000, 1295). Another argument I have come across, is the possibility that a private sector will have the capacity to drain talent from the public sector (Marshall, 2000, 48).
Is there a possibility that there could be regulations put in place to reduce the chance of a trend like this occurring? For example, perhaps a doctor must work for so long in the public sector before being able to earn the “right” to work in the private sector. Throughout the articles I have researched those are the main countervailing arguments. That is to say, they appeared most throughout the articles. In conclusion, I would like to state that when I took on this topic I was relatively impartial.
I have always considered myself quite conservative and naturally envisioned myself writing a paper opposed to a proposed two-tier health care system in this country. As I continued reading articles, I realized that many of the arguments against such a system were lacking. Several were based on the idea of making our country a wonderful place to live. I realized now that there is nothing great about a health care system that is not financially viable in the ever-increasing technology base health care society we are now emerged.