She has spent much of her career giving advice—acting as a consultant to health-care professionals, lecturing students and writing books on medicare. But now it is time for Jane Fulton to see where, in her own words, “the rubber meets the road.” Fulton, a 48-year-old mother of four, was appointed Alberta’s deputy health minister in early July. Although she was born in Edmonton, she spent the past nine years at the University of Ottawa as an associate professor in the faculty of administration.
Through her writing and public speaking, Fulton gained a controversial reputation as an advocate of private health care. In fact, she has argued that two-tiered health care already exists in Canada, that there are limits to what public funding can provide and that consumers should be free to purchase fancier or faster services if they choose.
Opponents of privatization protested Fulton’s appointment. But the new deputy minister seems a perfect fit for Alberta’s Tory government, which is into its third year of budget cuts and health-care reforms. Ottawa has threatened to cut its transfer payments on Oct. 15 unless the province stops private clinics from charging both a facility fee to their patients and a physician fee to medicare. Ottawa claims that the practice contravenes the 1984 Canada Health Act; Alberta disagrees.
In any event, Fulton said in an interview with Maclean’s, Ottawa should stop harping on that legislation. All the provinces believe in the principles of the act, she insists. But as governments struggle to balance their budgets and Ottawa cuts its transfer payments, “there isn’t a province in the country that can afford to meet the demands of the act 100 per cent. We have to make some tough choices.”
The best way to save health-care dollars, Fulton argues, is to stop doctors from doing things that less costly health providers can do. Physicians should not be immunizing children, for example, when a nurse could do that. Similarly, she contends, they should not be counselling lonely seniors. “That costs way too much,” said Fulton. “Those people need to go to a friendship drop-in centre.”
Fulton says she supports universal insurance. Medicare, however, should cover “things that make the population healthy,” such as child immunization, prenatal care and home-care nursing. And it should also “rescue individuals in crisis or extreme need,” paying if someone has a heart attack or needs an organ transplant. For anything discretionary or elective, patients should wait—or pay extra. If they can be discharged from hospital a day after surgery and safely make do with cheaper nursing care at home, Fulton says that is what medicare should pay for. At the same time, she feels, patients should be able to buy extra days in hospital if that makes them feel more secure. Fulton also says that people should be able to skip to the top of waiting lists if they are willing to “trade off their holiday to Las Vegas” and pay for prompter care.
Critics argue that the poor cannot afford to make those choices and that a private tier of medicine will eventually provide topnotch service for the wealthy, while the public tier—drained of the best physicians and much of its funding—will provide inferior care to the less well-to-do. Fulton counters that a two-tiered system already exists, given that many Canadians go to the United States for health services. They should have the right to buy the same services at home, she maintains.
Fulton argues that doctors would stay in the public system, even if there were more lucrative work in an expanded private health sector, because many chose their profession for “its esoteric nature, not because they’re rip-off artists.” And whenever quality or technology improves in the private system, she says, regulations could require that they be implemented in the public system. Many disagree with her, of course. But as the debate over medicare intensifies, Fulton at least articulates a distinct vision—one in which privately funded medicine plays a more significant role.
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