Politics

THE MEDICARE MONEY TREE

Are the Liberals really against private health care, or just trying to quash a touchy debate?

JOHN GEDDES May 17 2004
Politics

THE MEDICARE MONEY TREE

Are the Liberals really against private health care, or just trying to quash a touchy debate?

JOHN GEDDES May 17 2004

THE MEDICARE MONEY TREE

Politics

Are the Liberals really against private health care, or just trying to quash a touchy debate?

JOHN GEDDES

OFTEN IT DOESN’T do to be candid in politics. One of the most mocked slip-ups on Kim Campbell’s way to leading the Tories in 1993 to their worst election debacle was her remark that a campaign was no time to debate policy. She had a point, though. And in this feverish political season, Campbell’s axiom is proving true for the pre-campaign period, too. Witness Pierre Pettigrew’s apparently harmless statement that the Canada Health Act allows private firms to deliver publicly insured health services. Such was the outcry over the mere mention of this undeniable fact that the federal health minister had to read a mealy-mouthed statement stressing that he didn’t mean the government encourages that sort of thing. And so, Liberal rhetoric on arguably the most pressing issue facing Canadian politicians could be boiled down to this: public good, private bad.

Of course, the real world of health care doesn’t lend itself to such simplistic prescriptions. Like it or not, the private sector’s role—from for-profit MRI scanners, to doctor-owned walk-in clinics, to new hospitals built and managed by companies—is becoming one of the key elements in the system. Just don’t expect that to be frankly debated in the race toward the vote Paul Martin is now widely expected to call for June 28. Instead of discussing what’s really happening, the Liberals prefer to talk about a starker choice: between universal health coverage and what Martin darkly calls “chequebook medicare.” The problem is, no federal party is advocating anything like a user-pay revolution. Stephen Harper refuses to play the villain’s role, sticking to his line that Conservatives agree with the current formula of public insurance, allowing flexibility for private delivery.

Pettigrew’s apparently harmless statement provoked a major uproar

Lost in phony black-and-white, private-vs.-public rhetoric are all the grey nuances. There are signs that the Martin Liberals are far less categorical in their rejection of for-profit health care than recent posturing might lead voters to think. Take the situation in British Columbia. The rise of private MRI scanning clinics and surgery centres in B.C. put the province on a collision course with the Jean Chrétien government. Under Chrétien, Health Canada threatened to reduce transfer payments unless the province cracked down on cases where these enterprises charged for medically necessary services. Premier Gordon Campbell reacted last fall by quickly passing a law that would have given the province the power to audit clinics and levy fines up to $20,000 against doctors who accepted money for treatments that should be covered by public insurance. But soon after Martin took over in December, Campbell backed off and decided not to put the law into force. “I think it may well turn out that we don’t need it at all,” he said.

A spokesman for Pettigrew denies the transition from Chrétien to Martin was what took the pressure off Campbell. He said that, all along, Health Canada officials didn’t mean to signal that a law as severe as the one the B.C. government passed was being demanded by Ottawa. So what do the feds want B.C. to do, if anything, about the private clinics? The details remain to be worked out, Pettigrew’s spokesman says, in negotiations with the provinces, expected to culminate this summer—safely after the expected June election. No need to trouble voters in advance about the details.

So for now, it’s business as usual for B.C. firms such as Image One MRI Clinic Inc. in Kelowna, opened last year by Kris Stewart, a registered nurse. Stewart was inspired by personal experience: the doctor who was treating her for leg pain resulting from an old sports injury told her she would have to wait a year for an MRI scan. Her frustration led to a business plan based on this straightforward premise: “It’s a high-demand, lowsupply industry.” Stewart says many of her clients would never qualify for publicly insured MRI scans, such as patients involved in personal injury lawsuits who want scans to take to court. Others would get scans through the public system after lengthy waits, but are willing to pay about $800 for what is often same-day scanning.

Deciding who really needs an MRI can be tricky. Consider individuals whose doctors suspect they have multiple sclerosis. Deanna Groetzinger, vice-president of communications for the Multiple Sclerosis Society of Canada, explains that an MRI scan can help with the diagnosis of MS. Yet patients often wait two or three months, since getting that confirmation right away often isn’t regarded by doctors as medically urgent. Patients frequently decide to pay for scans themselves to end the stressful uncertainty and perhaps start treatment. “People shouldn’t be put in that position,” Groetzinger says. The MS society wants more MRI scans available quickly under medicare.

Even where there is no question of patients having to pull out their credit cards, making a buck in health is increasingly controversial. Advocates of a pure public system are up in arms about a few hospitals being built and operated through public-private partnerships, known as P3s. A prominent example is the new Royal Ottawa Hospital, a planned 188-bed psychiatric teaching facility affiliated with the University of Ottawa, slated to open in 2006. Its main tenant will be the Royal Ottawa Health Care Group, which has a public board and represents health professionals. Patients will be fully covered by medicare. But the landlord in charge of the building’s construction and management is a private consortium. “That doesn’t weaken or dilute our health-care values,” says George Langill, Royal Ottawa Health Care Group’s CEO. “There’s confusion that public-private partnerships somehow cross the line.”

Figuring out just where the federal Liberals stand on P3 hospitals is not easy. Martin has appointed Ontario MP John McKay as parliamentary secretary with a special responsibility for looking into how the federal government might benefit from publicprivate partnerships. But on hospitals, McKay said provincial politicians will have to decide if the model makes sense, since health is their jurisdiction. Still, he sounded broadly sympathetic with provinces that are looking for private capital and expertise when it comes to finding ways to afford new facilities. “They have to deal with ever-escalating costs and a demographic crunch,” McKay said. “So whether P3s are appropriate or not is going to be up to them.”

PUBLIC health

advocates are up in arms about a few hospitals built in partnership with private entities

And the private sector’s role is hardly limited to the MRI niche and big hospital projects. Martin himself gets treatment from the Montreal doctor who founded a clinic chain, Medisys Health Group Inc., that offers both publicly insured services and extras paid for by private plans. Doctors generally own their practices, and as health policy experts press for what’s called primary care reform—new ways of delivering basic doctors’ services—that model is still widely favoured. One of the most detailed reform proposals, a plan from University of Toronto health economists now being studied by Ontario, calls for bringing together doctors and other experts in new clinics “owned and operated by regulated health professionals, so as to ensure shared goals for service delivery, resource utilization and clinical outcomes.”

The report assumes this sort of private ownership doesn’t clash with public insurance. Whether voters are inclined to agree or not, there’s no sign so far that they’ll be treated to real debate on the question in the coming election. As Kim Campbell made the mistake of telling us, issues this important generally have to wait until the messy business of democracy is put to rest.