Column

Barbara Amiel

How to preserve the health-care safety net

December 2 1996
Column

Barbara Amiel

How to preserve the health-care safety net

December 2 1996

Barbara Amiel

How to preserve the health-care safety net

Column

Like all pundits, I’ve made some significant miscalculations. Here’s one prediction, though, written in 1979, that holds up. I was writing in my book Confessions about the future of health care if Ottawa abolished private insurance and private medicine: “When health care becomes a free commodity like air and water, it is treated less seriously. It is abused in major or minor ways. People go to see doctors for colds. My middle-class girlfriends go to see psychiatrists at public expense to cope with the problems of their love lives. Administrative costs soar as they do in any state enterprise.

“Reducing administrative costs is hopeless. However, coercion not only is possible, but becomes natural and the only way out of the government’s dilemma. Gradually, the freedom of doctors to opt in or out of the health-care scheme is replaced by a coercive condition of some kind. Then, the patients’ freedom to select their own doctors is limited by requirements of residence or workplace.”

I wrote that about the time Minister of Health Monique Bégin and Prime Minister Pierre Trudeau turned up the heat to abolish private medicine in Canada by withdrawing federal funds to any province that allowed extra billing. The story of how doctors responded to attacks on their independence is not impressive. The very few of us who were on their side, fighting for a health-care system that allowed private medicine to co-exist with a public safety net, simply gave up as the doctors started behaving just like unionized workers. They did not resist socialized medicine on principle and say this will ruin health care. By fighting only over the salaries and fees they would get in return for giving up their independent status, they proved that all the people who claimed the issue for doctors was just a matter of money were correct.

Now, we have Ontario’s Mike Harris faced with stratospheric health-care costs and planning coercive measures against doctors, such as denying them the right to practise in some urban centres. Harris and his government face problems inherited by the combined mismanagement of every Ontario premier from Bill Davis to Bob Rae, but more coercion is not the answer. The only solution is to tell people the truth about their cherished “free” health care.

There are two main problems with modern medicine. One, actually a series, has absolutely nothing to do with socialized medicine and would have existed in 1996 no matter what. Simply put, medical advances cost a fortune. It is marvellous that we can transplant organs and, instead of cutting off limbs, we can sew them back on. But an amputated limb is infinitely cheaper than the cost of all the hospital facilities required to sew it back. No one wants to forgo multimillion-dollar diagnostic machines, new drugs and technology, but this also increases costs by incalculable amounts. Then there are the increased costs of hospital workers, not including doctors, from nurses and orderlies down. Finally, we are able to extend the human lifespan in terms of economically useful life but also for economi-

The nightmarish conceptions that Canadians hold about the notion of ‘two-tier’ medicine are a he

cally useless lives at exactly the time our population bulge is in its 50s. This raises both cost and ethical problems. Who will fund care for these older people? Who will get the limited number of organs available for transplant? Who will get access to dialysis machines or CAT scans? First come, first served? Highest bidder? The person most economically useful to society?

What makes the current situation so difficult, however, is the second problem: socialized medicine itself. I arrived in Canada in the 1950s after experiencing the horrors of British socialized medicine with its lengthy waiting lists and run-down hospitals. Canada was a dream. At that time, Canada had private insurance plans that actually made a profit and gave fantastic benefits. When, as a university student, I couldn’t afford my insurance and happened to end up in Toronto General Hospital, I was amazed to find that I was on a “public ward” that had only six beds and my doctor was the most renowned internal specialist in the city. All the nightmarish preconceptions that the British held about North American health care were a lie. Today, the nightmarish conceptions that Canadians hold about the notion of “two-tier” medicine are equally a lie.

Socialized medicine raises problems that occur when any endeavor is shifted from private business between a customer and a service provider to a government bureaucracy. Bureaucratic considerations immediately take priority over service considerations. Neither customer nor provider (the doctor) will be in charge, but rather some government clerk. Patients will be reduced to petitioners. Inevitably, patients and doctors will find a backdoor such as under-the-table payments and personal connections. Two-tier medicine, whether official or unofficial, is re-established.

The bureaucracy will run out of money and will never cut itself deeply, only the services it provides. The first things to go are the hotel services health care gives: the little comforts for people when they are at their most vulnerable and needy. Hospital patients are de-humanized by humiliations: they need a bedpan or an understanding nurse. What they get is endless waiting, harassed staff and often lower quality personnel. Waiting lists get longer. The state makes all sorts of medical decisions based on non-medical criteria. The brain drain of doctors speeds up. The wealthy go out of the country for their heart surgery.

The public debate about this should be widespread and informed. Governments have to realize that insurance companies must be allowed to make money. If you don’t want a medical health-care system that functions like the post office, then return doctors to their role as independent professionals and not de facto members of CUPE. Cut the bureaucracy, make the so-called two-tier system official rather than unofficial and that way every indigent person in Canada will be assured of medical care. None of us want to have anything to do with a country that turns people away from necessary medical care for lack of funds. But today, that is what we have. It will take political guts of steel to undo it.