A Calgary symposium highlights the advantages of a hybrid health system
THE EUROPEAN FIX
A Calgary symposium highlights the advantages of a hybrid health system
RALPH KLEIN AND HEALTH CARE—it’s a sometimes toxic combination. Just ask Stephen Harper. During last year’s federal election campaign, Harper’s Conservative party appeared headed for victory until Klein, in one of his infamous shoot-from-the-lip comments to reporters, said he was considering health care reforms in Alberta that might very well violate the Canada Health Act. Paul Martin spent the final stretch of the campaign demonizing Klein and warning darkly of a conspiracy between the premier and Harper
to undermine the sacrosanct principles of Canada’s public health care system. Martin’s strategy was cynical, hypocritical—and brilliantly effective.
So with another federal election in the offing, Harper’s team was surely aghast at the prospect of last week’s Alberta Symposium on Health, a $1.3-million confab of policy wonks, physicians and economists
from around the world charged with bringing forward innovative solutions to the much ballyhooed “public health care crisis.” The conference was to be a key weapon in Klein’s hunt for what he dubs a “third way” in health care—something in between the Survival-
of-the-richest American system and the holy grail that is the Canada Health Act. Oh dear, one could imagine the Harperites sighing, here we go again.
As it turned out, the Calgary-based symposium did little to cough up the sort of Alberta bogeyman Martin would so dearly love to stalk again on the campaign trail. Quite the opposite, in fact. There was much from the three days of earnest discussion that Harper, if he cared to—or dared to— could use to counter Liberal attacks. Perhaps the most telling lesson: that allowing the private sector a greater role in health care—something Harper supports, but which the loudest defenders of our status quo consider heretical—is simply the norm in several European nations, many of them run by social-democratic governments.
Provinces could shorten some long waiting lists by contracting out to private clinics
There was probably no one at last week’s symposium with a broader knowledge of European health care practices than Richard Saltman, who has studied the field for 25 years. In addition to being a professor of health policy and management at Emory University’s school of public health in Atlanta, Saltman is a research director of the European Observatory on Health Care Systems, a virtual think tank that analyzes trends in health care policy across Europe. While Saltman is an American—and one who resides in a red state to boot—he is no fan of how U.S.-style health care has left 45 million of his fellow citizens bereft of medical insurance. “I view health care as a social good,” he told Maclean’s. “I see it as a core of what makes a society valuable, coherent, livable. I don’t believe, by the way, that most Americans share my opinion. They prefer to see it as a commodity and they are unwilling to pay for other people’s health care.”
All of which is to say that Saltman is an admirer, and defender, of tax-funded public health care systems as they exist in Canada and much of Europe. But not an uncritical one. In fact, he scoffs at what he calls health care Chicken Littles who “as soon as there is any entrepreneurial behaviour at all in the public sector, or any link to the private sector, start screaming, ‘The sky is falling, the sky is falling.’ That’s just pathetic.” Saltman finds it bewildering that there’s so much controversy in Canada over some provinces, Alberta among them, contracting a few overbooked services and surgeries to privately owned clinics, while continuing to pay for these procedures out of the public purse. “And this is a big deal?” he asks rhetorically. “This is not a big deal in any country that I know of in northern Europe that has a tax-funded health care system.” Moreover, says Saltman, several countries, Sweden, Denmark and Britain among them, have used the private sector to, in effect, make public health care more efficient and allow it to survive in the long run. He cites the example of Britain’s Tony Blair, whose Labour government has attempted to reduce the pressure on the country’s National Health Service by, among other things, allowing private contractors to deliver targeted services, and bringing in private money to build new hospitals. In
SALTMAN, who admires public health, says the use of private services doesn’t mean ‘the sky is falling’
addition to dramatically reducing waiting lists, says Saltman, “I would argue that Blair is saving the National Health Service so that all citizens get care for the next generation.” All the same, there are privatization options Saltman flatly rejects. He considers health care user fees, something Alberta and other provinces have flirted with, as counterproductive because they discourage people from seeing primary care doctors and end up costing the system more in the long run when people truly get sick. On another flashpoint—whether individuals should be able to get quicker access to MRIs if they pay for the procedure themselves— Saltman comes down on Ottawa’s side. This sort of queue-jumping, he says, “corrupts the system.” But the solution is not banning the private MRI clinics, especially when so many affluent Canadians could just as easily visit an American facility. Rather, says Saltman, Canada should follow Sweden’s example: make the public system so accessible and efficient that private diagnostic clinics soon go bankrupt for lack of business.
Among the 28 keynote speakers from nine countries who addressed the symposium, there was much the Klein Tories probably didn’t want to hear. Rudolf Klein, a professor emeritus from Britain’s University of Bath, joked about sharing a surname with the premier. But the British Klein also said that, after 48 hours in Alberta, he couldn’t understand why such an affluent society would even consider farming out medical services to the private sector.
Beyond the private-public minefield, several speakers delivered on the conference’s demand for innovative initiatives. Consider, for example, New Zealand’s PHARMAC agency, which rigorously screens what drugs the government will fund and, years ago, declined to endorse the since discredited COX-2 inhibitors such as Vioxx. Or the citizens’ and professional health council in Israel, which has wrested control from the politicians over deciding which medical services will be publicly insured. Or Britain’s massive investment in tele-medicine and electronic health care records.
Domestically, none of these ideas is likely to penetrate the pre-election posturing. That much became apparent when federal Health Minister Ujjal Dosanjh swept into Calgary two days before the Alberta symposium to attend a counter-conference put on by the Friends of Medicare lobby group. Dosanjh told reporters that Klein’s quest for a third way on health care “rings alarm bells for all Canadians,” and added that “Canadians are rightly suspicious of Mr. Harper’s hidden agenda” on health. Dosanjh also declined Klein’s invitation to attend the symposium, explaining that, with the Liberals poised to fall at any moment, he should best scoot back to Ottawa.
And what about Ralph? Ironically enough, the premier was a no-show at his own summit due to a respiratory infection. For the Harperites, this was decidedly good news. Klein is never more than a scrum away from igniting a national firestorm. By contrast, Iris Evans, the province’s personable health minister, soothingly told reporters at the end of the symposium that Albertans—and Canadians—had nothing to fear from the deliberations. But even Evans couldn’t resist taking a dig at Dosanjh, noting that Quebec had far more private health clinics than Alberta and wondering aloud why the federal Liberals never wanted to talk about that. It’s a funny country, isn’t it? 171
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