Medicare's socialist weeds vs. capitalist wheat
By John Williamson
A Vancouver private health clinic that was prohibited in December from treating British Columbia residents by the provincial government has re-opened its doors to the public. The False Creek Urgent Care Centre will charge $199 for a basic medical evaluation and offer patients a menu of other services. It will operate outside the government-run medicare system and provide emergency care for people willing to pay for immediate service. Predictably, fee-for-service medicine prompted the usual howls of protest.
The False Creek owner, Dr. Mark Godley, skirted provincial law banning doctors or clinics from billing patients for services covered by medicare by adopting a business model from the unlikeliest of places -- Quebec. Elsewhere is Canada, "save medicare" activists insist patients sit in queues waiting -- and at times dying -- for hospital treatment. Yet Quebec offers its residents more private health care than any other province and for-profit facilities operate unmolested by health bureaucrats. Dr. Godley decided to import Quebec's common sense to Lotus land.
Copying the Quebec model and recruiting physicians from outside the province not enrolled in B.C.'s Medical Services Plan appears to have worked. (The clinic hired two doctors from Alberta and one from Manitoba.) Provincial Health Minister George Abbott believes the private clinic is operating within the law. Moreover, he says Ottawa is unlikely to act because similar clinics exist in Quebec. Federal Health Minister Tony Clement stated the obvious, "This model already is in existence in Canada" and does not violate the Canada Health Act.
Some opponents of timely medical access are worried doctors will opt out of the public system. Indeed, the loss of three doctors from Alberta and Manitoba is a gain for B.C. patients. Yet Canada's problem is not training doctors but retaining them after graduation.
A study published last week in the Canadian Medical Association Journal reports one in nine trained-in-Canada doctors is opting to practice medicine in the United States. (It is "only" one in 12 if U.S. students are excluded.) With 17 medical schools in Canada, the impact of this brain drain is like setting aside the graduates from two average-sized schools for employment in the U.S. The economics of Canada's strict command-and-control medical system is responsible for the exodus of talent and shortage of doctors.
Permitting more private care, choice and competition in Canada will result in more doctors working in Canada, not fewer. As in all other areas of the Canadian economy, some will opt to work in the public system and others in the private sector.
Yet for defenders of the status quo, socialist weeds still taste better than capitalist wheat (to paraphrase China's deceased Communist leader Mao Zedong). Liberal MP Hedy Fry, cannot grasp why any Canadian would spend their income to buy a health service. Responding to the re-opening of the Vancouver clinic, she wondered how the private clinic will survive when Canadians are "100% entitled to have medically required services paid for" and why "someone [would] pay for something that is covered by public insurance?" Dr. Fry has spent too much time in Ottawa and not enough with patients.
The answer is obvious to anyone willing to look. Government managed health care has resulted in long wait lines for basic medical services. Furthermore, many Canadians are simply unable to find a doctor. According to a 2004 report from Statistics Canada some 1.2 million Canadians cannot find a family doctor. So much for a 100% entitlement.
Fewer and fewer Canadians believe mandatory wait lines are superior to private alternatives. As such, they are increasingly open to private delivery within a publicly funded medicare system, and even a parallel system operating alongside medicare.
Increasingly, Canadians want competition within medicare to ensure their tax dollars are delivering health care results, ensuring good customer service and improved outcomes. Many also believe government has no business telling people they cannot spend their after-tax dollars on additional medical procedures. As a result, they are looking to Europe -- not America -- for solutions.
Compared to other developed nations, Canada tops the list in spending, has the most restrictions on private medicine, and ranks in the middle in terms of outcomes. Sweden, for example, spends less money, has more private involvement, and offers more services to its citizens. Name your developed country -- Germany, France, New Zealand, Japan, etc. -- and chances are very strong they provide better care to their citizens at a lower cost. What these nations have in common is mixing a public system and a private system to deliver superior results. This is what Canadian governments ought to be striving for. Happily for patients it is what Dr. Godley is working to achieve.
John Williamson is the federal director of the Canadian Taxpayers Federation.