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Advancing a cure for Canadian health care woes
By Steven Martinovich
The stated goal behind Better Medicine: Reforming Canadian Health Care, essentially exploring ways to reform Canada's battered health care system, is an impressive one when you consider the scale of the problem. The health care system is Canada's untouchable third rail with the mere mention of anything other than increased government funding as a solution bringing vitriolic criticism upon the unfortunate person brave enough to do so. Better Medicine's strength, as well as its weakness, is that most of the authors who have contributed an essay have a solution in mind.
It's called the medical savings account, a device that editor and contributor Dr. David Gratzer compares to an RRSP, something most Canadians should be familiar with. Although there are various types of MSAs, at its simplest it is a system that sees taxpayers pay for their health care out of a special account made up of tax-free contributions or is government funded until costs reach a certain point. After that, catastrophic insurance takes over. Money left over at the end of the fiscal year could be used for an individual's personal use or for services that are not covered by the public health care system.
Gratzer, as do most of the other contributors, place a lot of faith in MSAs. Regardless of what aspect of health care they are discussing, few fail to include at least a passing mention of MSAs and their promise to inject competition into the health care system, reduce costs and give system users increased choice. If you happen to be a partisan of MSAs, it's music to your ears. If your mind has yet to be made up, you might find the blatant lobbying damages the credibility of the other arguments the authors make.
That would be unfortunate because the essays that Gratzer put together for Better Medicine are an impressive collection that cover everything from the history of health care in Canada to comparisons of health care systems among industrialized nations. Although each repeatedly makes the case that patients are waiting longer, costs are rising quickly and quality may be declining, Better Medicine is not a repetitive exercise. Rather, the essays overlap and strengthen each other, building an impressive case for desperately needed change.
Better Medicine opens with an eye-opening essay by Michael Bliss on the history of health care in Canada. Although Canadians tend believe public health care has long been a part of our lives, Bliss points out that the health care system we are familiar with was an invention of the late 1960s. In fact, Bliss points out, the fathers of Confederation never even considered health care as a priority. Only the explosion of government after the Second World War and a desire to differentiate ourselves from the United States prompted the creation of the public health care system.
From there Better Medicine moves on to vignettes from the front lines, an exploration by Margaret Wente into the pressures faced by health care professionals, to former president of the Ontario Medical Association Dr. William Orovan's belief that more private sector involvement is needed. Other stars among the essays include David Henderson's smashing of myths concerning the American health care system and David Baxter's sobering demographic analysis of the present and future overwhelming pressures the system will face.
Not surprisingly, the essays lead into a final one by Gratzer himself on the need for medical savings accounts. As Gratzer points out, MSAs are in use in countries like Singapore - which scores better results at a cheaper price - and South Africa and is being tested in the United States. Gratzer carefully lays out several implementation options and makes the case that both sides of the ideological fence should have little difficulty in supporting the concept of MSAs.
Although Better Medicine does a fine job overall of presenting its case for health care reform, it does suffer the ill that most collections of disparate essays do. Although it doesn't intend on serving as a manifesto written from a single viewpoint, it still nonetheless jarring to read different essays in the same book that start out from the same place yet interpret the same facts in strikingly different ways.
Despite that, Better Medicine is an impressive addition to the debate over Canada's health care system. Although few politicians would admit it and the public is reticent to consider it, it is clear that massive changes are necessary to stave off the eventual collapse of the public health care system. In a sense the system is a lot like a deep-sea diver. In shallow water there's little danger but as the diver gets deeper the pressure builds until finally an implosion occurs. Competing pressures of an aging population, tax fatigue and rising costs are combining to crush the system. The prescriptions contained in Better Medicine are at least worth considering.
Steven Martinovich is a freelance writer in Sudbury, Ontario.
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