For-profit medicare a threat to system

  • October 30, 2008
{mosimage}TORONTO - Canadian Medical Association president Dr. Robert Ouellet says he wants the private sector to take the pressure off medicare in Canada by running a parallel system of private clinics, but bioethicists and many doctors think the CMA president is blind to the science of public-versus-private health care.

Ouellet announced Oct. 21 he was leading a delegation to the United Kingdom, Denmark and other European countries to investigate how public and private health care exists side by side in those countries.
“We need to have a frank discussion about the current, unacceptable state of the health care system in Canada,” Ouellet told the Canadian Club in Toronto. “The Canadian health care system is sick. The patient will only get worse if urgent and aggressive treatment is delayed.”

Comparing two systems

Catholic Register Staff

While Canadian Medical Association president Dr. Robert Ouellet was on his way to investigate the European path to a mixed private-public health care system, the Canadian Medical Association Journal published an analysis of the differences between Canada's publicly funded system and the private, for-profit system in the United States.

In Dr. Marcia Angell's analysis published Oct. 6 on, the U.S. private system comes out a distant second. Total health care spending per capita in the United States is twice as high as in Canada while American life expectancy, infant mortality and deaths under the age of 75 which could have been prevented by treatment are all worse.

Angell found that:

  • In 2005 Canadians spent a total of $3,326 per person on health care, compared with $6,697 in the United States;

  • Government spending per capita in 2005 was $2,322 in Canada, compared with $4,048 in the United States;

  • Canadian life expectancy is 80.2 years, while American life expectancy is 77.8;

  • For every 1,000 live births in 2004 5.3 died in Canada, compared with 6.8 in the United States;

  • In 2002-2003 77 of every 100,000 deaths under the age of 75 in Canada were from diseases amenable to treatment, but in the United States the number rises to 110 per 100,000;

  • In 2003 Canadians averaged 6.1 visits to the doctor, compared with an average of 3.9 visits for Americans in 2002;

  • Canada has more acute care hospital beds at three for every 1,000 people, compared to 2.8 per thousand in the United States;

  • Americans have more doctors available to them than Canadians with 2.4 for every 1,000 people, compared with 2.2 doctors for every 1,000 Canadians;

  • Canadians have more nurses with 9.9 nurses for every 1,000 people, compared with 7.9 for every 1,000 Americans;

  • Americans have far more magnetic resonance imaging machines with 26.6 machines for every one million people, compared with 5.5 for every one million Canadians.
Two weeks prior to Ouellet’s prescription of more private health care for Canada, the CMA’s online journal published an analysis which showed private health care in the United States delivered worse care for twice as much money.

“The U.S. is the only country in the world with a health care system based on avoiding sick people,” said Dr. Marcia Angell in her Oct. 6 paper on privatizing health care.

Relying on private insurance means depending on private companies whose profits are based on denying medical treatment whenever possible, Angell said.

“There are not enough health care workers to staff a dual stream without further depleting the public system,” Dr. Claudette Chase told The Catholic Register.

No matter how you cut it, more private delivery of health services will translate into two-tier health care, said the family doctor from Sioux Lookout, Ont., who is also a member of Canadian Doctors for Medicare. She rejects Ouellet’s argument that Canada can have a mixed private-public system that is significantly different from the system in the United States.

“People keep saying, ‘Of course we don’t want the American model,’ but that’s the country we’re closest to. That’s the country we have the NAFTA free trade with. That’s the country that has the insurance companies currently taking us to court because they don’t have access,” the American-born Chase said. “They’re hovering at the border, oozing over the border, and there is really very little will from the federal government, which is where it needs to come from, to put a stop to it.”

In accepting a lifetime achievement award from the Canadian Bioethics Society, pediatrician and Dalhousie University bioethics professor Sr. Nuala Kenny ripped the federal government for ignoring the dangers of mixing private and public medicine.

“I’m appalled that no one is paying attention to the ethical issues related to privatization in health care,” Kenny told the Canadian Bioethics Society in June. “We are witnessing intentional neglect on the part of the federal government. At the same time, almost every province in Canada has established a goal of increasing the role of the private, for-profit sector in the delivery of medical care. The key point is universal access to care. A vision of such care is threatened today.”

Catholic Health Association of Canada president James Roche doesn’t think Canada can have it both ways. You can’t can’t have private clinics skimming off the easy cases, the wealthiest patients and a percentage of the doctors and nurses and still have universal, equitable access, he said.

“You won’t hear talk about two-tier health care, but you do hear talk — increasing talk — about a parallel private system, which seems to be somehow more palatable,” Roche said. “But I think its implications and outcomes would be the same.”

Academic studies of mixed private-public systems show that the private clinics exist at the expense of public health care, said Roche.

“You create incentives for doctors then to maintain actually long waiting lists in the public system in order to make the doctors’ private practice more attractive,” he said. “A parallel system and increased private insurance would lead us to a situation that would lead inevitably to a mediocre public system available to the larger part of the population and a superior private system which people could access if they have the dollars.”

Since the Romanow Commission delivered its final report in December 2002, recommending a stronger role for the federal government in overseeing health care, Ottawa has in fact backed away from either enforcing the Canada Health Act or leading the way on health policy, said Roche.

“I’ve seen a shift in terms of where advocacy has to take place,” he said. “Because of the federal government pulling away from responsibility, from a leadership role, many of the decisions that shape health care policy are being made at the provincial level.”

British health care researcher Prof. Sally Ruane of De Montfort University in Leicester, England, believes Ouellet will probably hear what he wants to hear on his visit to the United Kingdom.

“I suspect the team coming over is likely to talk mainly to those who fall within what I call the dominant paradigm,” Ruane wrote The Catholic Register in an e-mail.

Ruane accuses the Labour government of creating lucrative business opportunities for private consulting firms and companies that run for-profit clinics while closing down community hospitals.

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