Too much rhetoric in health-care debate

In the ongoing health-care debate, the claim is made that private financing and provision of medical and hospital services would harm services publicly insured by medicare. This claim is often put forward by public health-care unions, hospital associations and individual supporters of a government health-insurance monopoly.

While there is no convincing evidence for this claim, there is plenty of propaganda and political rhetoric. This is because of the lopsided financial and political power bases that have developed around Canada’s public health-insurance monopolies and single-payer health-care systems. The debate is highly politicized by its very nature, because virtually all medical and hospital services are financially controlled and reimbursed by governments. Special-interest groups lobby politicians, hoping to influence their health-care decisions. While these groups claim to be advocates of patients’ medical welfare, they should not presume that they are also representing their patients’ political and economic interests.

Opponents of parallel private health insurance and private health care raise the following arguments:

• If Canadians were permitted to buy alternative private health insurance and health-care services in a parallel private system, those who did would stop lobbying politicians to preserve the standards of quality, access and funding in the public system.

The facts of the matter tell a different story. These standards of quality, access and funding have steadily declined in Canada under the present public health monopoly arrangement, without a private parallel alternative. Furthermore, in European countries where parallel private and public health systems have existed for more than a century, and where they have a level of public funding similar to Canada’s, they have maintained health services of high quality and ready access without waiting lists. In fact, their public funding is often higher than in Canada and patients have freedom to choose public or private services or both. What is a public-vs.-private issue for Canadians is a non-issue for Europeans.

• If all Canadians were permitted to buy alternative private medical and hospital insurance and services in addition to their universal publicly funded health insurance (medicare), a large but diminishing number would see this as a threat to “Canadian values.” These values include “equity or fairness,” meaning equal access to only one tier of public health services and prohibition of private alternatives; “social solidarity,” by which all taxpayers must pay for public health insurance whether they use it or not; and “social justice,” as in the Marxist doctrine of income distribution – from some according to their means, to others according to their needs or merit.

According to the OECD, as long as universal access to publicly financed basic health services is present, equity exists, regardless of the presence of private alternative health services.

Not content with this OECD standard of equity, supporters of the above argument prefer the Marxist notions of class struggle, distributive or social justice and the envy-based prescription of egalitarianism. They call for progressively unequal rates of taxation and compulsory redistribution of individual earnings to finance government-run health-insurance monopolies and single-buyer health-service systems. The result is a forced equalization of all Canadians in a single mass of health-service mediocrity, rather than striving to use scarce public resources to optimize the level of care and outcomes for those who need assistance.

In order to achieve this egalitarian ideal in Canada’s health-care sector, it is necessary to treat equal individuals unequally under the law, to infringe upon their personal freedom and property and move toward totalitarian governance in health matters. These are hardly the characteristics of a free and democratic society founded on the principle of the rule of law where life, liberty and security are protected by a constitution. And yet this has already happened in Canada’s health system under current federal and provincial legislation.

• If we allow greater private-sector involvement, it would attract the best physicians and nurses to the more attractive private sector and leave the public sector short handed and with inferior staff. As noted above, this claim is contrary to experience in most European countries where parallel public and private health systems have operated side by side for more than a century. Instead of a physician shortage, they have a surplus in both sectors. Waiting lists are virtually unknown, and the World Health Organization rates their health-system performance as being higher than Canada’s.

Finally, the arguments that Canadian medicare would be harmed or destroyed by the introduction of a voluntary parallel system of alternative private health insurance and health-care services are speculative and not supported by evidence.

J. Edwin Coffey MD is an associate researcher with the MEI and co-author of Universal Private Choice: Medicare Plus, A Concept of Health Care with Quality, Access and Choice for All Canadians.