Money not the answer

Ottawa promised $69 billion more for the health-care system during the last 5 years, yet the system is still in crisis, indicating more creative solutions must be found.

During the recent federal election campaign, Prime Minister Paul Martin promised to pump an additional $9 billion into Canada’s ailing health-care system. Now that he has invited the provincial and territorial leaders to sit down with him in two weeks to discuss the future of health care, there is genuine reason for optimism.

Or is there?

Before we get too carried away by what seems like a renewed commitment to health care on the part of our politicians, let us review just a sampling of recent announcements on the subject, many of which have been accompanied by grandiose financial promises:

Feb. 16, 1999: In its 1999 federal budget, Jean Chretien’s Liberal government promised to commit an additional $11.5 billion over five years to improve Canada’s health-care system, including an immediate, one-time supplement of $3.5 billion, which the provinces would be free to apply to meet their most pressing needs.

March 14, 2000: In presenting its 2000 provincial budget, Premier Bernard Landry’s government announced that an additional $2.7 billion would be directed toward improving Quebec’s health-care system.

September 2000: At the conclusion of a first minister’s meeting, the Chretien government announced creation of a Health Action Plan, which included a promise of an additional $21.2 billion for health care. The bulk of that money – $18.9 billion – was to take the form of increased transfer payments to the provinces, to be paid out over five years. In addition, a special $1-billion fund was to be established to upgrade hospitals and their supply of diagnostic equipment. Another fund of $800 million was to be created to enhance front-line medical services and improve access to doctors and nurses.

March 29, 2001: As part of its 2001 provincial budget, the Landry government announced that an additional $1.3 billion would be invested in Quebec’s health and social-service sector. Presumably, health care was to be a major beneficiary.

Feb. 18, 2003: As part of its 2003 federal budget, the Chretien government announced it would invest an additional $34.8 billion in health care over the next five years. As the government proudly stated at the time: « This investment will improve the quality and accessibility of health-care services and ensure the sustainability of the No. 1 priority of Canadians today and in the future. »

March 23, 2004: The 2004 federal budget confirmed an additional $2 billion for the provinces and territories for health care, bringing to $36.8 billion the funding provided under the February 2003 First Ministers’ Accord on Health Care Renewal.

March 30, 2004: The Charest government announced an increase of $2.2 billion over two years for the health and social service sector. Yet here we are, on the eve of yet another first ministers’ conference on health care, and our health-care system is in no better shape than it was five years ago. Despite at least $69-billion worth of promises from the federal government, wait times for surgeries and other medical procedures are longer than ever before – almost 18 weeks on average and more than 32 weeks for some procedures, such as orthopedic surgery.

And Canadians are still denied access to the latest diagnostic equipment readily available in other developed nations. It is no wonder, then, that an increasing number of Canadians are choosing to travel abroad, often at steep expense, to obtain certain treatments?

Meanwhile, conditions in our hospitals are deteriorating. Witness, for instance, the difficulties in curbing the spread of the C. difficile outbreak, blamed in part on slashed housekeeping budgets and inadequate space to isolate infected patients. Perhaps most astonishing, 16 per cent of Canadians had difficulties finding a family doctor. Apparently, $69 billion doesn’t buy what it used to.

Indeed, a new survey conducted for the Montreal Economic Institute by Leger Marketing from Aug. 17 to 22 reveals that few Canadians still believe that medicare’s problems can really be solved simply with more public money.

And yet in the current debate, the position adopted by nearly every political party, by people in the health-care field and by many commentators is that the existing system can be maintained provided a few modifications are made to the way it is organized and a few billion extra dollars are injected. Disagreement lies mainly in the division of power and financing between levels of government.

And yet there is reason to wonder if the system in its current form is financially viable.

Canada remains one of the few countries in the world that maintains a public monopoly in health care and where it is impossible to obtain access to medically necessary care in the private sector. European countries such as France or Sweden have parallel private sectors, and their health-care systems work better than ours. So why won’t government let Canadians pay for speedier health care (through RRSPs or private insurance, for example)?

A separate Leger Marketing poll last May, also conducted for the MEI, showed that 51 per cent of Canadians, and more than two-thirds of Quebecers want the government to allow people wishing to obtain health care more quickly in the private sector to pay for it themselves. Citizens would have a stronger incentive to spend additional resources if their health is directly involved and if they have the impression they are getting better control over results, rather than sinking more of their tax dollars into an inefficient and uncontrollable system. This would also help take pressure off the public sector because new resources would be available.

Many avenues of reform can be envisaged, even within the framework of the Canada Health Act. It is time to get rid of the taboos that prevent us from seriously considering these alternatives.

Norma Kozhaya est économiste à l’Institut économique de Montréal.