By Dorothy Dobbie
Governments cannot fix healthcare!
Unfortunately, we are stuck with a 1950s model in a 2020s world. As an NDP friend of mine, former MP Lynn McDonald, recently pointed out to someone, a lot has changed since the universal program was started. Yet, the government and that same NDP under Jagmeet Singh insist that nothing in the way the plan is administered should be changed. But changes have occurred and they have not improved the situation.
It started out as hospital and diagnostic insurance in Saskatchewan in 1947. The program was adopted in a federal/provincial 50:50 cost share program in 1957. In 1962, Saskatchewan expanded its program to cover doctors’ services, which was added to the federal/provincial agreement in 1966.
The most profound change to the Act was introduced and passed by the Pierre Elliot Trudeau government. According to the Canada health website, “In 1984, federal legislation, the Canada Health Act, was passed. This legislation replaced the federal hospital and medical insurance acts, and consolidated their principles by establishing criteria on portability, accessibility, universality, comprehensiveness, and public administration. The Act also added provisions that prohibited extra billing and user fees for insured services”. This, to my mind, was the beginning of the end to a sensible, usable system. Suddenly it had become a monopoly and as we all know, monopolies mean an end to service, cost competitiveness and efficiency.
Early on in this province, everyone had to pay a small fee to access a doctor. This was a sensible policy that kept abuse under control. The ability to opt out of the program meant that there was more room in the public system to accommodate those who had the most need. It also meant competition for service providers.
That has disappeared as successive governments have tinkered over and over again with the rules, making the system more unwieldy and less responsive each time around.
Today, the system is thoroughly broken, and its foundations are crumbling. Six out of 10 provinces now allow physicians to opt out of the program and bill for their services separately. Private clinics are springing up everywhere offering diagnostic as well as treatment for a wide range of services not specifically covered under the Act. This will continue to grow as demand expands due to the inability of the public system to effectively respond.
Will the remnants of the system survive? Perhaps, but only if internal changes are made. I am not very hopeful that this is possible. The system survives to perpetuate the system.
The best possibility is to open competition and allow a public/private system to co-exist where patients can pay for services at will but where the public system still exists to service those who need but cannot afford care.
This the dual system is the case in the best health care models all around the world. And single payer systems are not part of that winning equation because they are expensive and lack the ability to nurture excellence through competition.
Governments can’t fix healthcare. All they can and should do is get the heck out of the way!