Ian Mulgrew: Coverage not denial needed in Medicare crisis
Credit to Author: Ian Mulgrew| Date: Thu, 23 Jan 2020 23:56:21 +0000
Medicare is in crisis across Canada while governments fiddle and insist there is no place for private insurance to cover medically necessary care.
A new report by the Fraser Institute says the de facto ban looks like folly since we are alone among 17 countries — including Australia, Germany, Switzerland and the Netherlands — who provide universal health-care.
Canada has the longest wait times, ranking in 2016 in last place for the percentage of patients who waited four weeks or longer to see a specialist, last for the percentage of patients who waited four weeks or longer to get treatment, and last for the percentage of patients who waited four or more hours in emergency departments.
Written by Steven Globerman, the 46-page study by the conservative think tank says eliminating the prohibition could shorten health care queues and encourage cost-efficient innovations.
“The idea of using private insurance to cover some or all health-care costs — instead of taxpayers paying for it — has been pilloried in Canada for many years, but it’s a common feature of other universal health-care systems around the world,” said the resident scholar and Addington Chair in Measurement, professor emeritus, Western Washington University.
Trouble is, Medicare in this country is a patchwork quilt — there are a baker’s dozen jurisdictions and medical systems.
As a result, you should get private insurance for travel within Canada so you don’t wake up in a hospital in another province or territory owing a small fortune for an ambulance trip or other service for which you aren’t covered.
At the marathon B.C. Medicare constitutional trial, which includes a challenge to the province’s ban on private insurance, it was evident both levels of government would rather Canadians remained in the dark, mistakenly believing they have the best health care system in the world.
The most cogent expert opinion and the data presented during more than three years of evidence, however, indicated the situation instead is dire, and this latest study echoes that view.
Titled Understanding Universal Health Care Reform Options: Private Insurance, the report released Tuesday underscores Canada’s laggard performance compared with other developed countries providing universal health care:
In 2016, no one in Germany waited four months for elective surgery, but nearly one in five Canadians did; only one in a hundred waited more than an hour in a French emergency room, while 29 in 100 Canadians sat around waiting to be seen; in the Netherlands, 77 per cent of patients got a same-day appointment, only 44 per cent of Canadians did. Even Americans do better than us.
In the 2000s, the Supreme Court of Canada wrestled with the issue of private insurance in a Quebec case known as Chaoulli.
The majority held that a ban on private insurance was unconstitutional given pernicious waiting times in the public system. For all the government hand-wringing, however, the decision did not result in significant change.
Regulation minimized the procedures private insurance could cover — hip and knee replacement and cataract surgery (those with the longest queues), who may provide the surgeries and where they may be provided.
Quebec Medicare endures.
Other nations allow two options: full coverage of all medically necessary services or supplementary coverage that facilitates faster access to medical procedures and treatments, a wider selection of providers and amenities such as private rooms.
There is little legal scope or opportunity in Canada for either.
Without any evidence, both senior levels of government insist allowing such private insurance will reduce public access to health care or let the well-heeled obtain “better” care.
The official fearmongering includes predicting the very death of Medicare.
No developed country has experienced such a catastrophe by providing private insurance.
And the rich in Canada can already get quicker, perhaps even “better” care, anytime with a cheap flight to the U.S.
As the evidence from Europe indicated, Globerman maintained a private health insurance market might reduce wait times for most if not all services.
In this regard, he noted the poor would enjoy improved access notwithstanding that their access would not be identical to that enjoyed by wealthier Canadians.
Interestingly, Globerman believed that the most significant benefit flowing from private insurance could be innovation.
His research indicated models like Canada’s often limit or restrict access to innovative medical treatment in the interest of short-term cost savings, while private insurers have stronger incentives to embrace innovations that may increase short-term costs but ultimately save money by improving long-term health outcomes.
Globerman added “a systematic reevaluation of allowing access to private health insurance for basic services seems appropriate, especially in light of theory and evidence that argues, on balance, that doing so would have net social benefits.”
But I’m sure his report will be dismissed by government and vested interests as right-wing propaganda.
Better to stick with the current three monkeys’ approach — hear, see and brook no discussion about Medicare’s ailments and potential cures.