Robert Winston: Expand private health care in Canada? No! says specialist who moved from U.S. to Canada
Credit to Author: Hardip Johal| Date: Sat, 07 Dec 2019 02:00:58 +0000
There is a B.C. Supreme Court case in Vancouver that will have an impact on universal single-payer health care in Canada. It is presented as an argument to allow a private clinic to fast-track patients and double bill — the clinic would bill the public system and also bill the patient. The case is deceptively framed by the private clinic as a “fight for civil rights.” By embracing the precepts of “self interest” and rejecting altruism, this Ayn Rand-ian approach is not appropriate for a healthcare system where the active word is “care”.
As a medical oncologist who moved to Canada after 10 years of practicing in the United States, I see the threat of this case.
While practising in one of the most “generous” states in the U.S. in terms of healthcare coverage, I saw patients: a) experience disruption of families, 2) lose homes, 3) enter bankruptcy, 4) refuse care and make countless other family sacrifices due to the financial burdens of cancer care.
I also saw a healthcare system in action that excludes 8.5 per cent of the population — more than 25 million people. An example of the impact of this lack of coverage was a young patient who I saw after she was diagnosed with metastatic malignancy. She had approximately six months of worrisome symptoms, but as she was uninsured and had modest income she delayed getting a medical opinion. She received palliative chemotherapy locally and was referred to a Mayo Clinic. She died approximately 12 months after diagnosis after receiving extensive treatment.
As a long-time member of the U.S. group Physicians for National Health Care, which is struggling for universal single-payer healthcare, I saw that practice in a universal single-payer system required a move to Canada. Earlier in my career, as a physician practising in the U.S. Indian Health Service, I had had a taste of the efficiency and humanity of a universal single-payer system.
After moving to Canada I saw that the unbelievable stress of a cancer diagnosis and treatment was not compounded by economic stress as it had been in the U.S. Increasing stress has a known negative impact on healthcare outcomes. I am currently helping a relative begin treatment for metastatic breast cancer in the U.S. and I am revisiting the impact of the focus on profit: degrading health care quality, including unnecessary and invasive procedures, excessive duration of treatment (against available peer-reviewed data) and exorbitant costs of medications.
For my relative, the time course from an abnormal finding to treatment was not faster than I observed in my Canadian practice, maybe slower. The power of healthcare profit is undeniably massive and universally results in a decline in the quality and access to care and an increase in patient’s costs. This is documented repeatedly in the U.S., where 37.5 per cent of Americans were under- or un insured in 2018, and is responsible for tens of thousands of deaths as noted by an Institute of Medicine study reported in 2002 and confirmed by a comprehensive literature review in 2017.
The economics of a public versus a private healthcare system is starkly illustrated by 2015 Canadian Institute of Health Information, which noted that the U.S. government spends $5,838 per person and private U.S. spending is $6,077. The Canadian government spends $4,047 per person while citizens spend $1,734 each. All Canadians have health care coverage and 25 million U.S. citizens have no healthcare coverage. An example of “civil rights” seen in the private system per the Canadian private clinic owners. I am not sure the term “civil rights” is accurate but rather should be expressed as “wealth privilege.”
Healthcare access and quality can be improved in Canada by providing national pharmacare, dental care and optician care but not by increasing profits of private insurance companies and private providers, which would increase costs and is guaranteed to reduce access and quality of health care. With a notable exception — the U.S. — concern about the well being of all is expressed by all developed countries in providing universal access to quality health care. Don’t allow this concern for our neighbours be trumped by the greed of providers and the financial power of insurance and Pharma lobbyists that seek to affect legislation in order to maximize profits now and in the future.
Dr. Robert Winston is a retired medical oncologist.