Jack Layton's Deal
I am personally glad that Jack Layton didn't succeed at getting the Liberals to support his health care ideas. His view on health care is a dogmatic one that public is good and private is bad. In reality, health care is a very complex subject that should never be approached from a purely ideological point of view. Neither a public monopoly on health care or a pure private system is desirable, rather we should be discussing what is the right mix between the private and public health care. The major component of the proposal is to prevent double-dipping i.e. working in both the private and public systems. Contrary to popular opinion, it is not illegal to work in the private system, so long as the doctor works exclusively in the private system. Every province with the exception of Newfoundland & Labrador has passed various pieces of legislation, which don't outlaw private health care, but make it unprofitable. 6 out of 10 provinces prohibit individuals from buying private health insurance for covered procedures, which no other country besides North Korea and Cuba prohibit. All provinces already making working in both systems illegal. This is not unique to Canada since other countries such as Sweden, Italy, and Greece have placed similar bans, while other countries such as Britain limit the amount of time a doctor may spend in the private system. Manitoba, Ontario, and Nova Scotia ban doctors in the private system from charging more than what they would bill the government in the public system. This type of restriction also exists in some countries such as Sweden and Netherlands, but not in others such as Germany, Britain, and Australia. Despite the fact it is possible to work in the private system, almost no doctors outside of Quebec have chosen to work in the private system, while none of the major health insurance companies will provide private health insurance for covered procedures, even if one lives in the four provinces where it is permitted.
Instead of the usual rhetoric of claiming that allowing any private health care will destroy public health care or that if we allow any private elements, we will end up with an American style system; we should instead look at examples of other industrialized countries that have universal public health care systems, but allow competition from the private sector. There is no one model, but countries such as Sweden, Germany, Netherlands, Britain, France, Switzerland, Japan, and Australia show that it is possible for the two systems to co-exist without destroying the public system. Although each country has its own uniqueness, the two primary models that should be examined is a parallel private system as exists in Britain vs. a social insurance scheme as exists in the Netherlands. Under a parallel private system, everybody would be required to pay taxes to support the public system and no one would be denied treatment due to inability to pay. However, those who wished to purchase private health insurance for covered procedures could do so. Under a social insurance scheme, health care would be funded through payroll taxes rather than general taxation. Individuals making above a certain income could opt out of the public plan and instead use private health insurance, however individuals on the public plan would be prohibited from buying private health insurance. We should also consider introducing a small user fee or co-payments, while allowing as France does and Britain does for prescription drugs, those making below a certain income to be exempt from co-payments. One has to pay to use an ambulance and this has not deterred low-income individuals from refusing to call for an ambulance when an emergency occurs, so why would it deter them from going to a doctor.
These changes would require making changes to provincial legislation as well as the Canada Health Act. I don't support the Harris-Manning recommendation of getting the federal government out of health care entirely since I believe all provinces, whether wealthy like Alberta or poorer ones like Newfoundland & Labrador should be entitled to the same level of health care. Instead the Canada Health Act needs to be amended. The Public administration principle should be scrapped altogether, portability should only apply within Canada as Romanow recommended, comprehensiveness should only apply to primary care in a hospital and doctor visits, while the ban on user fees should be replaced with a $10 limit to user fees. This would mean every additional dollar raised above the $10 limit would be docked from provinces who violate this. Doctors should be permitted to work in both systems so long as any doctor working in the public system who works also in the private system only works in the private system for additional income on top up what they would make in the public system; not to supplement their income they would make in the public system. Doctors working in both systems should also be prohibited from advertising in their office of their work in the private system or referring their patients in the public system to their work in the private system. Health Care is a complicated topic that cannot be discussed in ten second soundbites. It is necessary to have a thorough debate on the issue rather than political posturing.
Instead of the usual rhetoric of claiming that allowing any private health care will destroy public health care or that if we allow any private elements, we will end up with an American style system; we should instead look at examples of other industrialized countries that have universal public health care systems, but allow competition from the private sector. There is no one model, but countries such as Sweden, Germany, Netherlands, Britain, France, Switzerland, Japan, and Australia show that it is possible for the two systems to co-exist without destroying the public system. Although each country has its own uniqueness, the two primary models that should be examined is a parallel private system as exists in Britain vs. a social insurance scheme as exists in the Netherlands. Under a parallel private system, everybody would be required to pay taxes to support the public system and no one would be denied treatment due to inability to pay. However, those who wished to purchase private health insurance for covered procedures could do so. Under a social insurance scheme, health care would be funded through payroll taxes rather than general taxation. Individuals making above a certain income could opt out of the public plan and instead use private health insurance, however individuals on the public plan would be prohibited from buying private health insurance. We should also consider introducing a small user fee or co-payments, while allowing as France does and Britain does for prescription drugs, those making below a certain income to be exempt from co-payments. One has to pay to use an ambulance and this has not deterred low-income individuals from refusing to call for an ambulance when an emergency occurs, so why would it deter them from going to a doctor.
These changes would require making changes to provincial legislation as well as the Canada Health Act. I don't support the Harris-Manning recommendation of getting the federal government out of health care entirely since I believe all provinces, whether wealthy like Alberta or poorer ones like Newfoundland & Labrador should be entitled to the same level of health care. Instead the Canada Health Act needs to be amended. The Public administration principle should be scrapped altogether, portability should only apply within Canada as Romanow recommended, comprehensiveness should only apply to primary care in a hospital and doctor visits, while the ban on user fees should be replaced with a $10 limit to user fees. This would mean every additional dollar raised above the $10 limit would be docked from provinces who violate this. Doctors should be permitted to work in both systems so long as any doctor working in the public system who works also in the private system only works in the private system for additional income on top up what they would make in the public system; not to supplement their income they would make in the public system. Doctors working in both systems should also be prohibited from advertising in their office of their work in the private system or referring their patients in the public system to their work in the private system. Health Care is a complicated topic that cannot be discussed in ten second soundbites. It is necessary to have a thorough debate on the issue rather than political posturing.
posted by Monkey Loves to Fight at 5:39 PM
1 Comments:
I think the problem with your solution is you still have a government monopoly, which generally doesn't works. While I agree Britain's health care has its problems, Britain like Canada has no user fees, it is one of the most centralized health systems in the world and also the NHS is responsible for both the funding and delivery. Countries such as Sweden, France, Netherlands, and Germany have parallel private systems and all of them have shorter waiting times if any at all. The problem with the UK is doctors who work in both systems can refer patients from the public to the private one that is why I suggested they be prohibited from making referrals and advertising so there is no incentive to create longer line-ups to increase their profits in the private sector. Also your argument that all good doctors will go to the private system can be prevented by requiring doctors by law to work so many hours in the public system before they can go to the private system as is the case in Britain and Australia. In fact as it is now, it is legal for doctors in Canada to work in the private system, they just cannot work in both, yet we haven't seen a mass exodus of doctors heading for the private system. In fact fewer than 150 doctors nationally (90 being from Quebec) have opted out of medicare. In my home province of British Columbia only two doctors in the whole province have opted out while only one has in Alberta and zero have in Saskatchewan.
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