Bishop's Blog

"Ralph's Third Way"

There has been so much talk for so long with so few specifics about the so-called "Third Way" that I was beginning to expect something draconian in terms of controlling costs.

Perhaps a series of new policies were going to be announced that encompassed items such as:

  1. All first-time moms are asked to volunteer to help out on the Pediatrics floor - not only will this reduce hospital costs, but it will give you a much needed experience and a dose of reality after ogling over your own precious sleeping bundle of joy.
  2. Housekeeping and physical therapy are being combined. Mops will be issued to those patients who are ambulatory, thus providing range-of-motion exercises as well as a clean environment. Family members and friends of patients and ambulatory patients may also sign up to clean public areas to receive special discounts on their final bills. Time cards will be provided.
  3. Physicians will be informed that they may order no more than two x-rays per patient stay. This is due to the turnaround time required by your local drug store photo lab. Two prints will be provided for the price of one, and physicians are being advised to clip coupons from the Sunday paper if they want extra sets. Major grocery store outlets will honour all competitors' coupons for one-hour processing in emergency situations, so if you come across coupons from other vendors, please clip them and send them to the Emergency Department.

Regrettably, the recently announced Alberta plan, entitled Health Policy Framework, is even worse than my imaginings.

It includes measures that would allow doctors to work in both the private and public health care systems at the same time, and permit patients to pay to have some procedures done more quickly (thereby avoiding wait times), thereby establishing two-tier health care in Canada.

This cannot help but lead to an elite or superior private system and a mediocre public system.

Even more amazing is the fact that there is no evidence that creating a parallel private system will deliver better or cheaper care, or improve access, except for those who can afford to pay for care out of their own pockets.

Indeed, evidence from other countries, such as New Zealand, Ireland, and Spain, shows that where doctors are allowed to work in both the public and private systems wait times have actually increased in the public system.

Much more significant, however, is that the arguments in favour of increasing the role of the market and of investor-owned institutions within the health care system are based primarily on a view that says that the physician-patient relationship is fundamentally an economic one, and that health care is like any other marketable commodity such as food, clothing, and shelter.

Of course, this view also assumes that the market is more efficient than the public domain, and that efficiency is attained through the promotion of the values of individual consumer choice and competition.

Many of us believe that there is a fundamental difference between the provision of medical care and the distribution of products and commodities.

Health care has as its essential purpose a non-economic goal, i.e. the advancement of human dignity. Canadians have long recognized that non-economic ends of the family, education, and social services are essential to the advancement of human dignity and the common good. As a matter of citizenship all should have equal access to quality care.

It is highly ironic that in December 2005 it was trumpeted to all Canadians that an Alberta pilot project had reduced the wait times for hip and knee surgeries to a fraction of the average wait times. Patients who normally would have waited an average of 47 weeks for an orthopaedic consultation were treated in under five weeks. In Edmonton and Red Deer these dramatic wait time reductions were achieved in public hospitals, illustrating that such innovation is possible within the public delivery system.

How soon we forget.

In 2002, the Senate study of the health care system, headed by Senator Michael Kirby, reported that inappropriate prescribing and inappropriate prescription drug use is costing the health care system billions of dollars. Why don't we tackle these problems?

The important goals of managing health care costs and reducing wait times can be achieved through innovation and greater accountability within existing publicly funded, not-for profit delivery systems.

The so called "Third Way" is a dead end.

What we really need is a "Fourth Way" founded on the principles of universality (all are entitled), portability (coverage maintained in the case of a move or travel within Canada), comprehensiveness (all necessary services), accessibility (reasonable access unimpeded by financial or other barriers) and public administration (carried out on a non-profit basis by a public authority). All of which serve the common good and recognize that health care is a public good in which the few must not profit at the expense of the many.

We could even call it the Canada Health Act! Are you listening Ralph?

☩ Frederick Henry
Bishop Emeritus

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