In attempting to understand the complexity of Medicare issues, the data reveals that many of the beliefs about health care “out there” are myths and are not based on facts.
It’s a myth that private for-profit health care results in better quality health care. A 1999 study in the Journal of the American Medical Association concluded that for-profit US health maintenance organizations (HMOs) rated lower than not for-profit HMOs on all 14 quality indicators by the National Committee for Quality Assurance.
It is also a myth that for-profit hospitals and services are cheaper and more efficient than public ones. The New England Journal of Medicine concludes that in decades of research no peer-reviewed study has found that for-profit hospitals are less expensive. For-profit hospitals cost more to operate and spend far more on administration.
Nevertheless, we have lots of problems to fix:
In the Mazankowski Report, the first reform is to stay healthy. It goes on to recommend that appropriate financial assistance be available to support children living in poverty and low income homes. I can’t wait to see how the government handles that one! Are we going to have legislation and new programs that deal with affordable housing, social assistance, a higher minimum wage, and attempts to reduce the gap between the rich and the poor?
The second recommendation is “it’s time to put customer’s first.” Such terminology smacks of a market driven approach to health care. The commodification of care, commercialization of medicine, and the marketing of services and products mean that cutbacks, downsizing and the withdrawal of services will in all likelihood assume centre stage.
However, health care is not just another commodity but a public good and a fundamental right. Medicine and nursing must not be diverted from their primary tasks—the relief of suffering, the prevention and treatment of illness and the promotion of health. Potential financial incentives that reward over-care or under-care, weakening the doctor-patient bonds, should to be prohibited.
There is also a specific recommendation that all Albertans have guaranteed access to selected health ser-vices within 90 days of a diagnosis and recommendation by their physician. Good news, but the operative word is “selected.” We’ll have to wait for a definition.
I can’t quarrel with the implementation of effective ways of reducing waiting lists including centralized booking and posting waiting times for selected procedures. Furthermore, if the goal is integrated health services, it is essential to have integrated health information technology systems.
Nevertheless, the second recommendation sets the stage for the fifth recommendation: reconfigure the health system and encourage more choice, more competition, and more accountability.
Instead of a market paradigm, we need to advocate for a new paradigm reflecting a value framework that promotes a common citizenship, human dignity, community, solidarity and democracy.
And, of course, the sixth recommendation is to diversify the revenue stream. Instead of rationing health services we need to find better ways of paying for the services Albertans want.
However, the idea of a health care debit card and medical savings accounts are non-starters. In the health care domain we are not customers. The suggestion of user fees unfairly targets and penalizes the sick and vulnerable. Raising the tax on tobacco is, of course, a “sin tax” (this one is rather hard for me to oppose). The hiking of health care premiums would be nothing more than another regressive form of taxation. I must have dreamt it but I thought that the only way taxes were going in Alberta was down—as a matter of fact, wasn’t that a promise?
The Romanow Commission’s Interim Report contextualizes the discussion within the moral and ethical fibre of Canada; the Mazankowski Report doesn’t.
The Canada Health Act enunciates 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.
The Romanow Interim Report addresses the following themes: values and how they shape Canadians’ views; funding and fiscal responsibility; quality and access; leadership, collaboration and responsibility. It presents an update on what the Commission has learned in nine months of fact-finding, as well as preliminary observations and questions that need answering. It’s refreshing to hear that now he wants to hear from Canadians.
We have a lot of problems to fix but we would do well to heed the oft quoted 1982 prophetic words of Tommy Douglas: “There are two parts to medicare ... to remove the financial barrier between those who need health care and those who provide it ...The second step that you will have to take down the road will be to establish a new type of delivery system in the health field ...The ultimate goal of medicare must be the task of keeping people well rather than just patching them up when they are sick. That means clinics. That means making the hospitals available for active treatment cases only, getting chronic patients out into homes, carrying on home nursing care programs which are much cheaper, and having denticare programs, pharmacare programs ... All these programs should be designed to keep people well ... programs of this kind can be organized under medicare and that we have the obligation to go out and arouse the people of our respective communities to see that a program of prevention is instituted which in the long run is not only less painful but also less costly than the medical system which we have at the present time.”
☩ Frederick Henry