Public Values

Outgoing CMA president pumps private health insurance and user fees for patients

Private approach would be to dismantle more than 60 years of progress - activists.

Pushing private health insurance and user fees a disservice for patients - Natalie Mehra.by Natalie Mehra and Mike McBane

In August, two leading health care activists responded to remarks in support of private health insurance and patient user fees made by the outgoing President of the Canadian Medical Association, Dr. Anne Doig.

As Canada's largest social program Medicare was set up to remove the financial barrier for access to care when people are in need. Founded upon principles of compassion and equity the Canada Health Act is a powerful statement of our collective right to care on equal terms and conditions that has endured for a quarter of a century.

It is a disservice to Canadians to advocate for private health insurance and user fees for patients. To adopt this approach would be to dismantle more than 60 years of progress towards creating a comprehensive health care system. As such, we are deeply disturbed by the public comments of outgoing Canadian Medical Association president Dr. Anne Doig this week. We know that her views are not representative of many in her profession nor of Canadians generally.

Despite regular propaganda to the contrary, Medicare is neither in crisis nor is it unsustainable. According to eminent health economist Dr. Robert Evans, since 1975, public health care has remained relatively stable at between 4 and 5% of GDP. Medicare spending comprises the same proportion of provincial revenues as it did 20 years ago. While public resources for Medicare have remained consistent, it is tax cuts that have been eating away public budgets. It is easy to look like a bigger fish when the pond keeps getting smaller.

It makes sense to pay for health care through a progressive tax system. It allows us to levy bulk buying power to contain costs, something that patients cannot do when they are left to their own devices in a private health care market. It means that as a society, we can redistribute income to provide care when we are most in need; when we are aging or sick and when we have the least ability to pay.

The public system has expanded in recent decades to provide millions of Canadians with access to new technologies for cancer treatment, diagnostics, and dramatic increases in surgeries. But it has also contracted. Cuts to chronic care, rural and community health services have contributed to Canadian's concerns about the future of the health system. Instead of exploiting these fears and seeking inequitable methods of obtaining more money, the Canadian Medical Association should join with the thousands of patients, health professionals and care workers who are advocating for a fair tax system in which money goes to improving care. Rather than taking away from the public system, we must act now to protect the scope of care for seniors and those with long-term illnesses.

For the experience of privatization in Canada and around the world is that only the healthy wealthy can afford adequate coverage. Private insurance is neither available nor affordable for those with pre-existing medical conditions. In our recent research we have uncovered outrageous charges for private care: $1,200 per eye for cataract surgery; $500 - $800 for a physician consult; $800 - $2000 for MRIs; $15,000 - $20,000 or more for knee surgery. For these procedures and others, the public system costs a fraction of these charges. To embrace private health insurance and user fees is to embrace inequity and higher costs that will worsen the standard of living and reduce access for the vast majority of Canadians.

It is irresponsible exploit the aging baby boomers as a tool to create fear. Our society is more than capable of taking care of our aging parents who have contributed all their lives to the public health system. There is a clear path to restore confidence and ensure the sustainability of public health care. But it does not involve pretending that privatization is anything more than enabling private companies to make profit from people when they are ill and infirm. The CMA should join us in insisting that our governments uphold the principles of equity and fairness embodied in the Canada Health Act and renew the federal funding accord. They should work with us to ensure that chronic and rehabilitative care are properly covered. And they should push for the political leadership to expand Medicare to cover pharmaceuticals in a comprehensive public program that can provide more care for less money.

The only way we can safeguard equitable and effective care for Canadians is through a robust, democratic and responsive public health system. We would do well to remember the words of Justice Emmett Hall, whose report set the foundation for public health care in Canada: "We, as a society, are aware that the trauma of illness, the pain of surgery, the slow decline to death, are burdens enough for the human being to bear without the added burden of medical or hospital bills penalizing the patient at the moment of vulnerability."

Natalie Mehra is the Director of the Ontario Health Coalition. Mike McBane is the National Coordinator of the Canadian Health Coalition.

Posted: September 13, 2010

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