Monday, October 11, 2004


Health Care

So I'm on the GO Train home on Friday. After a 5-minute delay leaving Union Station, we are stopped for 15 minutes outside Burlington. During the stop, we are informed by the conductor that a freight train is in front of us and a VIA train is on the other track heading in the opposite direction. As a result, the GO passengers (as usual) had to wait for the VIA train to pass before we could get moving. This is always the case, I've noticed. When GO and VIA have to decide who goes first, VIA always wins. This despite the fact that VIA is less travelled. You see, people pay more for VIA and, as such, receive preferential treatment.

Made me think of health care. I will warn you that there is a strong likelihood that I will update this post over time.

Today's Canadian system, screwed up though it may be, promises "equal access" to basic health care for everyone. Basically, if you need a doctor, as long as you've got a health card, you get a doctor. Specialized services (dentistry, glasses, prescription drugs, etc.) are excluded and must be paid out-of-pocket. Many companies' benefit packages help offset this cost.

There are problems (long waits, over/undercrowding, underpaid doctors and nurses fleeing to the U.S. and elsewhere) but the system does work in emergency situations. It is not that often you hear of a person with a life-threatening illness/injury being denied access to the care they need.

There is a growing faction within the country that feels this system is broken and we should create a second tier of services whereby those who wish to pay for services can do so. This will allow them to avoid long wait times, get better quality services and so on. This is simply free-market logic at work. Some of the offshoot changes will likely include:

Insurance companies will create a new category of service for these folks which will allow them coverage (minus a deductible) for these "preferred" services. These services will, of course, come with higher premiums.

Hospitals will privatize and bill for every pill, apparatus and procedure used. They will also start charging doctors for their office space, which doctors will be able to recoup through being able to charge for services rendered.

Doctors will be able to "opt out" of public service and start charging the moment you book an appointment (like dentists today).

This whole argument is like my GO train story earlier. The vast majority of commuters today use GO because it does the job, despite the occasional delay. GO trains also are not very comfortable, but commuters adapt. GO is also considerably cheaper than VIA. However, because VIA commuters pay extra, they receive a number of perks (rapid express service, snack/beverage carts, preference over other rail traffic). This in spite of the fact that the masses prefer the cheaper GO system. Yes, we're occasionally late arriving and we're not travelling in high style, but we learn to live with it.

If the Pandora's box of national privatized health care is opened, it won't stop with specific services. I suspect that the wealthy, insurance companies and doctors (to name a few interested parties) will want to see private cancer clinics, private children's hospitals, private GP's, pretty much everything. The government may try to keep a lid on things, limiting the services that can be privatized while keeping a second, publicly-available tier for those who cannot afford specialized services. However, I suspect that the challenges to the legislation will hit the courts/ lobbying circles fast and furious.

Once it starts, the bigger problem will be who works in each circle. The private sector will draw many of "the best and brightest" who, right or wrong, will seek to cash in on their exceptional skills. Free Market, caveat emptor. The public sector will be populated with overworked, underpaid, less-capable medical professionals. In short, it will be a 20-20 situation: The most-qualified 20% of physicians will be serving the 20% of the country willing to pay for services, while the remaining 80% of the population will be served by the lower 80% of physicians. That's a kinda "doomsday" scenario, but it could happen.

I think of this from the perspective of my kids. Had I been faced with the prospect of choosing whether or not I would send my preemies to a top-tier facility (which I would pay for) or a second-tier facility (paid for by the government), I would have felt that I had no choice. I would want the best care for my kids and would have paid likely upwards of $20,000 per child to have them cared for at the tier 1 level. Thankfully, I didn't have to make that choice. Just as thankfully, I have been blessed with the financial wherewithal to afford the choice. But many haven't. And if anyone thinks that such critical services as children's health would NEVER go two-tier, they're dreaming.

We may have a GO transit-style system of health care in Canada. There may be waits, overcrowding, stress and the occasional mistake. But they (much more often than not) get it right and everyone, regardless of social status, gets a fair chance at the best treatment this country can offer. As a Christian, I believe that those with less than me should not be considered lesser people for it. It would be nice if I could change Christian to person, but sadly, some folks (Christians included) believe that they should be allowed to move to the front of the line just by waving some cash around.

This is a kind of unstructured rant, but I intend to go back to it and tweak it as I read it and get feedback from others. Thanks for staying with it to the end.