Who Can Keep us Healthy?


We have a landmark court case happening in B. C. that could change the course of health care in the whole country. You see, in Canada, we have what is supposedly a totally public healthcare system, and private clinics are not allowed. Well, actually, they are allowed, but insurance companies cannot sell insurance for their use. Which limits their scope somewhat. (To the very rich, mostly) There is a strange, shady, ill-defined private side to our health care system, with private clinics operating, but only to do certain procedures, and only on certain people, and all sorts of restrictions that no one bothers to enforce. We also have an expensive dinosaur of a public health care system with long waiting lines for many essential services and procedures.

So some bright legal light has decided it is against the Charter of Rights and Freedoms to deny patients the right to timely health care, and thus the anti-insurance legislation should be repealed, allowing many more people to use the private clinics. The letter of the law seems on that side.

However, On the Other Side…

Public healthcare fanatics respond with screams that if we allow one small private clinic to dip a toe in the public trough, next thing you know, our healthcare system will be just like the United States has.

So What?

Well, let’s do a little comparison of the Canadian vs American systems, keeping in mind how successful they are, compared to other countries:

Healthcare system performance: Canada ranked 30th and the U.S. 37th, while the overall health of Canadians was ranked 35th and Americans 72nd.

Oh. We’re comparing rotten apples to overripe oranges, are we? Let’s look at who provides health care in the rest of the Developed World.

France: Personal Experience

France’s health care system is a public/private hybrid: Everyone is covered to a certain extent by the government’s Assurance Maladie, but most people also have private insurance, called a mutuelle, that is either offered through their employer or bought on the private market. When my wife, Linda, was seriously ill during one of our stays in France, we checked out the hospitals in the nearest city and took her to the one that was privately run. The insurance company was paying; why not? Her only disappointment was that, because of the nature of her illness, she couldn’t partake of the wine that came around every night with dinner.

How do the French Rate?

They are often considered the best health care system in the world. Costs are low, even if you have no local insurance. The total bill for Linda’s care for 10 days in the private hospital, with a private room, three specialists, an ultrasound, an X-ray, a colonoscopy and a laparoscopy? 3,000 Euros, or about $5,000 Canadian. In the US it would probably have been $100,000. In Canada: completely free, but it might have taken three months.

So, given that we have our heads in the sand about the usefulness of our system, what’s the big argument about?

Compared to Education

The whole question is whether allowing practitioners to charge for private service will result in a mass exodus of doctors from the public system to the private system where they will make tons of money, and leave the poor to rot. Like in our ailing neighbor to the south.

We fear that our health system will end up like the American education system, where private schools have siphoned off all the upper-economic-class students, with all their money and all the benefits that attract all the good teachers, leaving the public system to deal with all the troublesome and needy children.

Since this is Canada, I sincerely doubt this will happen. The laws of supply and demand will regulate the number of people willing to pay extra just to get services they want sooner. And in the cases where there are long waiting lists, they should be allowed to.

After all, our education system (which ranks far higher by world standards than our health care does) is a public/private hybrid, with most children going to public schools, but those who can afford it paying extra for the priviledge of controlling their child’s school experience.

The American experience demonstrates clearly that medical service is not something that should be left to the tender mercies of the marketplace. Like education, if you want a service to be provided equally to everyone, you don’t let private industry anywhere near it. The Canadian system is universal and compulsory, and doesn’t fare too much better. Look at a few others, according to the Organization for Economic Co-operation and Development

Rankings of Health Systems in $ per Year Public and Private Expenditures

Country System Rank Cost/yr/person
France 1 $4000
Italy 2 $3100
Spain 7 $3000
Norway 11 $5800
Switzerland 20 $6100
Canada 30 $4300
U.S.A. 37 $8400

What’s Wrong with Us?

The interesting part of all this number crunching; as far as I can determine, all the developed countries that are high on the list have a combination of public and private systems. Canada is the only one that has a fully public system (sort of) and USA has by far the highest percentage of private care. Something is rotten, and it’s not in the state of Denmark.

I mean, look at who we’re competing with (and losing to). Italy, a country whose political system is famous for its corrupt and overbearing bureaucracy. Spain, whose economy is so shaky it is constantly under threat of being thrown out of the European Union.

Do We Have Hope?

The Supreme Court is not restricted to ruling by the letter of the law. It is allowed, even expected, to consider the intention of the law. So if the judges decide that allowing private clinics will not result in the erosion of the public system, they can rule on that precept, because the intent of public health law is to provide equal service to all Canadians. Let us hope.


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