Health-care future in doubt (Canada)

Considering that not only well-being, but life itself, can depend on good health care, it is troubling that public confidence in medicare continues to erode.

Only 45 per cent of respondents believed their children or grandchildren will receive health care of the quality Canadians get today, according to an Ipsos-Reid poll commissioned by the Canadian Medical Association. Thirty per cent gave public health care a C grade, and 11 per cent gave it an F.

Prime Minister Paul Martin and the provincial premiers will confront this nation's No. 1 priority when they meet to -- in Martin's words -- "fix health care for a generation," beginning Sept. 13. Canadians can hope they put politics aside and agree to a feasible, meaningful restoration of our health-care system.

# Martin, while championing the salvation of health care as his foremost goal in the recent election, promised only $9 billion in federal funds for it -- over 10 years. Let's hope he lowballed the figure to allow for negotiating room.

# Meeting on health care late last month, the premiers proposed that Ottawa institute, and pay for, universal pharmacare. The plan would cost $7 billion to $12 billion a year, and the federal government doesn't have the money. The premiers have begun this all-important dialogue with the crassest of grandstanding.

# Martin says next month's first ministers' meeting will be televised. Perhaps Martin thinks he'll best the premiers at arm-twisting under the glare of TV lights. On the other hand, political posturing could scuttle a useful accord.

Martin is the author of the crisis in Canada's health-care system. In his deficit-fighting zeal as finance minister, he cut federal health transfers to 16 per cent, plus tax points. Medicare started out 50-50, until then-prime minister Pierre Trudeau cut Ottawa's share to 25 per cent while handing tax points to the provinces. Ironically, the prime minister is in position to be seen as the saviour of a mess of his creation. He has claimed he'll come up with money by cutting costs in existing programs. We've heard that before -- and seen the results.

Prompt access to excellent medical care has come to be taken as a right of all Canadians. Yet public cynicism about the future of medicare is a measure of the public's loss of hope in the political process.

Choice in Health Care Insurers
Encouraging personal responsibility for health; ending the government monopoly on healthcare insurance.

In Ontario, no person or company is permitted to compete with the government's health care insurance plan. The government has a monopoly. The government, despite all we know about monopolies when it comes to such things as gasoline prices - e.g., inflated prices - tells you that the government's monopoly is good; that competition is somehow a bad thing. But, if the government health care insurance is so good, why does the government fear competition?

The fact is that the Ontario monopoly on health care insurance is not good. Worse, it leads to expensive over-use of the health care system. Here's why. In Ontario, people can over-eat, abuse alcohol and tobacco, avoid any physical exercise at all, and not have to worry about the effect that such irresponsible behaviour will have on the cost of their healthcare insurance: some other person will be forced to pay, with higher taxes, for the excess healthcare services they use. The result is predictable. Not having to worry about the cost of health-care insurance, many people choose to take little responsibility for their personal health: they eat poorly, abuse alcohol or tobacco, or become physically inactive. Their health care usage goes up: health care costs go up for everyone. Taxes are increased and health-care services are cut back. Drug companies realize bigger profits, while Ontarians and the quality of health-care in Ontario suffer.

Such a system of health care funding defies common sense and fairness. We would all expect dangerous driving and accidents to increase if speeding tickets and accidents had no effect on the cost of our auto-insurance: clearly, the total cost of insuring drivers would increase to cover all of the extra damages. But would we agree to let the government set up an auto-insurance monopoly and raise our taxes so that irresponsible drivers do not have to pay more for their insurance? Of course not. We all know that, if a person knows his insurance will increase if he drives irresponsibly, the person will be encouraged to drive responsibly. The same is true of health: if a person knows his healthcare insurance will increase if he eats, drinks or smokes too much, or if he is physically inactive, the person will be encouraged not to overeat, not to smoke and drink, and to get more physically active.

Why do the other parties refuse to allow competition? Because those who do not want to take personal responsibility for the consequences of their poor lifestyle choices will sometimes vote for a party that will continue to make everyone else pay for the extra healthcare services that result from their irresponsible lifestyle choices. But, if we continue down that road, the health of Ontarians will continue to erode, and health care costs will continue to increase. The responsible thing to do is to encourage everyone to live a more healthy lifestyle.

Healthcare will always be necessary, and it will always be one of the more expensive services in our lives, and the cost of health care will increase as our population ages. But by allowing competition in healthcare insurance, healthcare insurance companies will offer lower premiums to people who live healthy lifestyles. Ontarians will have a reason to eat well, to avoid unhealthy substances, and to be physically active. We will be a healthier, happier society with a decreased dependence on medical services. By using health care less, the cost of healthcare will be lowered.

Accordingly, the Freedom Party of Ontario is opposed to the current government monopoly on health care insurance. We would remove the current prohibitions against competition in healthcare insurance and discontinue the current, irresponsible government health insurance monopoly.

Choice in Health Care Service Providers
Greater availability of health care services; allowing competition.

Currently in Ontario, the government prevents competition in the provision of many healthcare services. There is only one business selling healthcare services: the Ontario government. The results are the same as in any other monopoly: there is little incentive to provide customers with faster service, or with more courteous or higher quality service. The provider - in reality, a group of politicians - doesn't have to provide better services to keep customers because the customer has no competitor to turn to.

Some politicians argue that with a government monopoly, the profit can be cut out of the costs of health care, such that health-care costs will be lowered. This is false and misleading. All that is really happening is that those politicians hold off on improvements to health care technology and infrastructure in the short term: seeking votes, they cut back on taxes that are needed in a government monopoly to keep services at an acceptable level and to keep the infrastructure from falling into disrepair. Because no competition is permitted within Ontario, patients either suffer through with the underfunded system or pay for better services in other provinces or in the USA. Then, when the Ontario medical infrastructure is in a shambles, and patients are so poorly treated that unnecessary harm and deaths occur, the politicians declare a health care crisis so that, when they impose higher taxes or health-care levies, they will not be punished at the ballot box for doing so. You might never have thought of it before, but those tax increases and levies are the government's brand of profits: it is false that a politician-run monopoly can run a healthcare system cheaper and better than a business.

Some politicians argue that allowing other health care providers to compete with government health care services would make for a "two-tier" system. In case you do not know already, that's a system in which you are free to direct your healthcare dollars to the healthcare provider of your choice. Politicians who oppose a "two-tier" system want to deprive you of the freedom to spending any of your earnings on health care services because, if they allowed competition with their own system, we would all see just how much better health care can be.

Even some people who are not politicians want to deprive you of the freedom to spend any of your earnings on health care services. They actually believe that it is more important for everyone to have the same services than for the services to be good. This argument clearly is flawed. If we all had only one dollar's worth of health care per year, we would all have the same quality of service, but it would be extremely poor service. If the quality of all health care services is to improve, we must stop trying to justify a monopoly with rhetoric about sameness. Quality must be the most important goal if healthcare is to be well in Ontario, and quality will be restored only if government health care has to face competition from other health care providers within Ontario. Who makes you well, and whose medical services satisfy your needs, should be your choice, not the Premier's choice.

The Freedom Party of Ontario is offering Ontarians the power to choose their healthcare providers in Ontario. We support the freedom of other health care providers to compete with government health care services. Knowing that providers who give their patients poor service will lose your business, all healthcare providers will be encouraged to cut costs and improve service to you and to other patients. And, by lifting the ban on competition, the number of providers in Ontario will increase: with more providers, services will be available when they are needed, not after it is too late. And, by allowing competition at home, Ontarians will no longer have to travel to othr jurisdictions to obtain the services they need, when they need them: they will spend their money at home, with the emotional support of nearby family and friends.

The citizens in the modern nation state have less and less discretionary income. Further, regardless of political policies it is unlikely they will get more. A full fifty percent of working Americans pay no Federal Income Tax at all and still have no savings and no appreciable discretionary income.

The problem with high tech and high value medicine is that when you really get sick it really gets expensive. When I managed an HMO in the early 90's 95% of our enrollees had medical bills less than $2500 per annum.

It would seem natural if governments were wise they would focus on "stop loss insurance" or some other remedy as a blanket benefit and leave the remainder to the private and local public sectors. In this fashion, costs could be anticipated and any utilization and review on large expenses could be done much easier than is done now.

Also, serious tort reform, even making an effort to develop a cost-effective, worker's compensation type of plan. After all, without workers comp, there would be little US industry. Even with it, there is considerable abuse and unnecessary costs, but at least there are limits to the abuse.

Finally, it must be understood with physician's licensure, hospital accreditation and all the other rules and regulations what has resulted is bootleg humanitarian monopolies for the health care providers. We definitely need much less regulation. At one time, the per diem for a hospital bed was only 1 and one half times that of a first class hotel: now that hospital per diem is commonly a multiple of a first class hotel.

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