Healthcare solutions: Universal care and freedom of choice are not mutually exclusive

A few months ago at Toronto’s Princess Margaret Hospital, Canada’s largest cancer treatment centre, officials announced a plan to have patients who were queued for radiation oncology sign releases acknowledging they were aware of the risks of long waits. The case illustrates the magnitude of Canada’s healthcare crisis. Healthcare professionals, some of the nation’s best specialists on the topic, are now formally admitting hat was, until recently, unmentionable. Delays for essential medical care are so great they imperil the health of Canadians.

Knowing this, the farsighted citizen will seek other solutions. In so doing, he or she will discover that the laws of many provinces, including Quebec, forbid private insurance firms from providing coverage for services guaranteed under the public healthcare system.

The Montreal Economic Institute will publish a report this May recommending some reforms. The two doctors authoring the article will consider prospective solutions, including a study of how healthcare systems work in certain European nations. No matter how good the healthcare system, it obviously won’t spare its users from illness or death. At the same time, we would hope it would not thwart their freedom of choice or their access to service. Which is why the Institute calls its forthcoming study: Universal care and freedom of choice: future solutions for our healthcare system.

Canada is the only OECD member state that does not permit the existence of a private parallel care system. On the other hand, only the United States, Mexico and Turkey fail to provide universal coverage to their citizens. Constantly contrasting the Canadian and US systems is thus counterproductive. Each nation can learn from the other. We should move beyond empty slogans if we really want to improve the quantity and quality of available care. Some claim we can solve this situation with massive injections of government spending on healthcare. But it should be remembered that well before the current budget crisis there were major logistical problems in Montreal emergency rooms. Deficit reduction alone is not to blame for the present predicament.

Canada generally falls between second and fourth place among all OECD member nations for the proportion of its GDP spent on healthcare. To continue pumping more money into this system is neither an enduring nor a viable solution.

And, while it is clear that an excessive bureaucracy – which currently seems to be the case in Canada – reduces resources available for direct patient services, it is illusory to think we could actually improve the situation at this point without instituting some competitiveness, or at least some kind of incentive system.

Calling for greater involvement of the private sector sometimes triggers stiff and emotional opposition based on precepts of “social justice.” However, countries well known for their social democratic traditions, like Germany, Denmark and France, permit the existence of private parallel or complementary systems.

The German approach provides universal access to healthcare, but it is paid both publicly and privately. In other words, any German citizen may also obtain additional coverage at a reasonable price from the private sector, to increase healthcare options. This makes waiting lists virtually nonexistent.

In England and in Sweden, public insurance companies and medical authorities can assign specific functions, like the purchase of medical or surgical services (including diagnostic tests), to those in the system who can provide the best possible quality-price ratio. In Alberta, the government has tried, although somewhat modestly, to introduce this kind of internal competition. Although this in no way affects the universal character of the healthcare plan, Minister Allan Rock is against it and is threatening Alberta with financial sanctions.

Defending a system just for the sake of defending it is not an acceptable response. We must keep our minds open to the best solutions present elsewhere in the world and stop playing the nationalism card or raising the emotional ante when it comes time to consider possible reforms.


Michel Kelly-Gagnon is President of the MEI.

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