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THE FOLLOWING ARTICLE HAS APPEARED IN THE RECORD December 11, 2002

Coming to grips with our
health-care costs

Part II: The private sector controversy

The debate on whether the private sector should play a greater role in our health care system is far from resolved, despite Ray Romanow's long-term prescription to infuse billions of additional tax dollars. About the only conclusion we seem to agree upon is that our health care system is plagued by growing waiting lists, for everything from access to medical specialists, diagnostic equipment to elective surgery and treatment. Even those who believe the solution lies in a cash transfusion are solidly divided on who should foot the bill and in what proportion.

The funding issues

For many Canadians the only long-term cure is more private funding. Others go further and argue that governments need to pare down on public coverage and allow the private sector to make up for the difference through user fees and private insurance. Facing them are the die-hard supporters of Medicare who view private funding as nothing less than a direct challenge to the principle of universal access. They value health care as a human right and are committed to the belief that medical services are not a commodity that can be bought and sold for profit. Their solution to lengthy waiting times is not more private clinics but for governments to end user fees and return Medicare to a universal 50/50 federal-provincial cost shared program.

Finally, there are those who are far from satisfied that our health-care system is working as efficiently as possible. Before putting more resources into the system, whether from private or public sources, they want to make sure that they are all getting the best value from their tax dollars.

The "for-profit" clinic phenomenon

During the prosperous years of the 70s and 80s universal health care benefited from generous funding increases. Money flowed towards new hospitals and technology until recession struck in 1991. When the public debt began to skyrocket, governments responded by down sizing. Years of health care funding cuts by both levels of governments led to a substantial reduction in hospital beds, long waiting periods and finally to the emergence of "for-profit" private clinics which began to offer medical services to patients who could afford to pay.

Made up of doctors who have a financial interest in their success, these clinics now provide high-tech diagnostic services as well as day and overnight surgery on a pay-as-you-go basis. This growing Canadian-wide phenomenon is also responsible for much of the controversy in the health care debate. Those who oppose private clinics view them as little more than profit-driven businesses, which contribute to the expansion of a two-tier system.

MRI private clinics

Among the more notable private clinics are those which offer MRI scans to patients for a fee of up to $1,200. Five years ago there were three private MRI clinics in Canada, today there are more than 25. Each MRI (magnetic resonance imaging instead of x-rays) unit costs approximately $2.5-million. Installation and operating costs mean another $1.5 million. As a diagnostic tool used for everything from cancer to spinal complications MRI produces an image that is far more accurate than any previous technique. Because much of the MRI equipment in the public system is aging, outdated and in such short supply, the waiting period in some jurisdictions can run up to 14 months for patients with non-life-threatening symptoms. Compared to the US, Canada has on a per capita basis 10 times fewer (MRI) units.

Opposing viewpoints

Those who oppose for- profit clinics view their owners as little more than "venture capitalists " who violate Canada's sacred single-tier system with the tacit approval of the federal government. They insist that the federal government must crack down on them because they allow patients to jump the queue based on their wealth rather than on medical need. As for those who can afford to pay for an MRI, they are considered as having a much better chance at getting a faster treatment because of a quicker diagnosis.

Romanow proposes that the diagnostic clinics be brought under the public insurance plan with the help of a $1.5 billion diagnostic services fund.

Free market philosophy

The supporters of for- profit clinics rely on various arguments, the most important one being the traditional freedom of choice or free market philosophy. They argue that patients in a free and democratic society must have the right to use their disposable income as they choose, within reasonable limits. This includes the right to purchase the best possible health care services rather than have to rely exclusively on the limitations of our public system. Rather than being burdened by additional health risks and worries caused by long delays they believe that patients who can afford it should not be barred from purchasing access to state-of-the-art diagnostic and treatment technology. They consider the more alternatives that are available, the greater the chance of meeting both the health needs and wants of people.

By restricting the application of the "law of demand" and discouraging the role of the private sector in the health care system, they contend that governments are only creating a health system destined for mediocrity and bureaucratization.

Is a two-tier system essential?

Insofar as creating a second tier of medical services, they see it as a means of speeding up access to the publicly funded system, particularly when the demands become too great. They also consider a private tier as being essential so as to enable governments to attract and retain high-quality health professionals in Canada. Finally, they suggest that a second tier would offer Canadians who seek health care in the US to be served in Canada, thereby creating more jobs for Canadians.

Next week: Part III: The verdict