If there is one thing Canadians can agree upon with near unanimity, it’s the value of a universal public health care system. In fact, a recent Nanos poll showed most people would like to expand our public system, even if it means paying higher taxes.
But rightwing groups like the Fraser Institute work relentlessly to roll back our public system and privatize Canadians’ health care. In one column the Fraser Institute’s Associate Director of Health Policy Studies argued that we need to privatize our health care system because wait times inside the public system are too long:
Which raises another key question. Why do these waits exist and what can be done about them? They exist because the government can’t fund enough services to keep up with demand. Consequently, medical services are rationed through waiting lists. And unfortunately, government policy prevents the situation from improving by discouraging the private sector from helping expand supply, and by prohibiting co-payments and user fees, which could help temper demand.
This is a common argument that rightwing groups use to attack public healthcare: wait times are too long, and the way to fix wait times is to privatize services.
But while it is true that Canadians sometimes wait longer than they’d like for specialized services, it is not the case that privatization would solve this problem.
The Fraser Institute implies that long wait times are a necessary part of a public health care system. But the reality is that there are plenty of public health care systems similar to ours which have much shorter wait times.
One study the Fraser Institute often cites is the Commonwealth Fund Survey. This survey does show that Canada experiences relatively long wait times for some services.
But it also shows that the United Kingdom outperforms countries with private healthcare systems, like the United States, on most measures including wait times. The kicker is that the United Kingdom’s health care system involves even fewer private services than Canada’s — doctors and nurses are employed directly by the government. Of course, the Fraser Institute doesn’t include this data in their reports on the Commonwealth Fund Survey because it undermines their agenda, which is to privatize Canadian health care.
Wait times are caused by underfunding and co-ordination problems
While rightwing critics of public health care crow that it’s the system itself that causes wait times, we can see that some public systems outperform private ones on this measure.
The real cause of wait times is not the fact that our system is public and universal — it’s that our system is underfunded and un-coordinated.
Andre Picard, the Globe and Mail’s health reporter who has been covering Canada’s health care system for decades, explains the root of the wait time issue:
What distinguishes the countries that have markedly better results than Canada – like the Netherlands and the Nordic countries – is the cohesiveness of the system, and the emphasis on primary care.
Every Dutch citizen must register with a general practitioner, who acts as navigator and gatekeeper for the system. Furthermore, the roles and responsibilities of all the key players in the system – practitioners, insurers and government – are clearly defined, and complementary. Better still, politicians do very little micromanaging of the health system because that is not tolerated. In the Nordic countries, in addition, there is a particular emphasis on the socio-economic determinants of health, in tackling inequality, but spending more on education and social welfare, and less on health, with impressive results.
In Canada, by contrast, we have very much a sickness-care system, with many silos, and very little co-ordination. There is far more crisis management than planning and political interference is commonplace. And, as the data in the new CIHI study highlight, patients are often left to navigate the complex system on their own, and too often fall between the cracks.
Canada also has fewer doctors per capita than most other western states, with just 2.4 physicians for every 1000 people. Germany, which often has shorter wait times than Canada, has 4.1 doctors per 1000 people. It’s no surprise that given our relative shortage of doctors, Canadians wait longer for care. The solution to this problem is simple: invest more in physicians and nurses.
Privatization would make care better for the rich, worse for everyone else
Health care, like most everything else, is a finite resource. That means not everyone can have an infinite amount of care. With any finite resource, we have to make decisions about who is going to get what.
In public systems, like Canada’s, we provide health care on the basis of need. If you are critically sick or injured, you go to the front of the line. If you can wait for treatment without suffering long term negative effects, you have to wait longer.
But in private systems, like the United States’, health care is provided on the basis of wealth. If you can pay to go to the front of line, you do — even if someone else needs treatment sooner than you. What this means in practice is that people who need care but aren’t rich simply go without. Prior to the introduction of Obamacare, the American Journal of Public Health found that 45,000 people died every year due to lack of health insurance. It’s not an exaggeration to say that private healthcare kills tens of thousands of people every year — and yet this is what the Fraser Institute and rightwing critics want for Canada.
Canadians have decided to provide health care on the basis of need rather than wealth. This is a just and moral decision. Under the private health care system the Fraser Institute wants, the rich would have excellent care with no wait times while everyone else’s care would be worse, or disappear entirely.