Wednesday, June 25, 2014

Is Hating the 1% worth Hurting the 99%?

Under a two-tier health system, the economically advantaged probably will get access to faster and better care than the average Joe and Jane Canadian on the street. They also send their kids to private schools, drive nicer cars and live in nicer houses in nicer neighbourhoods. Maybe they get to do those things because of a lot of hard work, and maybe they get to do those things because they got lucky – having either won lotteries or being the beneficiary of another’s good fortune.

Some take great satisfaction knowing that under the current system the economically advantaged do not have an advantage over the average Canadian when it comes to healthcare (they fool only themselves). It’s a kind of misplaced Schadenfreude – joy that should someone economically advantaged fall ill, they are at the mercy of the same system as everyone else. Perhaps some think that by forcing the economically advantaged to participate in the same system as everyone else that the economically advantaged will advocate for adequate funding of that system as they have a vested interest in its quality (again laughable, as by the time most people realize the reality of healthcare in Canada it is far too late to become an activist).

The thing is, it does not make a lot of sense to really worry about what the economically advantaged spend their (after tax) money on – be it better houses, health or education. It makes a lot of sense to worry that public systems are adequately resourced, provide an adequate level of access and quality of service and that taxation is fair. It makes a lot of sense to worry that what is provided publicly is done so with a view to both efficiency and effectiveness.

And it makes a lot of sense to worry that the prohibition on two-tier healthcare ultimately harms the public healthcare system and those who must rely on it the most – the middle class and economically disadvantaged.

As much as some people would like to think that the amount of money available via taxation is limitless – it is not. Yes, there likely is a fair bit of room for some tax increases – the GST used to be 7 percent and now is 5, however, there are also a lot of very significant challenges that are on the horizon – including an unfavourable demography, and an ever expanding number of conditions amenable to medical care. And don’t forget, that healthcare is not the only thing that is publicly funded – education, transportation, and economic development also deserve public funding. As such, it’s fair to assume that public resources available for healthcare, both now and in the future are indeed limited.

So what does the prohibition on private healthcare in Canada effectively do? It forces many people who would choose to spend their own resources on healthcare to spend public resources on healthcare (they are prohibited from domestically buying medically necessary services). That leaves fewer resources for those who would have absolutely no choice but to use public resources. It forces others to languish on waitlists, potentially disabled and unemployable because it assumes everyone has the same cost of waiting. Health inequities persist, because the best educated (and coincidentally more likely to be economically advantaged), are more likely to be aware of the health services available and to advocate for themselves for access. Some (if they are lucky enough to have the resources) are forced to go out-of-country to access care (and those who do may impose costs on the public system should the quality of care they receive abroad be inadequate, not to mention also bearing the cost of what would otherwise be unnecessary travel). Some spend their resources on unproven and ineffective alternatives to medical care (homeopathy is just a fancy word for water). And because resources are constrained, as demands on the system grow, the system becomes ever more focussed on urgent and emergent services, relegating medically necessary elective services to a kind of no man’s land where people feel disenfranchised for having paid into a system to which access is effectively barred. Further, the opportunities to expand into public provision of needed but not covered care (pharmaceuticals, optometry, and dental) remain limited. Some doctors, are forced to be either unemployed or underemployed – with some deciding to leave the country.

But, I guess as long as it is believed that the economically advantaged also got the shaft and that our system out-performed the US (albeit that’s the only system in the OECD our system outperforms), that it was worth the pain?

It’s time to quit worrying about whether or not someone else might get “better care” and to start worrying that everyone can get “adequate care” – this foolishness is costing many very average Canadians their health and well-being.

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