No answers in health care report
Framework for Reform full of contradictions and flaws
It is official. Canadians have turned our remarkable capacity for navel-gazing away from Canadian unity and what it means to be Canadian, and focused it on health care. The first of many coalescences of our group thoughts on the subject is the product of the Premier’s Advisory Council on Health for Alberta, the Mazankowski Report.
The report is another effort by the powers that be to heal our health care crisis by mashing together the principles of Canadian health care and the vaunted healing powers of private sector competition and efficiency.
The report succeeds in being most things to most people. Its vague language and care in touching on rhetoric important to both sides of the health care debate has muted most criticism – like a litany to ward off evil spirits, the words "competition," "private sector," "access," "fairness" and "equity" appear on almost every page. The language will give the Klein government enormous latitude to respond in the manner it sees fit (the result of six weeks delay in the release of the report?) and move the health system another painful step closer to its conservative vision.
If our health care system is not already an example of Sir Alec Issigonis’s camel – a horse designed by committee – it will be if the Mar-Klein connection implements the report’s recommendations. The report is built on troubling contradictions and a wilful avoidance of certain human realities.
The repeated goal of the report is to find ways of making the government-revenue-eating health care system financially sustainable. Yet, admirable as some of them may be, it is littered with dozens of recommendations that will cost more to implement and maintain.
The report assumes that a business model can be applied to Canadian health care. Maybe it can, but not if elements of the current system (strongly promoted in the report) of equity, fairness and universal access to primary health care are to be maintained.
This business model is most apparent in the report’s emphasis on treating patients as customers. There are times when health care practitioners could treat patients with more respect, but the human reality of illness means most patients have little in common with the mythical customer.
The business model’s efficiencies are deeply dependent on the customer having the right motivations and knowledge to make reasonable decisions. The average used car salesman can tell you this is rarely the case. Illness has added psychological implications that make patients unable to act as typical customers. For example, few people will bankrupt their family to purchase an automobile, but they will do so to pay for a loved one’s health services, even if the services have dubious benefits.
The Mazankowski report rejects a U.S.-style system, but it is the best example of a business-like model. The U.S. spends more per capita on health care than Canada. A majority of U.S. citizens are well served (although many complain about the system and it is also in a financial crunch), but a significant minority have little access to primary health care. What is true about the U.S. system is that its health practitioners and insurance companies make a lot of money compared to their Canadian counterparts.
The crux of the report’s business model argument, that the current health care system is an unregulated monopoly, is flawed. Ask anyone working in the system today, and they will tell you it is heavily regulated. There is also more choice in the system than the report admits to. Patients can do more than simply choose their family physician – they are free to move about the province to access specialists and medical treatment, and often do.
The report also promotes an array of contradictory motivators for practitioners and patients. Health authorities and hospitals are given incentives to both compete and co-operate. Albertans are to be given incentives to stay healthy and a greater ability to make choices about their own health. Practitioners are to make the most out of every dollar spent and be more innovative, even though most innovation efforts end in failure and waste.
The most fatal flaw comes in the report’s recommendations on diversifying the sources of revenue for the health care system. The report lists a number of alternatives, but, to borrow from Mr. Klein, there is only one taxpayer. Whether it’s increased health care fees, user fees, taxes or health accounts, all of the alternatives rely on squeezing more money out of a single source: you. Choose your poison.
On Wednesday, January 23, Mar-Klein will unveil its response to the report. Expect the expected, charming assurances about public health care, a strong emphasis on customers (and their wallets), outcomes, and involving the private sector to make health care more efficient. The only thing more predictable will be the hysterical outcry from opposition benches and the defenders of the health care faith.
Other responses to the report
· The Alberta Medical Association – www.albertadoctors.org/advocacy/sustainability/index.html
· Alberta Association of Registered Nurses – www.nurses.ab.ca/newsrel/mazankowski.html
· Friends of Medicare – www.keepmedicarepublic.ca/mazankowski/
· See the similar direction the Federal Romanow Commission is heading – www.healthcarecommission.ca/ |
