31 July 2007

Health care vs. wealth care

Haply you shall not see me more; or if,
A mangled shadow: perchance to-morrow
You'll serve another master.

Antony and Cleopatra 4.2

The Canadian Medical Association unveiled its "new vision" in a policy document released on July 30. As reported by the CBC, the CMA wants provincial governments to hire private-sector firms to deliver publicly funded health care services to prevent delays for medically necessary treatment. Association president Colin McMillan said Canadians need timely access to medical services, and the private sector could act as a "safety valve" to ensure wait-time guarantees are met. "The CMA believes that we must now take that principle forward to meet the needs of a new generation."

Just as Dr. Michael Rachlis, a well-known critic of privatization, predicted last year (1), the operators of private clinics and their supporters -- encouraged by the Supreme Court’s ruling against a Quebec ban on private insurance for Medicare-covered treatments -- are aggressively shilling their wares, with the CMA’s explicit support.

Despite the CMA’s stance on the matter, polls consistently show that a large majority of Canadians endorse the recommendations of Health Commissioner Roy Romanow, whose 2002 Final Report strongly opposed privatization and outlined a system for updating and re-inventing health care (2). These popular instincts are strongly supported by reams of research, including a recent systematic review comparing health outcomes in Canada and the United States. It concluded that Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost (3) -- while, it should be added, ensuring that no one is consigned to the special circle of hell reserved for the uninsured.

Many Canadian health librarians care deeply about this country’s successful single-provider system and see their work as an integral part of publicly funded health care delivery. Access to knowledge-based information and promoting health literacy were important issues in the Romanow Report (pp. 76-82), and were clearly reflected in Recommendations 10 and 12. There is even a pull-quote from the Canadian Health Libraries Association on page 79. Publicly funded and operated services, such as Alberta’s Health Knowledge Network or the UK’s National Library for Health, emphasize access and delivery through policy coordination, shared technology, and improved cooperation. Such resources are a fundamental part of a public health care system, and librarians should be concerned that any serious tampering with that system could eventually lead to their dissolution.

For a compelling alternative to the CMA’s vision for Canada’s health care system, see Mending Medicare, a collection of articles published by the Canadian Centre for Policy Alternatives. As the title of one of its contributions declares, health care and wealth care can’t viably co-exist (4). Tepid tolerators of Medicare, like the Canadian Medical Association, have taken advantage of legitimate public concern about delays in the system to push ill-advised policies such as for-profit delivery and private finance. But allowing private insurers to compete with the public system will increase wait times for treatment, not lower them. There is currently a shortage of doctors and nurses. Letting the private system draw already limited human resources out of the public system, and letting doctors bill on both sides of the fence, will only make this situation worse. As many astute observers have asserted time and again, solutions can be found and implemented within the public system.

If the Canadian Medical Association is successful in its efforts to disassemble public health care, then we shall have failed to heed Malcolm Gladwell’s warning. His disturbing meditation on the plight of uninsured Americans appeared in The New Yorker two years ago:

The United States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193. … And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy -- a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper -- has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers (5).


  1. Rachlis M. Better public than private solutions to Medicare wait problem. The CCPA monitor. 2006 May:34.
  2. Commission on the Future of Health Care in Canada. Building on values : the future of health care in Canada. Saskatoon : Commission on the Future of Health Care in Canada, 2002. Available from: http://www.hc-sc.gc.ca/english/care/romanow/index1.html.
  3. Guyatt GH, Devereaux PJ, Lexchin J, Stone SB, Yalnizyan A, Himmelstein D, et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open medicine 2007 1(1).
  4. Flood CM, Sullivan T, Roos N, Lewis L, Noseworthy T. Health care and wealth care can’t viably co-exist under Medicare. The CCPA Monitor. 2006 May:16.
  5. Malcolm Gladwell. The moral-hazard myth: the bad idea behind our failed health-care system. The New Yorker. 29 Aug 2005. Available from: http://www.newyorker.com/archive/2005/08/29/050829fa_fact (Gladwell is the author of The tipping point, and Blink: the power of thinking without thinking.)