On the contrary,
Medicare is not sustainable on its present course. A modest slowdown in the rate
spending increases has been bought chiefly through reductions in services,
closure of facilities, fewer health professionals, increased waiting times and
through forgoing innovative, but expensive, new technologies.
Medicare as we know it can only be "sustainable" if Canadians are willing
to accept less service or more taxes. Polls, as I’ve already mentioned, indicate
that neither is acceptable. And given increasing consumer expectations for
expensive health technologies, drugs and procedures, and the expected health
demands from an aging population, Medicare’s problems are only going to grow. In
fact, a paper by Bill Robson, vice president of the C.D. Howe
Institute, a very prestigious think tank in Toronto, has argued that the
unfunded liability of Medicare (promises to pay for services that normal
increases in the take from the existing tax load will not cover) is in the $500
billion — $1.2 trillion range. Canada’s entire national debt, by comparison, is
currently about $530 billion.
Yet Roy Romanow has
already publicly rejected these arguments and has recommended not only retaining
but even expanding the centrally planned, government monopoly model of health
care in Canada.
other major inquiry into health care, including the Kirby Report (by a committee
of the Senate of Canada), the Mazankowski Report (by the Alberta Premier’s
Advisory Council on Health, of which I was a member) and the Fyke Report for the
Government of Saskatchewan (where Mr. Romanow was premier), identifies
sustainability of the health care system as the challenge we face. Mr.
Romanow’s own former Minister of Finance in Saskatchewan, underlined this when
she testified before his commission.
But Mr. Romanow
denies there’s a problem. We’re spending the same share of GDP today on public
health care as 30 years ago. If a little more than 7 percent of GDP was
sustainable in 1972, why is that same percentage unsustainable today?
It’s the wrong
question. It’s not how much we’re spending, but how we’re paying for it and what
we’re getting in return. For years we borrowed and spent on health care (and
other services), so we got more than we were willing to pay for. Today, as the
only G7 country consistently in budgetary surplus, we pay the full cost of
today’s services, plus the interest on money we borrowed for health care
and other things in the past. So while the spending has remained constant
as a share of GDP, the tax burden has grown and quality has declined.
force of demand for "free" services is running headlong into the immovable
object of unavoidably limited health budgets. To date, the pressure has been
relieved by crumbling health infrastructure, loss of access to the latest
medical innovations, declining numbers of medical professionals and lengthening
queues. By and large, people have access to ordinary, relatively low-cost
services like GP office visits, but find it increasingly difficult to get vital
services such as sophisticated diagnostics, or many types of surgery and cancer
care, where the waits can be measured in months if not years.
This is the exact
reverse of what the rational person would want. We should use the public sector
to pool everyone’s risk of expensive interventions, ensuring that they are
available when needed, but leaving ordinary interventions, whose cost can easily
be borne by the average person, to individuals, supplemented by private
insurance and by subsidies for those on low-incomes. Hardly anyone can afford
cancer care, bypass surgery, gene therapy or a serious chronic illness on their
own. These are the things that, without insurance, destroy people’s finances.
Yet as much as 30
percent of the services consumed under Medicare are unnecessary, not medically
beneficial or even harmful. No one would be financially ruined by having to pay
for an ordinary doctor’s office visit if we ensured that people on low-incomes
were subsidized and that there was a reasonable maximum anyone would be called
on to pay. No one would be harmed by an incentive not to go to the emergency
room when a visit to the family clinic would do just as well. The biggest health
care study in the world, the RAND experiment, found that people who had to pay
something towards the cost of their care consumed less of it, but that their
health was, with very slight qualifications, every bit as good as
those who got totally free care.
The extra infusion
of taxes Mr. Romanow recommends will merely put off the day when we realize that
we must concentrate scarce public health care dollars where they’ll do the most
good, and that we must give users of the system incentives to be prudent about
how they spend them. We spend vast sums on procedures of little or no value,
while we place patients whose condition endangers their life, in lengthening