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Thursday, May 06, 2004

Re: Health Care

Laurent - I'm with you as far as it goes, but I think the Conservative Party - and other conservative groups - have to make a tough but practical political decision right now. The Liberals continue to demonize any attempt at reform by conflating public provision of health-care with public funding. There seems to be very little possibility of conducting a reasoned and calm discussion on the merits of mixed or private payment for health-care; it may be as close as we have to a third rail right now.

I don't think that's true for private provision. In fact, I think that the Conservatives - or provincial parties - could be very successful by a) de-linking provision and funding in the public mind, and b) demonstrating how private provision would lead to better and cheaper services. In fact, if universal public funding is maintained, private provision can be quite easily cast as a means of getting better value for the tax-payers' dollar (or, more simply, getting better health-care for less).

Private provision is often labelled an 'interim step' towards private financing, and Conservatives (and conservatives too) have to be very careful in the rhetoric we use. If public financing is a fundamental demand of the Canadian electorate - and I'm willing to be persuaded otherwise - then Conservatives should accept that state of affairs, and work to shape it in a more cost-effective mold. Private provision in a publicly-funded system would be a tremendous victory for common sense, for Conservatism and, most importantly, for Canadian citizens.

Posted by David Mader on May 6, 2004 | Permalink


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Private provision will, almost certainly, be characterized as an attack on the wait list driven model of health care provision Canadians seem to believe is the best of all possible worlds. As the arguments about private MRIs are demonstrating.

As much as anything, notwithstanding the assorted studies and commissions, the single payer, single provider model has now become the litmus test for a politician's commitment to healthcare in Canada.

In many ways this has become decoupled from any question of efficient provision of services. And that decoupling has more to do with the entrenched interests within the healthcare system than with any real question of efficiency.

As the near general strike in British Columbia earlier this week demonstrated, there are a lot of people who like making over $20.00 an hour providing non-medical services in the public system.

Private provision will be seen as an end run around the heavily unionized public system. Which, to be fair, is exactly what it will be.

While private provision might well be "sold" as "a means of getting better value for the tax-payers' dollar" the public sector, non-medical, unions will recognize it as a means of outsourcing "their" jobs and fight every step of the way.

One of the fascinating things about the ongoing healthcare debate is how rarely it turns out to be about health and how often it is actually about entrenched interests. Doctors, nurses, hospital administrators and the vast support staffs all seem to require are less than eager to implement efficiencies which will reduce their take home pay.

Posted by: Jay Currie | 2004-05-06 11:36:07 AM

That's all true and fair, but I think that's a fight worth fighting - and a fight that could be won. Most Canadians, I believe, tend to support striking health-care workers (as in BC) - but I imagine that support would be quite drastically reduced if it were made clear that those workers were not, by in large, medical professionals. That's another point of confusion - calling janitorial staff, kitchen workers and so on 'health-care workers' because they ply their trades in hospitals.

Showing Canadians that a) public-sector unions are charging huge sums to do non-health-related work in the health sector, and b) private-sector companies could provide the same services for much less seems like a winning solution. Sure, Canadians are sympathetic to unions. But they - we - are also reasonable, and there are limits to the extent of our sympathy - and our patience.

Posted by: David Mader | 2004-05-06 1:31:11 PM


I think you hit the nail on the head. Canadians are not ready for private insurance or private payment for medically necessary services. I think they are ready to at least discuss private provision of services within the publicly funded system - and of course, it is already happening all over the place. The Conservatives have been fairly open that they support experimentation in service delivery within the publicly funded system. The Liberals have dishonestly allowed private delivery while claiming that Conservative / Alliance musings about private delivery are in fact a code for allowing private funding.

I think Pierre Pettigrew's (sensible and true) comments on experimenting with private delivery will make it very hard for the Liberals to run a mediscare campaign this time. But let's not dump on the Conservatives from the right for not being willing to commit electoral suicide and advocate private financing.

Posted by: Mark C. | 2004-05-06 2:34:38 PM

Did any of you see the news in the National Post about the move by a Saskatchewan Indian band to put an MRI clinic on their reserve on a pay-for-service basis. The band also indicated that they are looking at opening a full-service pay-for-service hospital.
Since they are on the reserve they are out of the jurisdiction of the various regs in provinces.

Conservatives who are all for erradicating Indian Reserves might want to examine this. If you want a two-tiered system in Canada, people might do well to partner with Indian Bands and set up hospitals and clinics on reserve - so people can stay in Canada to get good quality health-care and avoid long wait-lists by paying.

Posted by: Meaghan Walker-Williams | 2004-05-06 2:57:31 PM

Harper and the Cons will be tarred as right-wing enemies of public health care no matter what they do. Why try and out-squish the Libs? Come on right out with a sensible proposal for health care reforms that involve things like means testing, Medical Savings Accounts, etc.
If all we're going to do is tiptoe towards contracting out a few services here and there, the waste and inefficiency of third party provision will remain and the blame for its failures will be placed at the feet of 'privatization' by lefty demagogues.

Posted by: Jay Jardine | 2004-05-06 3:10:05 PM

David, I'm pretty sure the Conservatives will do exactly what you suggest. However it is more than a little disturbing to know you can spend all the money you want on riotous living while you would become a mortal threat to the societal fabric of Canada if you spent one cent for a MRI scan. It is more than a little distressing that a policy pursued by every country under the democratic banner save Canada is described as radical, extremist, electoral suicide or 'American-style'.

As Jay Currie has noted, the Liberal defense of medicare has little to do with actual health care issues. But I also think it has little to do with entrenched interests. It has everything to do with nationalism. You only have to hear how Herle and Martin (and countless other Canadian nationalists) describe Conservatives as unCanadian. However, as my post has noted, this medicare nationalism leaves Quebec distinctly cold. Contrary to what Liberals may claim, the Canada Health Act is *NOT* something that holds the country together.

Posted by: Laurent Moss | 2004-05-06 6:55:45 PM

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