Canada's healthcare remains public  
By Ken Warn  
Published: December 4 2002 18:58 | Last Updated: December 4 2002 18:58  
 
 
Few topics are as guaranteed to make Canadians go misty-eyed as hockey and healthcare. The country's universal, taxpayer-funded healthcare system is widely seen as one of the foundations of national identity, an overwhelmingly moral rather than economic enterprise offering equal treatment to those of different class, race or language.

 
Like hockey, healthcare raises strong passions. Canada's system, modelled on Britain's National Health Service, is widely cherished. But lengthening waiting lists and shortages of key personnel have led many Canadians to urge more resources for the creaking system.

Canada is truly the home of one-stop shopping for health. Unlike in Britain, private parallel healthcare provision is in effect outlawed. Unlike France and a host of other developed countries, there is no use of "top-up" health insurance, and there are no user fees.

After an 18-month, C$15m commission into the system, Roy Romanow, former premier of Saskatchewan, said he would like to keep it that way. To the dismay of the Canadian right, Mr Romanow last week rejected fundamental changes in how the system is financed.

He suggested increased public funding for magnetic resonance imaging (MRI) and other diagnostic scanning, which would roll back one of the few areas where private provision has been growing. Private clinics have been opening across the country to provide scans or minor surgery in provinces keen to reduce waiting lists.

However, such clinics contract directly with local health authorities, and their services remain free at the point of delivery.

Mr Romanow appeared to tap into opposition to the idea of private healthcare embedded in the psyche of many Canadians. "Let people buy their way openly to the front of the line. Make healthcare a business. Stop treating it as a public service, available equally to all . . . No! Not now, not ever," he wrote in the preamble to his report.

Instead of private cash, he prescribed a C$15bn injection of federal funds into the C$100bn-a-year system by 2006. The funding would increase the federal share of healthcare spending to about 25 per cent from the current 19 per cent - the remainder is made up by the provinces.

He urged more accountability through creating a healthcare watchdog, and extending the scope of Medicare through a national home care programme and assistance with drug costs for the chronically ill.

Mr Romanow's report raises several dilemmas for Ottawa. Economists believe the recommendations cannot be fully financed unless the government puts other spending plans on hold.

"If healthcare wins out there is just no room for other measures," said Derek Burleton, senior economist at TD Bank Financial Group. Even if healthcare alone wins extra funding, the government's projected budget surpluses will turn to deficit in 2003-04, TD Bank said.

The commission's recommendations will go through federal-provincial negotiations, starting with a meeting of first ministers in January. But Ottawa is hinting it will not fund all Mr Romanow's recommendations.

Many of the provinces, in turn, are wary of the report's suggestion that federal health funding should come through a dedicated block grant, which they say would increase Ottawa's control of a key provincial responsibility. The talks could prove lengthy and difficult.

However, the government is committed to substantial increases in healthcare spending and appears certain not to challenge Mr Romanow's rejection of an increased role for private provision.

That makes the entire report a lost opportunity, according to John Graham, senior policy analyst at the Fraser Institute, a pro- market think-tank. "The main problem is that Romanow wants to throw more money into a government monopoly. He can't see that a lot of the problems in the system are caused by that very monopoly."

For all its power as a symbol of social solidarity, international comparisons do not show Canadian healthcare in a good light. Canada is one of the biggest spenders among OECD countries providing universal coverage, in terms of the proportion of GDP spent on healthcare.

However, in terms of the numbers of doctors per thousand people, or the numbers of MRI machines, Canada languishes well down the list of developed nations.

Canada appears wedded to universal, taxpayer-funded healthcare for the foreseeable future. But in spite of Mr Romanow's distaste for private provision, provinces such as Ontario, Alberta and British Columbia look set to continue contracting for services with private clinics - moves the unions claim open the way to privatisation.
 
 

That makes the entire report a lost opportunity, according to John Graham, senior policy analyst at the Fraser Institute, a pro- market think-tank. "The main problem is that Romanow wants to throw more money into a government monopoly. He can't see that a lot of the problems in the system are caused by that very monopoly."

Being a Canadian I do not share you views on our Country.

I can never see healthcare go the way of dino's.  If any thing there tier health care will come, not never totally go...

I'm confident in our Government to find a solution.
And, Sorry Mandark, but this is our problem, not yours.