Thursday, March 16, 2006

Ten (really crappy) reasons against private insurance in health care

I posted the following response to this blog post which cited this article opposing the moves by Ralph Klein on health care. I'm posting it here because I wrote quite a bit, and I think some of these "reasons" against private insurance in health care are awful enough to be repeated.

"10. The Supreme Court decision in Chaoulli only looked at the Quebec law preventing the purchase of private health insurance. It did not strike down the law stopping doctors working in both the public and the private sectors nor did it speak to any law in any other province."

This is merely a technicality. In the decision, three of the seven justices ruled that it did violate the Charter. One of the seven justices (which would have made a majority) said that the wording of the Quebec Charter and the federal Charter is identical in all relevant respects, and chose, therefore, to treat only of the question of a violation of the Quebec Charter. Since he prefaced it with the claim that the two are identical in all relevant respects (not all of it, mind you, just the relevant sections of the Charter), it stands to reason that we can infer a violation of the federal Charter, making it a majority. It is the subsequent intellectually dishonest interpretations of the ruling that have made this a bigger mystery. Speaking with Chaoulli, he told me that future court cases in the provinces will undoubtedly rule like the Chaoulli decision because of the precedent set.

"9. More private funding will not improve the sustainability of our system. Countries in which private spending is high spend more in total on health care, not less."

This argument borders on stupidity. When people are given a choice to spend money on health care, they do so. That increases the amount of money spent on the system. Sustainability, in the health care context, is a matter of government spending, not private spending. In addition, mentioning the U.S. is intellectually dishonest since the Supreme Court only talked about European models as examplars, and not the U.S. model, which no one wants, and no one argues for.

"8. We have a shortage of doctors and nurses. Most developed countries do. Wealthier provinces are luring doctors from poorer provinces. This problem will be exacerbated if doctors are allowed to top up their public sector incomes by doing less difficult work for higher rates of private pay. If you were a doctor, wouldn't you?"

This assumes a stagnant labour pool. Sure, provided there is no increase in doctors and nurses, we would see more people topping up in the private sector. However, the potential additional wage is an incentive to enter the health care profession in the first place. There are no doctor or nursing shortages in France, Belgium, Portugal, and other European nations that have the kind of mixed system that we are talking about.

"6. In countries that have two-tier systems, only a relatively small percentage of the population holds private health insurance (for example 11.4 per cent of U.K. citizens); typically the wealthiest buy insurance. In other words, the vast majority of Canadians would not benefit from being able to buy private health insurance as either they will not qualify for it, or they won't be able to afford the premiums."

Uhm, so what? 10 per cent of Canada is still about 3 million people that would benefit from such private provision. It's stupid not to allow such a huge proportion of Canadians to benefit just because less than a majority chooses to pay for insurance. As a sidenote, private insurance is likely to have positive side-effects for the publicly insured individuals through a probable increase in doctors and nurses, and reduced wait times at public facilities.

"5. From the perspective of a private insurance company, if you are on a waiting list you do not have an insurable risk. You don't have a risk of disease or illness, you have the disease or illness -- current needs that must be met. If you can't pay cash, the public system is your only option. People presently on wait lists will not be helped by privatization unless they can pay cash."

Uhm, okay, so why prevent those who are currently on wait lists to benefit by paying cash if they can afford it? Because others can't afford it (or don't want to go into debt for it)? So Jones, who could have gone to a private clinic or to a private insurer, has to either suffer an extra six months or die on a wait list because Smith can't afford private insurance or to go to a private clinic? How stupid is that? It's super stupid, that's what.

"4. Don't buy the baloney that Canadian medicare is in league with communist states like Cuba and North Korea. We are third in the world in terms of the contribution of private health insurance to the funding of our system."

The actual comparison is in terms of the ability of the citizens to purchase care privately. And the fact that Canada is third is interesting, don't you think? We talk as though we only have public health care. It's not true. And it's interesting.

"3. NAFTA requires that we must compensate U.S.-based private insurers for denying them access to Canadian "markets" if we subsequently change our mind about the benefits of two-tier insurance."

I suspect this would result in a case before the NAFTA tribunal or court or whatever to be established. I also doubt that this is required by NAFTA.

"2. Governments and health-care providers can fix wait lists. Together they have been able to achieve extraordinary improvements, for example, in cardiac care treatments in Ontario and with respect to hip and knee services in Alberta."

Of course they can! And if you blow a billion dollars on something, you're bound to get a few things right. But that's not the point. The point is at what price, including opportunity costs.

"1. And the top reason why we shouldn't allow private health insurance for essential services? Access to essential care should be based on need and not ability to pay. If resources are constricted we should revisit what is essential but not allow a two-tier system for what are core services."

Right. Sure. Need. "Health Card, not a credit card." And so on. If the government could have secured this health care in a fashion that didn't violate the Charter, then we wouldn't have this problem. But they have failed, and there is little reason to suspect that they could succeed. Ultimately, what matters are health care outcomes and quality of life, not the particular philosophy that underpins the system. If health care outcomes can be improved with the inclusion of private insurance, then that's the way we should go. If that means we have to pay for it, like we pay for food and housing (also basic human needs), then so be it.


Anonymous primvs pilvs said...

If half of all our family income is going to taxes and 40%? of that is going into health care then we will spend somewhere around 2 million dollars on the system. Not exactly value for money. That doesn't even cover any extras like eyes, dental etc.

7:23 a.m.  
Anonymous ollivia said...

where's number 7?

4:05 p.m.  
Blogger mostlyfree said...

I am still waiting for some pro-public-only system to try to tell me that someone who is "stuck" in the public system is going to start yelling and screaming when the guy in front of him leaves the system to go for private care.

And I'm also interested in where #7 went, but never would have noticed on my own.

4:21 p.m.  
Anonymous ollivia said...

"I am still waiting for some pro-public-only system to try to tell me that someone who is "stuck" in the public system is going to start yelling and screaming when the guy in front of him leaves the system to go for private care."

That's awesome, Janet. haha. I like that. Most reasonable thing I've read on the subject in a while.

2:05 p.m.  

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