Tuesday, April 15, 2008

The health care sustainability scam

The best you can hope for from George Abbott's bill making "sustainability" a sixth principle of medicare is that it doesn't mean anything.
That's a reasonable assumption. The Liberals have been trying to make health care a theme of this session, presenting lots of bills. Some are bound to be slight.
But if the Liberals argue that the bill does demands action, people who support public health care should be worried.
Gordon Campbell promised that sustainability would be added to the five principles of the Canada Health Act in the throne speech in 2006, at the same time he announced the conversation on health.
The conversation took a year to get going and didn't produce the results Campbell expected. Generally, people were keen to protect and improve the current public system.
Despite some fear-mongering by the government, British Columbians public weren't overly concerned about paying for heath care.
Not what the government had expected. Campbell had made much of the need to cut health spending radically to avoid a looming crisis. The public, rightly, didn't buy it.
The sustainability bill could just be an effort to deliver on the 2006 promise.
But it raises concerns that the Liberals are creating a legislative pretext for radical change in health care - perhaps denying patients' treatment that has been accepted as medically necessary or closing hospitals.
The Canada Health Act sets out five principles for medicare: All medically necessary procedures have to be covered; the system must be be publicly managed and paid for; everyone has to be covered; access has to be equal - no user fees or special payments for preferential treatment; and provinces have to make sure residents are covered within Canada. There are additional details, but broadly the principles are pretty clear.
Sustainability takes the government on to murkier ground, and at worst manufactures a crisis.
Health-care costs are increasing. New drugs, expensive technologies, an aging population looking for great care - cost pressures are inevitable.
But there is no crisis. Back in 1985, about one in every three dollars the government took in went to pay for health care. In 1995, the same. And last year, it was about the same - 35.5 per cent of the money government collected was consumed by health care.
Look at it another way. In 1985, health spending was about five percent of GDP. By 1995, it was 6.6 per cent. This year it will be about nine per cent. The increases are an issue, but the notion that we can't afford health care - that it's not sustainable - is simply not supported by the facts. (We spend four per cent of GDP on dining out in restaurants and taverns.)
Health-care spending was just under $13 billion last year. With the government's encouragement, British Columbians put about $10 billion into slot machines and lottery tickets.
And other countries - including France, Germany and the U.S. spend a higher proportion of GDP on health care.
None of this is to dismiss the importance of good heath-care management. Especially over the next two decades, as the boomer bulge moves into the senior years, pressures will mount. It will be important to reduce demand by encouraging healthier choices and to look for the most cost-effective ways to deliver services.
But there's no sustainability crisis.
Perhaps Abbott will clarify the government's intentions during debate on the bill.
In the meantime, the legislation fuels fears the government will use scare tactics to justify cutting care or offering patients the chance to pay extra for private treatment. (A shift that would actually increase health care costs overall. User fees mean the total cost for a specific procedure rise.)
Health care will cost each British Columbian about $3.50 a week more this year
than it did last year.
That hardly seems a crisis.
Footnote: Even the federal Conservatives are on the opposite of this issue. Abbott asked his federal counterpart to add sustainability to the Canada Health Act last year. Federal Health Minister Tony Clement said he saw no need to make the change.


Anonymous said...

Where do you get the 35.5 percent number from? The government frequently quotes 46cent of every dollar.

paul said...

Hey Alex M.
The 35.5 per cent is based on taking actual health spending from the budget documents as a percentage of the revenue the government takes in. (The numbers are all available on the government site.)
The government sometimes quotes health care costs as a percentage of total program spending.
The better indicator seems to me the amount of disposable income - revenue - that's spent on health care.

Anonymous said...

BILL 21 — 2008

"Sustainability - 5.7 - The plan is administered in a manner that is sustainable over the long term, providing for the health needs of the residents of British Columbia and assuring that annual health expenditures are within taxpayers' ability to pay without compromising the ability of the government to meet the health needs and other needs of current and future generations."

What happens if the cost of health care pushes the BC Liberal government into another "structural deficit"?


PW wrote: "The government sometimes quotes health care costs as a percentage of total program spending.
The better indicator seems to me the amount of disposable income - revenue - that's spent on health care.

I would disagree. The BC government can, and does, manipulate program spending AND revenue numbers.

GDP numbers are pretty much outside of BC government control (iirc, Statistics Canada does the number crunching) and seems (imnsho) to be the fairest way of measuring health spending - of course the BC government will always manipulate what to include in their program spending numbers.

Wayne said...

I pulled some numbers from the OECD. The numbers are scary and our system would appear to be a joke.