Thursday, July 02, 2009

A smart and scary article on health care

Our inability to manage health care is one of the great public policy failures of the last 25 years, at least. The same issues and the same lack of information come up again and again and again.
Given Kevin Falcon's musings on private and two-tier care, this New Yorker article is must reading.

Falcon fumbles on two-tier health care

Kevin Falcon is off to a bumbling and alarming start as health minister.
Falcon sat down with the Vancouver Sun's health reporter and said he saw nothing wrong with letting affluent people pay for speedier treatment than the rest of British Columbians.
"I do not have any objection to people using their own money just as they do for dental care or sending their kids to private school," he told Pamela Fayerman. "I think choice is a good thing."
That's a radical shift away from equal, universal access to health care as promised under medicare.
After Fayerman sat down to write, Falcon phoned.
He should only have been talking about plastic surgery or treatments that aren't medically necessary, he said.
The Canada Health Act bars paying for better or faster care in any other case.
I'm new on the job, he explained.
Which is troubling on at least three levels. First, any cabinet minister - anyone who has been paying attention - should have known about the two-tier care issue and the basics of the Canada Health Act. But it appears Falcon only caught on when his handlers boxed his ears.
Second, Falcon's retreat was less than reassuring for those who think equal access to health care is important.
He didn't say he believed in the principles of the Canada Health Act or supported equal access to care. Just that it was the law and the official Liberal position was to support it, so he would.
And third, Falcon hardly came across as a medicare supporter. When he called Fayerman to clarify what he meant to say, he had this comment: "If we're talking about medically necessary care, we don't have the right to allow people to do that. Frankly, in my second week in the health portfolio, I haven't yet got my mind wrapped around that."
Before you take the health job, you should have "your mind around that." It's the law, federally and provincially. If you haven't decided whether you understand or support the principle, health might not be the right ministry.
It matters that Falcon didn't support equal access to care in the first interview.
And that even in the correction call, he talked about the law, not principle.
A full debate on health policy is important. But some principles are also important.
And Falcon's stumbling is telling.
What Canadians have said, so far, is that the right to health care shouldn't be restricted by wealth.
If two little girls are sick they should get treatment based on their needs. A child with rich parents shouldn't get speedy treatment help, while another child suffers on a waiting list. The sickest child should get the promptest care.
That's not what would happen if people could pay for better, faster treatment.
Nor would two-tier care reduce health costs. In fact, it would inevitably increase them. More money would be spent on the same treatment as extra charges were piled on. If proponents of two-tier care were proved right, and more procedures were done overall, then costs would rise even faster.
Falcon's comments came as three private clinics are suing the government, claiming the right to extra-bill patients for faster or better care.
The government has been fighting the case, pointing to the Canada Health Act and B.C.'s Medicare Protection Act, which both bar extra-billing.
Falcon's confused and confusing comments won't help the case.
Two-tier care has been increasing in the province for about 15 years, as NDP and Liberal governments turned a blind eye to a growing number of private clinics that charge a fee to those who can afford speedier treatment.
The increase has at least been slowed by occasional government threats to crack down on the practice, although the clinics now treat some 50,000 patients a year who can pay to beat the public system's waiting lists.
Falcon's failure to state a clear, principled position on two-tier care will be a great encouragement to the private providers.
Footnote: The debate about extra fees, queue-jumping and two-tier care is separate from a discussion of the best way to deliver services under a universal, public plan. Private providers already play a significant role in the system. The benefits and risks rate a separate column.