RECENTLY, I had the opportunity to spend a month working at a marina in the United States. It was fascinating to listen to the various opinions on President Barack Obama’s health care plan. One neighbour, who at first avoided me like the plague, found out I was from Canada. One morning, he asked me: "You have state health care in Canada. What do you think of it?"
"I like it," I replied. "I like not worrying about whether or not I will go broke if I have a serious accident or illness."
"Mmmm," he muttered quietly and continued on his way.
The next time we crossed paths, he burst out, "But don’t you mind paying for someone else’s health care?"
"I see health care as a universal right, like education," I responded. A louder "Mmmm" expelled from his lips.
Later that day, as I was getting into my car, he leapt, seemingly out of nowhere, and said, "But what about immigrants? Surely they are not covered?"
"I think they are," I answered, "although I think they have to be in the country for a while before the coverage kicks in."
Interested in further exploring the thoughts of my American marina neighbours, I bought a used copy of Michael Moore’s documentary Sicko. I invited my curious neighbour over to watch the movie with me. "I don’t know," he replied, "I don’t really like Michael Moore. I’m pretty conservative. I think I’ll pass."
My other neighbour agreed to come watch. He sat mesmerized during the whole documentary and at the end said, "There is nothing I didn’t know. I am living it right now."
He told me that a year ago, he had suffered a stroke but had no medical insurance to pay for his treatment. Slowly, over the year since his illness, he lost his job and his income, and then used up all his savings. Currently, he was depending on friendly doctors to see him from time to time on the cheap.
After he left, I reflected on how lucky I am to be a Canadian citizen. But I also reflected on how fragile our system of universal health care is. As a politician who served on the government side in the provincial legislature for 10 years, I saw the health care budget grow at three to four times the rate of inflation. Such increases were not enough to keep the government from being hammered for not funding this project or that, for the lack of doctors and nurses, and for the periodic closure of rural emergency rooms.
From my work on the constituency level, I knew that while hospital care is free, prescription drugs are not and for those living on limited incomes, drug costs can eat up their entire monthly income.
All is not well with the Canadian health care system. Those on the right push for private care, while those on the left advocate throwing more money at the system. Both responses are wrong. Private health care results in poorer population health, lower life expectancy, and the unseemly situation that exists in the U.S. where as much as one-fifth of the population has no health coverage.
But throwing money at the health care system is also not the solution. Money delays the reforms that are needed. Without such reforms, Canadians will either not be able to afford to support public health care or we will end up with a patchwork quilt of care where far too many fall between the seams.
Needed reforms are: an end to physicians operating as private businesspeople within a publicly funded system; universal catastrophic drug coverage; slowing of the technological pressure to buy the latest equipment or prescription drug; clinics with appropriate levels of care; and more emphasis on prevention, rather than acute care. The provinces are trying to implement such reforms, with varying levels of effort and success. But two further changes are needed for Canadians to enjoy sustainable health care.
The first is the recognition of the need for rationing. No society can afford complete free health care for all its citizens, especially as our population ages and health care demands increase. Rationing will be difficult. My colleagues and I in the government endured session after session in the legislature where we were publicly flogged for failing to provide this drug or this service to this person, even though the service was experimental or the drug was excessively expensive.
Rationing of services and drugs occurs now, but it is done quietly, in the backroom. It needs to be brought into the open. Should a terminally ill man who has six months to live be given a hip replacement? Clearly not, but this happened in our province due to political pressure. And such cases could be multiplied a thousand times.
The second change is an acceptance that death is part of life. I am not arguing for euthanasia, as euthanasia is often a flight from death rather than an acceptance of it. But when the vast majority of health care expenses occur in the last six months of a person’s life, something is wrong. We are not meant to live forever and we must accept this, whether we subscribe to a religious creed with its hope of an afterlife or believe this life is all there is.
With the needed reforms, a well-thought-out and ethically defensible rationing plan, and acceptance of death as part of life, Canada’s health care is sustainable. Without them, it will further erode and we will end up with a system that is the worst of all possible worlds.
Mark Parent is a former Progressive Conservative cabinet minister and MLA for Kings North.
