Karen Selick of the Canadian Constitution Foundation, who are challenging the Ontario government for its “monopoly” health system in court, advises us to “get real” about profit and health care delivery in a Globe and Mail article. Of course, part of getting real may be recognizing that it was precisely the unbridled drive for profit that landed the Canadian and other economies in the current financial crisis. But in terms of the health system, we need to carefully analyze the institutional drivers that shape service delivery. Her simplistic analogy of health professionals “profiting” because they earn more than subsistence wages is hardly comparable to the incentives that drive major pharmaceutical and health care corporations.
The adverse impact of for-profit care is illustrated by important features she fails to mention; particularly well documented in the American system that proponents of private care so often promote. If the amount of funding to hospitals, clinics or other providers is fixed, or if the price of particular services are set, then the evidence shows poorer quality from commercial providers as owners seek to cut costs to increase profit. If people or their employers can pay for higher quality, better insurance or preferential services, then access is inevitably inequitable. While Selick seems not to be concerned with some people “making do with hamburger health care” and assures that “in the long run, even low-income patients would benefit” under a for-profit system, we have seen time and again that this is not the case. Wherever user fees and private payment are introduced – and there is a great deal in Canada already –many people who can’t afford to pay are denied the quality care they need.