According to the Vancouver Sun, new B.C. health minister Kevin Falcon doesn’t “have any philosophical objection” to patients being allowed to pay for faster access to medical services in private surgery clinics (http://www.vancouversun.com/Health/Health+minister+says+private+
health+clinics+okay+with+limits/1729495/story.html). I don’t have a philosophical objection to it either. My objection is practical.
If we allow health care procedures to be mere market items, then level of wealth becomes one of the main factors that determines whether someone gets care or not. That partial privatization would offer all patients more choice and create a more efficient system is merely a myth. The evidence has shown, time and time again, that for-profit health care is not only more costly but also often poorer quality than not-for-profit, or public, health care. Take a look at the United States, where privatized health care has resulted in costs per person that are twice as high as in Canada. Even with more money being spent, many key health outcomes, such as life expectancy and disease-specific mortality rates, are significantly worse than they are here.
There is a widely held belief that partial privatization in Canada will lead to shorter waiting lists, but the reality is that creating a private health care market on the side would only draw resources out of the public system, slowing down access to care for those who can’t afford to leave the public system. A parallel private system would split the population in two, based on their ability to pay, and health care would no longer be treated as a right, but as a commodity. As for wait times, international comparisons indicate they wouldn’t change much. What would change is who has to wait and who does not.
Proponents of privatization argue that individuals should have more choice in their own care. Sure, “choice” sounds great on paper, but only if it is given to everyone. Giving more choice to the wealthy, and leaving the poor to be cared for out of what is left of the public system, will create an equity crisis. This notion that patients should have more choice forms the foundation of a current hot topic in B.C., where private clinics are suing the government for forbidding doctors from accepting private forms of payment from clients. This is pretty outrageous. What Canada needs is quite the opposite: stronger protection of the Canada Health Act (CHA) in order to prevent violations of it, which are already not uncommon. Canadians value the equitable guarantees that come out of the CHA, and it needs to be upheld as the core of our health care system.
That being said, our current system is far from perfect. Improving it is going to require re-organizing and integrating services, emphasizing promotion and prevention, focusing on disease management, and prioritizing health disparities. These are all changes that can and should be done within the public framework. Privatization is not the answer.
Yes, Falcon did later call back to clarify that he was referring, of course, to the privatization of non-medically necessary services only. A small after thought, perhaps? We need to stop viewing privatization as a solution. It will not shorten wait-times, it will not support better healthcare resource allocation, and it most assuredly will not improve quality of care. What privatization will do is lead to increased inefficiencies and a plethora of equity-related issues. Should access to care be based on ability to pay, or on need of medical attention? Maybe that is a “philosophical” question after all. Or maybe it’s just a question of justice.