Wednesday, March 22, 2006

Canadians Shouldn't Be So Afraid of Two-Tier Medicare

In light of recent events in Montreal regarding greater privatization of the Quebec health care system, I thought it was fitting to address the fear surrounding the issue of two-tiered medicare.

Most Canadians are afraid of a two-tier system and yet they don’t know much about it. Whenever we speak of the subject, right away most Canadians equate it with the American approach, which is one of the most costly and inefficient systems. A two-tiered healthcare program is one that has a parallel publicly- and privately-funded system. Of course there are multiple examples of a two-tier system and because of that, Canadians should not be afraid of the concept. Instead, we should remember that some of the best systems are in fact, two-tier.

Now most opponents to a two-tiered approach are primarily concerned about equal access. The Canada Health Act stipulates 5 mandatory conditions to the Canadian system: public administration, comprehensiveness, universality, portability and accessibility. Personally, I am committed to the last four of these principles – accessibility being front and centre. I also believe that it is possible to get better results under a more comprehensive two-tiered system.

Take France for example. A two-tier system has done them quite well. In June 2000, the World Health Organization rated France as the best healthcare system in the world. This rating was based on a comprehensive assessment of the overall health of the population, health inequalities, health responsiveness and patient satisfaction and distribution of the financial burden. By and large, in France, hospitals are clean and efficient, waiting lists are short, general and specialist doctors are in plentiful supply and, above all, the benefits are universally available. All this for a country that spends less on healthcare than it does on defense.

So how do they do this? Anyone with a job pays part of his or her salary into the Secu, or social security, whose budget is then kept entirely separate from the rest of the government expenditure. Those unemployed or below the poverty line have their health expenditures covered by the government. As well, most people top up their coverage with added profession-based insurance associations, called Mutuelles. Patients pay for their services up front and then using these resources, 100% of the majority of normal medical procedures is promptly reimbursed, with a sliding scale for non-essential treatment, like orthodontistry.

Canada is very different from France, so we cannot simply “cut-and-paste” their system into ours, but regardless, France should serve as a great example of what a two-tiered medicare system can do.

The Canada Health Act was adopted in 1984, making it 22 years old. The political and economic landscape of today is much different and the public needs to be flexible enough to allow policies to change with the times.


At 1:54 AM, Anonymous Anonymous said...

it may not be as bad as the american system, but it is still morally bankrupt and economically inefficient. NO ONE should be able to get better or quicker access to health care because of how wealthy they are. We definitely need to make our health care system better and more effective, but just for a select group of the wealthiest among us.

At 1:55 AM, Anonymous Anonymous said...

*NOT just for a select group of the wealthiest among us, I obviously meant to write, sorry.

At 6:28 AM, Anonymous Anonymous said...

I agree with your post completely. Even though we might be at opposite ends of the political spectrum, I couldn't agree with you more. Unfortunately we will always have the nay sayers like the above anonymous who keep crying "what about the poor". Contrary to what we hear from the left and far left, the poor would have complete access to healthcare with a two-tier system. And another thing "anonymous", next time you go to the hospital for an overnight stay, ask for a semi-private or a private room. Do you know the first question you'll be asked? That's right . . . "do you have insurance"? If I am poor, why can't I have a private room? Even though I'm un-employed, or lazy or just don't have insurance, shouldn't I deserve a private room? The real world doesn't operate that way. We can't keep sinking billions into healthcare without realizing the ultimate consequences 20 years from now . . . 75% income tax.

At 7:55 AM, Blogger Pedro said...

Anon 1:54/1:55AM,

I totally agree with you that everyone should have equal acess to healthcare. That's why I chose to use the French system for comparison - because insurance is universally mandatory and I think that is the way it should be.

But making our medicare system work is paramount. I think a two-tiered system can be our solution as long as we pursue it in an inclusive and universal manner.

How is two-tier morally bankrupt?

At 8:25 AM, Anonymous Anonymous said...

I live in Montreal and we have an almost two tier healthcare system here. It benefits those you can pay to the detriment of those you can't. It is inhuman and discussing. A small example, my partner gave birth in a public hospital. and we had private insurance. We had a huge private room all to - even had a spare bed. I saw how other mothers were crammed into smaller rooms - while we had 4 times the space they did.
If I or my family has a health problem, we are always offered a "private" alternative that speeds up the process by months - I am appalled that people would want to weaken our system even more...

At 10:01 AM, Anonymous Anonymous said...

Hey good post,

I have to agree with you. I swear people don't know much about two-tier healthcare when they reject the idea.

We need to start getting the word out that two-tier isn't all bad (it can be but it doesn't have to be) so that the public isn't so freaked out when the government is trying to be innovative in dealing with public policy.

Thanks for the analysis!

At 4:46 PM, Blogger Vincent Riccio said...

I must admit that I have to learn more about the two systems in question and have been working hard at learning as much as I can.

Great post though! It shed some light on the issue for myself!

Thanks for stopping by my blog.


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