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.