Commentary
The state says it needs more federal funding for health. The federal government says it wants to ensure improved results first.
In my view, adding more money is not enough, even with different states and indicators. There are still major issues such as inadequate staff, waiting lists, procedures simply not provided, lack of innovation, and other issues.
This system cannot be amended within the rigor imposed by federal policy, and states do not have enough leeway to provide the optimal mix of public and private payments. Reasonable combinations are possible in all developed countries. In Canada you have to find your own hybrid. Otherwise the paradox will continue. You pay more and get less per person than in many other countries.
Let me suggest a way forward for Canada. The idea is to seek approaches that can be broadly agreed upon by people with different political views, beliefs, and practical experiences.
First, the Health Canada Act must allow more room for experimentation and innovation by provincial governments. Federalism is a fundamental Canadian value. States have primary authority over the provision of health care. Different states can formulate and test new ideas. They may include several options that the patient pays for directly or through private insurance. You’ll know what works and what doesn’t. The Federal Health Insurance Act was inspired by the introduction of public insurance in Saskatchewan.
Second, the flexibility granted by Health Canada could be guided by the principle of ‘mutual reinforcement’. More private payment options will be permitted if state governments reasonably determine that they do not compromise the quality, timeliness, and accessibility of the public insurance system. The standard is that “private payment options may be permitted or facilitated by state governments if they do not harm, and preferably facilitate, the public insurance system.”
Therefore, the current public insurance system remains the starting point. The aim is to be as good as possible in terms of accessibility, quality, timeliness, efficiency, and results, given all other constraints on public spending. Allowed to investigate whether public payment options actually improve the public insurance system (rather than just under ideological assumptions).
For example, in some circumstances, it may make sense to allow a doctor to practice in both mainstream clinics (that is, publicly funded) and in their own privately funded clinics. If the two roles are well coordinated, physicians will perform more procedures overall, reducing demand on the mainstream system. Depending on the creativity of the provider and the preferences of the patient, the self-funding clinic can become a space for innovation that will eventually be incorporated into the mainstream system.
Freedom to practice outside the mainstream system may encourage physicians to stay in Canada or invite other physicians to be placed here. Patients who do not can continue to practice here instead, and taxes from private practice could help support the mainstream system.
I can suggest another scenario where private pay options would harm mainstream systems. For example, in some situations fewer overall steps may be performed in a mainstream system. Another scenario could show that the existence of private payment options significantly reduces voter or government enthusiasm for maintaining and improving the mainstream system.
The key point is that increased freedom and flexibility for state regulators, health care providers, and especially patients, is not precluded or precluded by reformed federal policy. Instead, there are standards. Will the innovation help in some way and improve the mainstream system, or at least not harm it? There is a requirement to apply that criterion. Certain innovations are introduced and monitored in a transparent, evidence-based manner, rather than rigid ideologically based.
The analogy is apt. It is widely accepted that economic development and environmental improvement are mutually reinforcing. However, there is no guarantee that this will always be the case. Instead, both state and federal governments conduct environmental assessments. Evidence is reviewed to ensure that a particular development is unlikely to actually harm the environment.
A more flexible federal framework could include additional safeguards, at least initially. Privately paid options may initially be limited to certain types of procedures or surgeries, such as diagnostics, hip replacements, and other elective surgeries.
It is no exaggeration to say that the inflexibility of the current system has a significant impact on the quality of life, and in some cases, life itself, of some citizens. We can now proceed in an evidence-based, harmonizing way of different value systems.
The current stifling of debate and policy innovation has deadly consequences for Canadians. We can do much better for everyone in need.
Views expressed in this article are those of the author and do not necessarily reflect those of The Epoch Times.