Health Care - Private - Public
but above all universal

White Rock B.C. - Thursday, June 23 2005 - by: Brian Marlatt
Two health care decisions followed instructively one after another this month.

The first, by US corporate giant General Motors, identified skyrocketing private health insurance and delivery costs as sources of unsupportable multi-billion dollar loses requiring layoffs of 25,000 GM workers, mainly in the US. The second, by the Supreme Court of Canada, opens the door to private health insurance and delivery, citing unsupportable wait-times for single-payer publicly insured services.

GM US employees will lose their jobs and health care access for their families while Canadian plants will be spared by the GM decision, perhaps because of their reputation for high productivity and very likely, although surprisingly no one is saying it directly, because our comprehensive public health care system is part of our national infrastructure and industrial strategy. The Supreme Court decision offers Canadians the chance to revisit our arrangements and to adapt the public context in order to avoid the fate of those abandoned by private systems and to sustain the Canadian advantage.

Yet Health Care is another pillar of our society subject to criticism whenever adaption and innovation are needed or proposed. Sustainability has for some time been the buzz word. The costs of the baby boom demographic bulge and increasing costs of new technology are frequent points of reference. Too often they have been the excuse to abnegate responsibility and to abandon established social responsibilities.

But to say let the "marketplace" decide is not good enough. Doctors, not stockbrokers or investors, should be empowered to make medical decisions. Private sector participation in delivery of diagnostic services under strict public sector control of costs and distribution is one thing. Privatization, even through so-called Public Private Partnerships, is something else; after all, private providers are free to leave the field when the going gets rough, while public responsibility remains. And privatization may actually make the problem worse.

I recently learned from an interested party that private clinics in Vancouver have recruited Operating Room nursing staff from area hospitals, promising less work for the same or more money to overworked nurses, increasing wait times for available surgeries in public hospitals. Procedures can then be obtained, for those with the money to pay, in private clinics which do not have the obligation to provide nursing and beds for postoperative care; instead, patients are transferred to public hospitals which must accept them, again increasing wait times for those who cannot afford private clinics. This is anecdotal and based on personal experience and disturbing. It seems PPP might also stand for Private Profit at Public expense.

Long term, stable, predictable funding and improved input into diagnostic services, which might include a private contribution, is not the whole solution by any means, but it is a good place to start, I suggest. The model advocated by Mr. Justice Emmett Hall needs to be revisited, I think, mindful of the principled mission on this file of Tommy Douglas and without consideration for mere political opinion.

Brian Marlatt



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