National Medicare Week has just passed, buoyed with optimism as a fresh-faced government takes the reins in Ottawa — elected partly on a promise of renewed federal leadership on health care.\u00a0 Yet these \u201csunny ways\u201d are overcast by recent developments at the provincial level that entrench and legitimize two-tier care.<\/p>\n
Saskatchewan has just enacted a licensing regime for private MRI clinics, allowing those who can afford the fees — which may range into the thousands of dollars — to speed along their diagnosis and return to the public system for treatment.\u00a0 Quebec has just passed legislation that will allow private clinics to extra-bill for \u201caccessory fees\u201d accompanying medically necessary care — for things like bandages and anesthetics.<\/p>\n
Once upon a time, these moves would have been roundly condemned as violating the Canada Health Act<\/em>\u2019s principles of universality and accessibility. \u00a0These days, two-tier care and extra-billing are sold to the public as strategies for saving medicare.<\/p>\n Under Saskatchewan\u2019s new legislation, private MRI clinics are required to provide a kind of two-for-one deal: for every MRI sold privately, a second MRI must be provided to a patient on the public wait list, at no charge to the patient or the public insurer.\u00a0 Quebec\u2019s legislation is touted as reining in a practice of extra-billing that had already grown widespread.<\/p>\n Underlying both reforms is a quiet resignation to the idea that two-tier health care is inevitable.<\/p>\n This sense of resignation is understandable, coming as it does on the heels of a decade-long void in federal leadership on health care.\u00a0 Throughout the Harper government\u2019s time in office, the Canada Health Act <\/em>went substantially unenforced as private clinics popped up across the country.\u00a0 Even in its reduced role as a cheque-writer, the federal government took steps that undermined national unity around health care, switching the Canada Health Transfer to a strict per capita formula, which takes no account of a province\u2019s income level or health care needs.<\/p>\n If Canadians hope to reverse this trend, we cannot simply wage a rearguard battle for the enforcement of the Canada Health Act, <\/em>as it was enacted in 1984.\u00a0 Even if properly enforced, the Act <\/em>protects universal access only for medically necessary hospital and physician services.\u00a0 This is not the blueprint of a 21st<\/sup> century public health care system.<\/p>\n We desperately need universal coverage for a full array of health care goods and services — pharmaceuticals, mental health services, home care and out-of-hospital diagnostics.<\/p>\n Canada is unique among OECD countries in the paucity of what it covers on a universal basis despite falling in the top quartile of countries in levels of per capita health spending.\u00a0 Far from being our savior, the Canada Health Act <\/em>in its current incarnation is partly to blame \u2013 not because of its restrictions on queue-jumping and private payment but because it doesn\u2019t protect important modern needs, like access to prescription drugs.<\/p>\n There are limits on what a public health system can provide, of course — particularly as many provinces now spend nearly half of their budgets on health care. \u00a0But fairness requires that these limits be drawn on reasoned basis, targeting public coverage at the most effective treatments.<\/p>\n Under our current system, surgical removal of a bunion falls under universal coverage, while self-administered but lifesaving insulin shots for diabetics do not. A modernized Canada Health Act <\/em>would hold the provinces accountable for reasonable rationing decisions across the full spectrum of medically necessary care.<\/p>\n Instead of modernizing medicare, Saskatchewan and Quebec are looking to further privatize it.\u00a0 Experience to date suggests that allowing two-tier care will not alleviate wait times in the public system.\u00a0 Alberta has reversed course on its experiment with private-pay MRIs after the province\u2019s wait times surged to some of the highest levels in the country.<\/p>\n The current wisdom is that long wait times are better addressed by reducing unnecessary tests.\u00a0 A 2013 study of two hospitals (one in Alberta, one in Ontario) found that more than half of lower-back MRIs ordered were unnecessary.<\/p>\n Skirmishes over privatization have to be fought, but they should not distract us from the bigger challenge of creating a modern and publicly accountable health system — one that provides people the care they need, while avoiding unnecessary care.\u00a0 Achieving that will make National Medicare Week a true cause for celebration.<\/p>\n From EvidenceNetwork.ca<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" National Medicare Week has just passed, buoyed with optimism as a fresh-faced government takes the reins in Ottawa — elected partly on a promise of renewed federal leadership on health care.\u00a0 Yet these \u201csunny ways\u201d are overcast by recent developments at the provincial level that entrench and legitimize two-tier care. Saskatchewan has just enacted a […]<\/p>\n","protected":false},"author":913,"featured_media":292614,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","ep_exclude_from_search":false,"footnotes":""},"categories":[],"tags":[],"article-status":[],"irpp-category":[],"section":[],"irpp-tag":[],"class_list":["post-292620","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"\n