Let’s argue about health care (Editorial)

Canadians tiring of the private versus public debate

During a visit to Toronto last month former U.S. President Bill Clinton delivered a warning to be wary of American-style health care.

Clinton described the U.S. system as “a nightmare” and a “colossal waste of money” that sees 34 per cent of health-care spending going to administrative costs instead of patient care, compared to the 19 per cent Canada spends on administration. Clinton said that while Canada’s publicly funded system has its problems, Canadians should think long and hard about introducing American-style private insurance.

These are words of encouragement to those who think Canada’s health-care system is a better deal for both patients and the business community than any other model. But is anyone listening anymore? Has Canada’s health debate ground to a halt? Are we tired of arguing about one-tier versus two-tier, opting instead to wait and see what we end up with?

Trying to get a national plan for maintaining and reforming the health-care system has been a national effort in futility. There have been numerous commissions and reports over the years, going as far back as the days of Pierre Trudeau. Earlier this decade the Romanow Commission (led by former Saskatchewan Premier Roy Romanow) and the Kirby Report (by Senator Michael Kirby) added to the mounds of opinions, advice and data collected to support recommendations for the future of Canadian health care. But little — except the length of waiting lists and further announcements of service cuts — changes.

With federal politicians locked in minority-government mode, Canadians shouldn’t expect any bold initiatives either for or against publicly funded health care. It will take a majority government for anything significant to happen in the health portfolio, but even when a majority comes to pass, politicians who wade into the health-care debate will be venturing into an area that has frustrated their predecessors for decades. Is anyone in Ottawa (other than Jack Layton) interested in tackling the health-care monster?

With federal MPs busy laying the groundwork for the next election, provincial politicians are free to carry on debating the merits of a publicly funded system versus one with increased levels of private-sector delivery and funding.

Alberta recently chimed in with “a third way,” but that fizzled when Premier Ralph Klein announced he’s leaving politics. Not that anyone was all that clear on what he meant by a third way. What was the second way? It seems even Alberta has tired of the health debate.

Ontario is too concerned with getting some of the billions of dollars it figures Ottawa owes it to worry about health reform. Those missing billions would likely do more good than reform would anyways. In the meantime, private-sector clinics are looking to open up shop. Ontario’s response to such threats to the Canada Health Act is to “monitor” operations. Another case of not wanting to get involved in the health debate.

British Columbians are quite anxious about provincial changes to health-care delivery and hospital services. And while there’s lots of complaining — “What else can one do?” — it’s not like there’s any value in asking for another commission or some national discussion among leaders.

Meanwhile Quebec is busy trying to work around last year’s Supreme Court of Canada ruling that struck down a ban on private health insurance. In the Chaoulli decision, the court ruled long waiting lists for surgery were a threat to life and security and therefore unconstitutional. Quebec is trying to accommodate the ruling without opening a two-tier Pandora’s box (not that any private insurers are eager to start offering health insurance packages given the current climate).

As for other provinces, everyone seems to be hunkered down doing their best to fund the health system with the dollars available.

Canadians themselves can be excused for tiring of the debate. Even ardent supporters of one tier over the other would likely be willing to forget the whole thing as long as wait times improve.

And as citizens and politicians withdraw from the discourse over health-care delivery, intrusions such as the Chaoulli decision will be more likely to happen. It is the absence of clear public policy that breeds court involvement in social issues.

So thanks for the advice Mr. Clinton, but we’re not talking about this at the moment.

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