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What's Left to Privatize?
(Two-Tiered Medicine)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 24 in the July 30-31, 2005 issue of
The Mississauga News under the feature: Health & Wellness, Medical Matters

I realize that I am only one of many doctors practicing in Canada, but I must confess my ignorance. I wish that someone would wake me up and explain to me just exactly what the concept "two-tiered medicine" means? I tried to figure it out on my own and couldn't. I then went on to solicit opinions from the wise and mighty, not necessarily in that order. Feedback from federal politicians suggests that it means that a second medical system might arise in which Canadians would have options to buy services when they are not available in the public system. In defense of this concept is that everything is available in the public system, all you have to do is wait long enough. At what point do we as a society re-define a "long wait" as non-available?

I think that this all started as a wonderful idea at one time, when Canadians went bankrupt attempting to provide care for their loved ones. With universal health care came the Canada Health Act which guiding principle was that we are all entitled to socialized health care. Over the years the principle has not changed much, but we can add another clause to it; we are all entitled to the same wait, and same amount of worry about the consequences of delay. This stance by the feds smacks a bit of the kettle calling the pot black, because believe it or not, there currently exists a separate federal system of hospitals, cat-scanners and more. I am uncertain when the separate federal system came into existence, but it does make one wonder where federalists receive license to comment on provincial health systems.

As many of my patients love to remind me, they need to pay for many aspects of their health care as it is. Physiotherapy services are no longer covered for most community-based patients. If you injure yourself at work, you get to jump the public cue, and head for a diagnostic test, because as it turns out your insurer can buy what you yourself cannot. I just don't understand this. Scores of enterprising Americans line up and down our neighboring border don't understand this either and are happy to help us understand by dangling quick access to whatever our hearts desire in their system. They seem to have no problem in accepting Canadian money. By the increasing number of ads appearing in our papers, I would surmise that the results are lucrative. In our system, we are free to purchase eyeglasses, chiropractic treatment, breast implants, cosmetic surgery, dental repairs, and ear candling, yet we are largely denied the choice to decide which hip prosthesis or pacemaker we receive or how long the wait is. Strangely enough, the Canada Health Act applies only to Canadians. If you are not Canadian, feel free to immediately step right up and buy anything you want on our health care shelves.

Our system is still able to deal with catastrophic emergencies in a timely fashion, and that provides some illusion of security. There is no argument that it was constructed as a react-to-the-illness kind of way. Prevention takes a back seat in this system frustrating doctors and patients alike, and persuades many people to purchase alternatives. I fail to see how denying choices in health care will destroy the status quo. It is sheer political fear mongering to suggest that the Quebec decision will drastically change anything. It is ridiculous to suggest that our health social net will disappear, it will simply inspire us to take a closer look at the definition and perhaps revise it. I was never a big fan of Alberta's Premier Klein, until I was visiting Edmonton for a medical meeting recently and witnessed clear-cut differences in the inter-provincial provision of health care. The mood ruining session started with a mobile MRI unit pulling into the parking lot during a coffee break and went down-hill from there. I gained a new respect for this politician.

I can easily identify at least seven tiers of care available today, despite everyone insisting that a single system exists. Which one you fall into depends on your native status, wallet thickness, benefit plan, poverty level, political status and illness severity. It is naive to believe that we are all treated the same. I wish that someone would explain to me how this all gets whittled down to two-tiers? When my Dad was alive, he had a pet peeve about people driving around in loud smoking junkers. Canadians have lost pride in their health care system, and our ability to provide efficient care with favorable outcomes is no longer world class. It is difficult to find another socialized system whose "middle layer" is as costly, hidden, expansive and thick as that found in within our own system. Many years later, I believe that Dad's advice still applies to many things including health care. At the very least it needs to be made road-worthy and safe or sell it for scrap metal, but there will be no smoking junkers in our neighbourhood!


Related resources:

Australian health care system an example for Canada in reducing costs and waits for treatment.
Privatization 101 from Nurses for Medicare.
Viewpoint: The Privatization of Medicare from National Committee to Preserve Social Security and Medicare (NCPSSM). ". . . the National Committee will continue to oppose initiatives such as means-testing premiums and the premium support demonstration that likely could result in a two-tiered Medicare program based on income and health status."

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