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Jay Currie

One Damn Thing After Another









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6/17/2005

Fixing the Lottery

And there is a larger issue here: the woes of Chaoulli's patient are, unfortunately, all too common in Canada. People wait for practically any diagnostic test, surgical procedure, or consultation with a specialist. The doctor shortage is so severe that, in Norwood, Ont., winning the town lottery isn't a ticket to material wealth. With just one family doctor to service the entire town, the physician will take only 200 new patients over the next four years. As a result, the town held a lottery, with the 200 winners getting an appointment with him.
david gratzer, macleans
Lorne Gunter pointed me to this troubling story. The distortions created by a purely public healthcare system replicate the town of Norwood everytime a person actually needs that system.

Allowing private provision of medical care, or, to be more accurate acknowledging that this is already happening as Canadians go south for needed medical care at a price, would go some distance towards altering the harrowing lack of choice patients face in the current system. Being told that a) you have cancer, b) that it is treatable, c) the line for treatment is three months long and forms to the right is not what Tommy Douglas had in mind.

Critically, in looking at what comes next for Canadian healthcare, we need to look at the entire equation. Not just the provision of critical care but also ways of reducing demand for such care.

Ian Welsh at Tilting at Windmills makes interesting points as to where the bottlenecks are in the present system and suggests that allowing a parallel private system to evolve will not deal with those bottlenecks. In my view he has his facts wrong but, even granting his facts, it is not clear that a private system would not, in principle work to reduce those bottlenecks.

Where there are a lack of facilities and equipment private providers could easily bring more equipment online. Hell, they could lease the hours that MRI machines are not being used by the public system because it cannot afford to pay the public service union overtime rates and the operating rooms which stand idle for want of funding for the overtime of nurses and techs. Simply using what we have efficiently, and at realistic wage rates would go a long way to reducing rationing.

As well, the existence of a parallel private sector could improve the situtation with respect to a percieved scaricity of trained people. Canada loses nurse and doctors, as well as the highly skilled respiratory techs and profusionists, to the US and the Middle East because they can make tons more money working there. (Make and keep as the tax rates are significantly lower.) However, if those professionals could find additional work in the private sector they could boost their incomes and have a greater incentive to stay in Canada.

What the Supreme Court recognized in Chaoulli is that the present system is broken badly enough that it constitutes a threat to the security of individual Canadians. So now the challenge is to fix that system. And the first step in fixing the public system is recognizing the potential of a parallel private system.