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Public vs. private health-care debate back on the table

Photo illustration by Mathias MacPhee

Canadian courts just may be opening up the health-care battle with cases gearing up to challenge the current system. Years have gone by since the Supreme Court of Canada banned Quebec from using private health-care establishments for medically mandatory services, but B.C., Alberta, and Ontario are all going to face the Supreme Court in hopes of creating a private health-care system. It’s a debate that’s been plauging politics for many years: how should health care be administered to the masses?


Point: Private isn’t the way to go

Private health care: Seems like a good idea, right? No wait times, you get what you pay for, the hospitals get cleaned more often—who wouldn’t jump on board? Maybe the millions of people who can’t afford to go to a private doctor every time they have any illness, disease, or mild malady.

Private health care is health care for the richest in society. If you have the money, or your company’s benefit plan has the money, then you get to be healthy, but if you can’t pay for your blood pressure pills or diabetes medication, well, that just sucks for you, doesn’t it?

The concept of the two-tiered system creates a problem: why on earth would a doctor be a public doctor, when they could make a lot more money as a private one? The money for private doctors is incredibly lucrative, and people are hedonistic. If you say to a person, “You can help a lot of people, but you have to work a ton of hours for shit pay, or you can make a lot of money and work fantastic hours,” it’s easy to predict which one they’ll choose.

If the best and brightest were to go private, who would be left for the public health-care system? For the most part, it would be those doctors who scraped by in medical school. So while rich patients get the best, those without a lot of money get screwed over.

Our health-care system isn’t perfect, but fact is, it’s the best system out there. Canadian medicare is emulated around the world. In the U.S.—a country reliant on the private system—Barack Obama used the Canadian health-car system, combined with Mitt Romney’s system set up in Massachusetts, in the original plans for his health-care reforms.

Canadians have a government right now that does not like public health care. In the next few years, the healthcare issue will be addressed and when it does, we should all be very afraid.

Public heath care is sacred. It is a part of our identity as Canadians. Free health care is the best thing about being crazy socialist Canucks, and we should embrace it.

—Andrew Ikeman


Counterpoint: the best of both worlds

Two people walk into a clinic. Both of them suffer from severe arthritic hips and are in need of a hip replacement. The first person has to wait three months before seeing a specialist, and then is put on an 18-month waiting list for hip surgery. The second person goes in to see a specialist the day his hip begins to hurt and gets an appointment for surgery for the following week. As inequitable as this may seem, both these individuals exist in every Canadian neighbourhood. The difference is that the first story is about my 85 year-old grandmother and the second story is about her dog.

Nanos Research, a prominent Canadian polling company, surveyed Canadians last month on what issues they considered the most important, and found that “keeping our health-care system strong” was our number one priority. In the paltry economic climate that we are all living in right now, I think the fact that health care beat out our employment issues says something quite significant about how seriously we take our medical system.

How strong is our universal public health-care system in practice, though? Wait times for most major surgeries average over a year in many provinces, although the interprovincial variation is significant (with some of the shortest wait times on the west coast, and the longest in Quebec). Nonetheless, all life-threatening surgeries are thankfully dealt with immediately. Despite its flaws, we Canadians have generally been enamoured with our universal access system over the years, especially in contrast to what our southern neighbours had until Obama’s reforms in 2010.

But could we re-jig our health-care system to provide better service to all citizens? An argument of interest, recommended by institutions like the Fraser Institute and the Canadian Health Coalition, refer to the potential of a two-tiered system or a public system with a small private option.

Private health care would not be a new thing in Canada. Recent figures indicate that 28 per cent of our health care is paid for out-of-pocket. Think of going to the dentist, seeing a psychologist, counsellor, optometrist… the list goes on. What is illegal in many provinces is paying for services that are provided for under the Canada Health Act of 1984.

In 2009, Nanos Research found that 92 per cent of Canadians want to find a public solution to our health-care problems. In some ways, I agree. Why should one Canadian get service quicker than the next? We are a much more egalitarian society here in Canada than in the U.S., and this is something I am proud of.

The model I have seen proposed is one where doctors become allowed to open up private clinics across the country and charge fees to clients with the capacity to pay. This would supplement their salaries, providing significant incentive to stay in Canada. In line with this, the doctors would be legally bound to spend at least 75 per cent of their time in the public system, upholding the Canadian value of providing quality service to all. They would then have more time for those without the ability to pay, cutting wait times for all Canadians.

—Daniel LeRoy