Scott Stinson wrote in "Ours is not public health care: Dodge", (National Post, Dec.6, 2011):
David Dodge wants Canadians to have an “adult, public conversation” about health-care funding. Finding someone to have that conversation with, though, has proven difficult.
“It’s hard, it’s really hard,” Mr. Dodge said in an interview on Monday after speaking to the Toronto Board of Trade, where he said the worst thing governments could do would be simply to stick to the status quo. The pressures on the system will become too great, and more money won’t cause them to abate.
It’s a conversation, he argues, that needs to include some form of “co-payment” — in which individuals would contribute to the cost of their health care. It could mean user fees. It could mean having health costs treated as income at tax time. It could mean having taxpayers contribute to “health savings accounts” that they would draw on when needed.
Asked if any politicians seem to be listening, the one-time deputy minister of both the finance and health ministries waves his arms and clenches his fists to express how hard he knows this kind of talk can be.
“All a kibitzer like I am now can do is prepare the public ground so that the political systems can do what they know they have to do,” he said.
“There are enough people who have been at this for enough time that maybe, just maybe, the thing is getting more fertile.”
Then he smiled. “Maybe.”
Mr. Dodge’s message is straightforward: Canadians are going to be paying significantly more for health care over the next two decades. Unless things change, he said, we should expect that total health spending will be almost a fifth of the country’s gross domestic product by 2030, up from 11% today — and up from 7% in the 1960s.
That looming problem demands major changes.
“The real disaster would be if governments stood up and said, ‘We have no money, so we’re going to freeze wages in the sector and cut services.’ You do that, and five years down the road you’re going to have all the same problems and the care being provided will be that much worse.”
In April, Mr. Dodge produced a report for the C.D. Howe Institute in which he said that steadily rising health-care costs — partly, but not exclusively, due to the aging population — would force governments to either increase fees, raises taxes or delist services. “Federal politicians are going to have to face this issue,” he warned.
But in the middle of an election campaign, federal politicians did precisely the opposite, falling all over themselves to pledge perpetual increases in the amount of health money transferred to the provinces while offering nothing in the way of reform.
The problem with calling for an adult conversation is that someone else has to be willing to talk.
The general reluctance to do so, Mr. Dodge says, both among politicians and the public, stems from the misunderstanding about how our system works.
“Most Canadians think we have a purely public health-care system,” Mr. Dodge says. “We don’t.”
About 70% of total health spending comes from the provinces, with the other 30% coming from individuals out of pocket, or through private or corporate insurance plans. Canada’s system is actually less public than most places in Europe, he says, where countries on average have about 85% of health spending in the public sphere.
When our system was created in the 1950s and ’60s, he says, it ensured that governments paid for acute care, for hospitals and for doctors. Drug costs? Chronic care? Physiotherapy? All of it, and more, falls outside the government envelope. It’s been that way for 50 years, but to suggest otherwise is to border on heresy.
“We have clung to that model with absolute tenacity, even in the face of evidence that it is no longer the right model,” Mr. Dodge says. He outlined some ways in which the system could be changed, then apologized if his speech was starting to sound a little prosaic.
“But it kind of has to be prosaic,” he added. “Unless we get it off the emotional, we’re never going to solve the damn problems.”
The budget crunch won’t be addressed by piping in more money, he says. “Forty years ago, if your knee was bad, we gave you a cane,” as Mr. Dodge put it. Today, when more costly treatment is available, it is inevitably done.
Most important, he says, health care needs to be considered comprehensively, “not just hospitals and docs,” with the public system including a broad range of services such as chronic care and home care.
If all aspects of health care were under the public umbrella, people would “be able to use the services and the provider that are most appropriate,” he says. “Right now, all of the incentives for both doctor and patient are to use the very expensive acute-care system. But in many cases there is more effective delivery outside the acute-care system.” Specialist clinics over hospitals, in other words.
But the broadening of the system, though it would help find efficiencies, would burden the taxpayer unless reforms were part of the plan.
Which brings us back, again, to that adult conversation that no one wants to have.
So, let's ask Liberal MPP Jim Bradley about Dodge's comments.
After all, Jim Bradley is a practising single-payer-pushing health-care monopolist, who has made a comfortable career maintaining that rigid, unsustainable status-quo. Do we need 'all aspects of health care to be under the public umbrella'?!
Will Jim Bradley ever have this 'adult conversation' publicly with David Dodge about the issues raised here?
For several elections now, secretive Bradley hasn't bothered to have one with the St.Catharines Standard!