I find it especially ironic that this two-tier approach to medicare is being announced on the heels of the announcement of an unprecedented surplus in Alberta, reportedly 7.4B!
The argument I have heard most commonly to justify the need to gut medicare is that it is just too expensive. This is clearly not the reason in Alberta.
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Krissa Fay, MSW
Health Promotion Consultant
Health Promotion Affiliate
Canadian Health Network
c/o The Ontario Prevention Clearinghouse
180 Dundas Street W., Suite 1900
Toronto, ON M5G 1Z8
T (416) 408 -2249 x 275
F (416) 408-2122
email: [log in to unmask]
www.canadian-health-network.ca
The Health Promotion Affiliate is a joint project of the Ontario Prevention Clearinghouse and the Centre for Health Promotion, University of Toronto
-----Original Message-----
From: Social Determinants of Health [mailto:[log in to unmask]]On Behalf Of
Dennis Raphael
Sent: March 3, 2006 10:22 AM
To: [log in to unmask]
Subject: [SDOH] Lessons from Alberta -- the 'medicare advantage'
FYI, op-ed from today’s Globe and Mail by Armine Yalnizyan and Danielle
Martin weighs in on latest Klein health care proposal.
Lessons from Alberta -- the 'medicare advantage'
By ARMINE YALNIZYAN AND DANIELLE MARTIN
Globe and Mail, March 3, 2006 – A15
Alberta Premier Ralph Klein likes to call his contribution to politics the
"Alberta Advantage." Unfortunately, if he gets his way with Alberta's
health-care system, only the financially advantaged will partake in his
version of the Alberta Advantage. The rest will be truly disadvantaged.
The Alberta government's latest proposal to allow people to buy private
insurance for medically necessary services and let doctors "double-dip"
between public and private payment flies in the face of the best evidence
available around the world while breaching cherished Canadian values.
It violates the principle that people should have access to health care
based on need, rather than ability to pay, and it ignores the opportunity
for true improvements within the public system.
Mr. Klein's musings on this subject have become almost commonplace. What is
odd about these salvos is that they run counter to Alberta's own history
and experience. In the past and still today, Alberta has been a proven
showcase for the medicare advantage.
Back in 1970, Alberta became the first province to expand the newly minted
medicare principles beyond doctors and hospitals when it introduced
Canada's first publicly insured drug program for seniors, based on the
clear benefits of risk-pooling and a single-payer system. The case was so
convincing, other provinces followed suit.
Fast-forward to 2005, and again Canada was seeking answers for how to
improve medicare. The Alberta Hip and Knee Replacement Project capitalized
on medicare's economies of scale, procedural specialization and streamlined
information flows to dramatically decrease wait times for joint
replacements. The average time from a consultation with a family doctor
through to actual surgery fell to 11 weeks from 82. Against the rising
voices of the naysayers, the success of this venture happened strictly in
the publicly insured system, not by letting people jump the queue.
Looking for other homegrown success stories? Strategic chronic disease
management techniques at Calgary's Capital Health Authority have produced
faster access to care and better health outcomes for people with diabetes.
So why would Alberta abandon medicare now?
Clearly the "private insurance" or "two-tier" route chosen by Mr. Klein
late in his career is one blinded by the glare of ideology, not driven by
the engine of pragmatism.
Instead of trying to offer faster services to the small number of people
who can afford to pay for them, Mr. Klein should focus on continued
improvement of the publicly funded system.
A focus on improving medicare brings together two fine Canadian traits:
fairness and practicality. Improving publicly funded services is the right
thing to do, because it helps everybody, based on their need, not their
ability to pay. Improving publicly funded services is the smart thing to
do, because the evidence shows that it is the most cost-efficient way to
run a health-care system.
Mr. Klein and others who favour private insurance have cited the high cost
of health care as a reason for privatization. He's right about one thing:
Health care is expensive.
The growth of chronic disease, the aging of the population and soaring drug
costs all mean we will be spending more money on health care over the
coming decades.
This is true in all industrialized countries, no matter what the mix of
public and private funding. For any system to be sustainable, we will need
to get better at preventing illness and managing costs.
What the Alberta plan misses is the fact that a system with multiple
insurers is more expensive than a single-payer system. Witness the American
system, in which 25 cents of every health dollar goes towards
administrative costs. Canada's publicly administered health systems average
two per cent overhead costs. To abandon a single-payer system, the most
cost-efficient method of insuring citizens in this context makes no sense.
These reforms may prove the most dangerous political experiment of Mr.
Klein's daring career.
Framed as a "necessary" response to cash-strapped public systems and
choice-hungry "consumers" of health care, it won't be long before Canadians
begin to realize that putting in place advantages for the
already-advantaged won't help advance health care in the least. Alberta's
free spirit has helped drive experimentation and innovation in health
reforms. But Alberta, like all other Canadian jurisdictions, will keep
coming back to the "Medicare Advantage," which is based on overwhelming
evidence and long-standing Canadian values. Albertans should settle for
nothing less.
Armine Yalnizyan is a health economist and research associate with the
Canadian Centre for Policy Alternatives. Danielle Martin is a family
physician and sits on the Health Council of Canada.
http://www.theglobeandmail.com/servlet/Page/document/v5/templates/hub
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