Lorne Gunter: Public health care has no claim to moral superiority
Lorne Gunter, National Post Tuesday, Mar. 22, 2011
Please tell me how this is better than two-tiered American health care?
Monday, the Ontario provincial government decided to cover the cost of Herceptin, a breast cancer drug, for patients with tumours smaller than 1 cm in diameter. Previously only patients whose tumours were 1 cm or larger had the drug paid for by the provincial health care plan, OHIP.
It’s clear the decision was prompted by unflattering news coverage that generated public pressure for the change. It was not the result of a different medical or scientific assessment by health professionals. The risk to small-tumour patients has not been recalculated and found greater than before. All that has changed is the public demand for a new policy, which means this was a political decision, period.
So how is that morally superior to the way things are done in the States?
This shows just how much alike the private, U.S. insurance system and our government monopoly system are, except that here instead of market incentives driving decisions, bureaucratic and political considerations do the steering. We smugly turn up our nose at the U.S. system because private insurers make life-and-death decisions all the time based on profit and loss calculations. But in Canada, similarly crucial decisions are based on civil servants’ desire to control their budgets and protect their turf.
Private insurers try to exclude treatments and patients – i.e. ration care – to save money. But, gee, so does our system. Our federal and provincial health ministries make economic calculations all the time to control public health budgets .
In the case of Herceptin, Ontario knew all along that without Herceptin, small-tumour patients had a one-and-a-half to two times greater chance of recurrence of their cancer than those taking the drug, but it calculated that that risk was acceptable if it saved the public health budget hundreds of thousands of dollars in prescription drug payments. That calculation hasn’t change in the past two weeks. All that has changed is that the public found out and put pressure on the Ontario Liberal government to stop making cold, economic calculations where patients’ lives are at risk — on this one treatment. The ministry hasn’t changed its medical opinion about the wisdom of Herceptin funding, it has simply decided to throw taxpayer dollars at a noisy problem to make it go away.
Squeaky wheels and all that.
You can be sure there are hundreds of other similar calculations made by health bureaucrats every year, hundreds that don’t get funding because the public is unaware of them. Heart transplants for grannies and new hips for nonagenarians, knee repair surgeries for weekend-warrior athletes and MRI tests for people with persistent, but not intense headaches all carry risks but are denied routine public funding because those risks are deemed acceptably small by government health economists.
That is no different than a private insurer’s actuaries calculating that this or that treatment cannot be covered because doing so threatens the bottom line. Especially to the denied patient, the real-life result is the same either way.
Sure, if you think profits and private enterprise are bad things, you will likely be able to convince yourself that the calculations in a public system are preferable because they “socialize” the risk – meaning the risk is spread throughout the community, no one is able to get better care because of their higher income.
But people still end up untreated and even dead based on mathematics.
It is also true in our system that if you are somebody – a premier, a federal party leader, a professional athlete, a health care worker – you get jumped to the head of the line and get preferential treatment not available to ordinary citizens. In other words, status can do for you in our system what cash does for Americans.
Patients here may not die on hospital steps due to lack of insurance (they don’t in the States either), instead in Canada they die at home on waiting lists, out of sight and out of mind of the friends of government monopoly health care.
On top of that, here there is no option of switching insurers for better value or coverage. We are stuck with a single insurer who is susceptible to political pressure and is as efficient as governments typically are.
Gimme some private options. Even such social democratic paradises as France, Germany and Sweden permit private health care delivery for those willing to pay. Canada is almost alone in making private options all but illegal.
Follow Lorne on Twitter @lornegunter