I saw this attention grabbing headline recently: BC Supreme Court Case Biggest Threat to Medicare in this Generation. Dr. Danielle Martin, head of Canadian Doctors for Medicare, is sounding the alarm about an upcoming supreme court case regarding extra billing. You’ll recognize Dr. Martin from a while back when she made the rounds on YouTube schooling American senators on the Canadian Healthcare system.
I’m not interested in arguing the legality of this or the constitutionality of that. What does interest me is the amount of energy our society puts into resisting any suggestion of fundamental change to our healthcare system.
But our healthcare system is the best in the world, right? Our healthcare system is better than America’s, so it makes sense you’d resist change if you’re world class – don’t fix it if it ain’t broke.
Who cares about America – let’s look at the world
The Organization for Economic Cooperation & Development (OECD) presents data on the performance of its member countries’ healthcare systems. The figure below shows Canada is the sixth highest spender on healthcare per capita.
But of course, our healthcare system is awesome, and awesomeness costs, right? It’s a price we’re willing to pay for the best healthcare system in the world. Well, let’s see how the outcomes of our system compares internationally.
Two things jump out at me when I look at that figure.
- On most outcome measures, we’re in the bottom half. 6th in terms of per capita spending … 16th or worse in terms of outcomes
- HOLY CRAP, Canada is only 22nd in terms of public coverage of healthcare costs.
Read that second point again and let it sink in. Only five countries spend more per capita than Canada does, but 21 countries manage to cover more healthcare costs than we do.
Which is weird, because if you ask a Canadian about why they love their healthcare system, they’ll say something along the lines of “it’s universal”. Hardwired into the fabric of our nation is the idea that everyone will have their medical expenses covered, regardless of their economic state.
But of course, we know we don’t have universal coverage. We have to pay for our own dental care and eye care. Medicare pays for your visit to the doctor, but that $100/month medication you need to take for the rest of your life, well, good luck with that. In Canada, the public system only covers 70% of healthcare spending, the balance being covered by corporations and households (Source).
Universality, this belief that one’s economic state should not determine your access to healthcare, is part of our culture, part of our very morals and values. But 21 countries are living up to our values better than we are, and do so while spending less.
You can’t just throw money at this problem
It’s easy to ask our governments to cover more expenses to match that of other countries, but with one of the highest per capita spending in the world, we’re reaching the limits of the money we can throw at the problem. For years, provincial and federal governments have been saying healthcare spending is unsustainable, and here’s why. The figure below shows the breakdown of the expenditures of provincial governments in Canada.
About 42-45% of provincial spending goes towards healthcare, and that is growing. Left unchecked, I see only three outcomes.
- Provincial governments become less like governments, and more like massive healthcare administrations. Spending on other areas, such as education and infrastructure, suffer,
- Healthcare funding fails to keep up with needs, and our medical system deteriorates further, or
- Taxes rise, and they rise a lot.
But, those three options do not have to be our destiny. As I showed above, many other countries spend less than we do, and get more. Many countries live up to our values better than us, and do it with less money. We don’t need to invent new systems to achieve those same gains, we just need to borrow best practices others have already developed.
So, what’s the real danger to our healthcare system?
I think that moving from 22nd place in healthcare coverage to 1st, at a lower cost than what we’re currently spending, is going to require fundamental changes. You cannot achieve such a significant improvement just by asking professionals in the field to work harder and smarter for the same or less pay. Sure, doing so will give us marginal improvements, but we need fundamental improvements.
And here’s where I see the big danger. We, as a society, are wholly unwilling to have this discussion. Any suggestion of change is shot down amidst cries of “it’s a slippery slope to a two-tier American style system.” Who cares about America? Let’s start comparing ourselves to countries that are covering more healthcare expenses, those countries that are living up to our own values better than we are, and are doing so for less money.
Instead of asking our leaders what they’re doing to defend our healthcare system, let’s ask them what other countries do that allow them to cover more medical expenses and provide more services at lower overall costs. And, then, let’s discuss which of those systems we can incorporate into our own.