Two Visions of Sustainability

Randall F. White, MD
19 April 2008

Professor Marie-Claude Premont said that the BC government is attempting to undermine the foundation of publicly funded, not-for-profit health care in British Columbia. She spoke to the delegates of the The Health Sciences Association of BC at their annual convention on April 18 about Bill 21 www.leg.bc.ca , which was introduced by health minster George Abbot and has had first reading.

Premont, on the faculty of L’Ecole Nationale de l’Administration Publique de l’Universite du Quebec, said that the preamble of the Medicare Protection Amendment Act contains important words that belie its intent. It calls for “individual choice, personal responsibility, innovation, transparency and accountability,” each of which may be used as means to introduce privatization and profit motives into health care. Accountability, she said, is a business term and not a traditional term in public administration. Despite this, the bill would insert it into the “public administration” paragraph of the Medicare Protection Act. Premont believes this may facilitate activity-based or, as Brian Day prefers, “patient-centred” funding.

The bill’s rhetoric also aims for an “integrated” health care system, which many Medicare supporters would endorse. But Premont said this could mean an integration of public and private elements.

The heart of the bill is its call for sustainability, defined as “annual health expenditures that are within taxpayers' ability to pay” without taking too much of the provincial budget. This leaves the door open for spending caps. Premont pointed out that the denominator of the equation is tax revenues, not provincial GDP or some other measure of total wealth. If the BC Liberals continue to prioritize tax cuts over social spending, the inflation-adjusted budget for health care will shrink in coming years. This will pave the way for shifting costs to patients, a wider market for commercial insurance, and accelerating privatization.

Canadian Doctors for Medicare has a different, broader vision of a sustainable health care system, one that considers patients’ and providers’ needs, not just the minister of finance’s needs. Increasing the capacity for publicly funded and delivered health care, including innovative surgical programs, better primary care access, collaborative care, and universal pharmacare could help achieve sustainability. The BC government, however, is enacting a narrow vision and is setting the stage for health-care profiteering. BC residents should immediately let their MLAs know what they think of that.