Wednesday, April 30, 2008

CDM calls on BC government to reject two-tier health care disguised as "sustainability"

The BC government should remove “sustainability” from the proposed Medicare Protection Amendment Act, Bill 21, unless it unequivocally rejects private for-profit care for medically necessary services and commits to keeping the universal single-payer system, says Dr. Randall White, BC Chair of Canadian Doctors for Medicare.

“We all believe in a sustainable health care system,” says Dr. White. “We all believe in innovation, transparency and accountability – words the government wants to enshrine in the legislation. We all believe patients should have choice in the kind of care they get, that there should be personal responsibility. But we believe in these principles within the context of the public system because the evidence is that single-payer systems provide better value for money than private systems, with health outcomes that are as good or better.”

When governments enshrine these principles in legislation, they provide fodder for the supporters of for-profit care to argue that choice, personal responsibility, and the needs of other public programs require private for-profit health care, says Dr. White. This creates the impression that health care is siphoning funds from other programs, like education. “The reality is the health care budget has grown so much compared with other program budgets because the BC Liberals have reduced social spending and cut taxes.”

Alarmist rhetoric from promoters of commercialized medical care suggests Canada has a crisis that demands privatization, says Dr. White. For example, for-profit supporters use statistics stating Canada ranks 30th in the world in health care. This is from a discredited World Health Organization report that ranked Colombia as No. 1 in "fairness in financing" and the United Arab Emirates as No. 1 in "responsiveness". Meanwhile, favourable studies, such as a 2008 report showing that Canada ranks sixth in preventing deaths from medically treatable disease, are ignored.

Private for-profit care requires commercial insurance, which most Canadians will not be able to afford; or will not quality for. Studies elsewhere show the major beneficiaries of private insurance are investors in insurance companies, private hospitals, and specialist doctors who command high fees. Private clinics will take less complicated cases, leaving the more difficult cases to the public system – along with even longer waiting lists because the specialists will be busy in private clinics.

“We don’t need private for-profit care to have a sustainable system,” says CDM Policy Advisor Karen Palmer. “What we need are innovation and reform within the public system (see Successful Medicare Innovations). This means more surgical capacity in our public hospitals, queue management to reduce wait times, the most efficient use of operating space and staff; and systematic collaboration between generalists and specialists. We also need widespread efforts to prevent chronic diseases such as obesity, diabetes, and addiction.

“The path to sustainability is through a universal, single payer system, not through efforts to cap spending, outsource care to for-profit clinics, and shift costs to patients.”

For More Information:

Randall F. White, M.D. - BC Chair, Canadian Doctors for Medicare
Phone: 604 221 2313 or 604 682-2344 x63966

Saturday, April 19, 2008

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 , 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.

Sunday, April 6, 2008

Patients should be at the centre of the health care system

Re: Healing the system, Vancouver Province, Wed 02 Apr 2008, Page: A4

Dr. Day has it right; patients should be at the centre of the health care system. Unfortunately his prescription for getting them there - forcing competition between hospitals and private clinics - will put profit at the centre, resulting in unhealthy outcomes for most Canadians.

Patient-centred care requires collaboration, not competition. The British Medical Association has expressed serious concerns about the effect of competitive practices, as have doctors south of the border, a majority of whom now want a collaborative style national health insurance program[Annals of Internal Medicine]. The major side effect of competition in countries that allow private for profit care is that the benefits generally go to private hospitals, insurance companies, specialists and wealthy patients. Even Dr. Day's own organization the Canadian Medical Association has said private insurance for medically necessary physician and hospital services does not improve access to publicly insured services, does not lower costs or improve quality of care, can increase wait times for those who are not privately insured, and could exacerbate human resource shortages in the public system.

No doctor wants to see their patient languish on a waiting list. But reducing wait lists does not require the profit motive. It's being done across the country through queue management, improved primary care access and collaborative care models, resulting in dramatic drops in waits in such key areas as hip and knee replacements, cataracts and cancer care. We need a lot more of this.

However, it's also important to remember, that far from being at the bottom of the pack in providing health care – as Dr. Day often suggests - a recent study in Health Affairs by researchers at the London School of Hygiene and Tropical Medicine rated Canada sixth in the world in preventing death from treatable conditions, an excellent value for money.

Danielle Martin and Randall White
Canadian Doctors for Medicare

Tuesday, April 1, 2008

Majority U.S. Physicians support single payer national health insurance

A new survey [Annals of Internal Medicine] of US physicians has found that 59% support legislation to establish a single-payer national health insurance. A previous survey completed in 2002 found that 49% supported a single-payer program. The 10% increase in support during 5 years parallels the increase in uninsured Americans from 43.6 million in 2002 to 47 million in 2006, the last year for which a US Census Bureau estimate is available.

The survey, done by two Indiana University researchers, found that a majority of physicians in every specialty support single-payer universal coverage except surgical subspecialists, anaesthesiologists and radiologists.

The American Medical Association, which represents an estimated 19% of US physicians, has steadfastly opposed a single-payer model. The organization is perceived to represent all US physicians, but its diminutive membership and lack of leadership in addressing the crisis of the uninsured would seem to make it irrelevant. Because no countervailing organization has emerged to represent the other 81% of US physicians, the AMA could make a large difference in the debate by acknowledging these new survey findings endorsing a national health program. I think it would then reverse its membership decline, but I also think it highly unlikely the AMA will change its position.

The leadership of the Canadian Medical Association wants to move away from a single-payer system, and the procedural specialists are leading the way. The current president, an orthopaedist, and the president-elect, a radiologist, both advocate for privatization. This reflects the US survey findings, suggesting that highly paid specialists feel constrained by a publicly funded system.

In Canada, physicians face a dilemma. How can we prevent the discontented procedural specialists from taking us down a path that will be destructive to our single-payer, equitable system? Some of their grievances and frustrations are legitimate. Yet their ability to obtain operating room time, new equipment, and high remuneration should not undermine access to care for our patients, the majority of whom would find premiums for private care a serious financial burden or even unaffordable. Furthermore, we know from experience in Australia and the UK that private clinics flourish at the expense of the public system. We need to establish dialogue within the profession, but we also shouldn’t play nice indefinitely lest we find ourselves with a CMA that no longer reflects the values of most Canadian physicians.

Randall White, M.D.