> To relate back to Jordan's point there are many problems related to health
> care
> delivery and government cost control in Canada. Politically speaking,
> creating
> single-payer in the United States may solve many problems but there will
> be
> trade-offs between benefits and taxes. Inherently socializing insurance
> without
> strong formal controls over the strength of drug companies, hospitals,
> doctors
> is guaranteed to have problems. Solving the average families horrors over
> co-pays, coinsurance, exclusions, high deductibles, and massive premiums
> are
> worthwhile benefits of single-payer but I doubt it would be politically
> sustainable at the the tax rates necessary to fund it if the current
> health
> care delivery system and drug co. propaganda remain in place.
----------------------------------------
There are a lot of problems - and misconceptions - about the Canadian public
single payer system. But it is to the US system what parliamentary democracy
was to absolute monarchy, an advance. Apart from the all-important equity
issue, it is administratively more efficient and single payer appears to be
the most effective means of applying price pressure on Big Pharma.
The Canadian public system was defended by the Romanow Commission which was set up to review it in the wake of mounting privatization pressure from the right. Below is the joint statement reacting to the Romanow report, its strengths and deficiencies, by the Canadian Labour Congress and the Canadian Health Coalition.
You're probably familiar with the latter. List members who have been following the thread can consult its website at http://www.healthcoalition.ca/. The Canadian Union of Public Employees, which has led the fight and is a central player in the CHC also has an excellent site at http://cupe.ca/www/healthcaremedicare, which refers to a study in the Archives of Internal Medicine (2003) pointing to the administrative savings in the Canadian system.
Canadian Labour Congress and Canadian Health Coalition Preliminary Analysis of Romanow Report
2002-12-07
Overview and Broad Principles
The Romanow Report on the Future of Health Care concluded that there is a consensus among Canadians that Medicare is a moral enterprise, not a commercial venture. Canadians believe that equal and timely access to medically necessary health services on the basis of need alone is a right of citizenship. The core values which underpin Medicare remain the same - equity, fairness and solidarity. As a result, Canadians reject diluting the principles of Medicare, scrapping national standards, paying privately to get faster care, and treating health care as a business.
In his message to Canadians, Commissioner Romanow said, "I believe it is a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to care." The Report clearly states that Romanow challenged those advocating user fees, medical savings accounts, de-listing public services, greater privatization, and a parallel private system to provide him with evidence that these choices would improve or strengthen the health care system. He clearly said that "The evidence has not been forthcoming." There is no evidence that these solutions will deliver cheaper care or improve access to care. Further, the principles underlying these solutions are directly contradictory to the values of Canadians and the values of Medicare.
For those reasons, the Romanow Report rejects a parallel tier of private, for-profit care for the delivery of what he calls direct health care services such as medical, diagnostic and surgical care. This conclusion is to be applauded. It is based on evidence that for-profit care will harm, not improve, Medicare.
However, the Report mistakenly says that a line can be drawn between health services and ancillary services such as laundry, food preparation, cleaning, and maintenance services. These services are said to be appropriate for delivery in the private sector. The labour movement disagrees with this approach. These services are health services and those who provide them are health care workers, and they see themselves as health care workers. These services are pertinent to the health of patients. Good nutrition is critical to people who are sick, and the cleanliness of hospitals is essential to patients, staff and the public.
While the Report has rejected a parallel tier of for-profit care, there does not appear to be a mechanism for ensuring that this does not happen. It does recommend that the Canada Health Act must be clarified to include these services under the Act. The Report needs to be looked at more closely.
Overall, the Romanow Report offers some important steps forward to preserving and expanding Medicare for today's and future generations, but it is just a starting point. It has established some fundamental principles which need to be built and expanded upon.
Public-Private Partnerships
The Report rejects the argument that Public-Private Partnerships to design, build and operate health facilities, such as hospitals, will save the public money. Romanow notes that these agreements have been shown to cost more over the longer term, and can have the effect of hospital bed closures and a reduction in nurses and other health staff. Romanow stops short of recommending no Public-Private Partnerships.
Medical Savings Accounts, User Fees and Co-payments, Tax Credits, and Deductibles
Romanow rejects these alternative measures to raise more funding for Medicare. In the end, all of these measures violate the core principle of equity and equal access to care based on need for care. These measures promote access based on ability to pay.
MRIs and CT Scans
The Report calls all diagnostic services required to assess a patient's need for health services to come under the conditions of the Canada Health Act, including the prohibitions of user fees, facility fees and extra-billing. The CHA should be amended to clarify this.
CHST
The Report calls for federal health funding to be taken out of the CHST and put into a new transfer - The Canada Health Transfer. This transfer would be a cash-only transfer and have an escalator clause so that federal funding would keep pace with economic growth and our ability to pay. The CLC has called for this since the CHST was put in place in 1995.
Expansion of the Public System
The Report recommends that the Canada Health Act should be revised to include home care services in priority areas. This would include post-acute home care, including drugs and rehab services, as well as coverage of palliative care in the home during the last six months of life. Also, it would include a program of support for informal care givers. Home mental health services should immediately come under the CHA.
It calls for a Catastrophic Drug Transfer to help provinces with their drug plans. Eventually, the CHA would cover the cost of prescription drugs.
(snip)