Book review

The London Free Press - November 12, 1999
Fine book on the need for fundamental medicare reforms
By Rory Leishman

"Sir, we have the best health care system in the world," declaimed Dr. Rey Pagtakhan, Liberal MP for Winnipeg North, to a caller on a radio talk show who complained about medicare waiting lists. More and more Canadians, though, are no longer willing to accept such smug non-answers to their growing concerns about Canada's failing medicare system.

In Code Blue: Reviving Canada's Health Care System, David Gratzer cites an Angus Reid poll conducted earlier this year which found that only 24% of Canadians still rate medicare as "excellent" or "very good."  That's down from 52% in a similar poll conducted four years earlier.

What has gone wrong? Liberal politicians and their academic allies insist there is no reason for alarm. Thus, in a recent book on what the United States might learn from Canadian experience with medicare, Pat and Hugh Armstrong of Carleton University maintain that, "Canadians do not wait for care that is required immediately."

That's plainly false. In a 1995 study, the Radiation Oncology Research Unit at Queen's University reported that while most patients in Ontario began radiation treatment within medically prescribed time limits in 1982, that was true of only a few patients in 1991. Over this same period, the waiting time for radiation treatment by women with post-operative breast cancer increased by more than 100%.

Earlier this year, the Harris government resorted to the humiliating expedient of sending Ontario cancer patients to the United States for timely radiation treatment. Defenders of Canada's publicly funded medicare monopolies blame such deficiencies on cutbacks in government funding.

That, too, is patently false. Gratzer points out that even after Finance Minister Paul "the Axe" Martin had supposedly slashed the medicare budget, total health care expenditures amounted to $80 billion in 1998, up from $61 billion in 1990. Even in Ontario, provincial spending per person on medicare increased more during the first three years of the reportedly tight-fisted Harris government than during the last three years of the free-spending Rae government.

In the decades ahead, the costs of Canada's purportedly "free" medicare are set to explode. Gratzer cites a study by the Fraser Institute, which found that the hopelessly inefficient system already costs the average working Canadian about 21 cents out of every dollar earned. However, if the age distribution of the Canadian population were the same today as it is likely to become in 2040, fully funding medicare and other current government programs would require tax rates for the average Canadian family of 94.5%.

That's out of the question. Gratzer persuasively argues that nothing short of radical reforms can save the medicare system from impending collapse.

"Canada," he points out, "is the only major economy in the world in which it's illegal to sell private insurance for services covered by the public system." Unlike Britain, France, Sweden and every other European country, Canada maintains a public-sector medicare system that is entirely sheltered from private-sector competition.

To remedy this fatal defect, Gratzer favours the creation of tax-free medicare savings accounts for the purchase of medicare insurance from competing private-sector companies. Under terms of this system, all Canadians, regardless of income, would still be guaranteed access to affordable coverage for all major medicare bills, while physicians, hospitals and other medicare providers would be forced to compete in offering services to the public.

To curb abuses of the system by patients, there would be a limit on coverage for routine procedures, such as consultations with a physician by people suffering from a cold. In the case of a healthy young man, this limit might be $400 a year. If he were to exceed that amount, he would pay the next $100; but all of his medicare costs in excess of $500 would be fully covered.

Aging defenders of the medicare status quo denounce the kind of reforms proposed by Gratzer as tantamount to adopting a two-tiered, allegedly United States-style medicare system.  Such mindless cliches are wholly unpersuasive. Anyone open to fresh ideas about how to remedy the fatal flaws in Canada's public sector medicare monopolies would do well to give fair-minded consideration to the well-reasoned arguments for reform in Gratzer's book.