Privatization and health care

Viewing profits as primary is a dangerous move

Andrew Lodge, Volunteer Staff

In this country, debating health care is as defining as hockey. It is a perennial affair that grabs headlines and touches nerves with seeming impunity. Over the past decade, public health care has lost its almost sacred status and now privatization is discussed as a legitimate alternative.

It is very difficult to tease out the various components of this debate, primarily because so many agendas are at play, and because the debate itself, being a national pastime as well as being so important on a fundamental level to so many in the population, enflames passions on all sides. Peoples’ health and well-being (not to mention billions and billions of dollars) are at stake.

The standard argument for increasing privatization (often referred to as the politically benign “two tier” model) hovers around the notion that the current system is clumsy and inefficient. The root of the inefficiency, so the argument goes, lies in the fact that the system is regulated publicly, through multilevel government organs. Allowing greater private operation would afford a more significant role for market forces, which is assumed to maximize efficiency.

It should also be noted that, too often, the debate becomes hopelessly confused because of absent definitions. What exactly is “two-tiered” anyways? And just how private do we want to go? Even more pertinent, perhaps, is the lack of an accurate portrait of the current system. Much health care in Canada is already publicly funded but privately delivered. So the system is already something of a mixed one today, a fact that is not always readily acknowledged.

Essentially, though, two-tiered means that people have the opportunity to pay for a procedure to be done privately, thereby jumping ahead of a long queue and solving the problem of the so-called waiting list. Less people on the public side of the fence would, in theory, help relieve the over-stressed system.

It is instructive to look to our friends south of the border. The U.S. model is one of the most privately-directed systems in the world. That should, therefore, make it one of the most efficient. Au contraire. The U.S. government spends almost double per capita on health care than other industrialized countries. There are 50 million people in that country who are uninsured, for whom illness is not only a biological catastrophe but an economic one as well.

The U.S. system is recognized globally as the most inefficient health care system in the world. Furthermore, even with this massive and disproportionate spending, the U.S. rarely makes the global top 20 when it comes to various health outcomes. With respect to life expectancy, the U.S. ranked 27th in 2004, just ahead of Cuba, which spends about 10 per cent of what the U.S. does.

Granted, the pitiful American example is not the only privatized health care model. But when it comes to restructuring (or rolling back) social spending, Canadians have a pretty consistent habit of following the American path, albeit in a somewhat blunted form.

And other experiments with privatization across the ocean in Europe are also producing some worrisome results. Care improves for richer segments of the population while publicly-funded and universally accessible care erodes. The point here is, you don’t judge a society by how well its richest members fare.

Even if private delivery was as efficient as public, this would not necessarily be a carte blanche to privatize. Efficiency does not mean effective distribution. The ideology of privatization comes with its own set of language and definitions. The “individual” is the focus, and individuals should have the “freedom” to be able to pay for health care. This “freedom” is promoted as a moral right.

But it should be fairly obvious that simply by virtue of having a wallet full of cash does not bestow the individual a moral right unavailable to someone whose wallet is empty. Fundamental components of our world — health care, education, security, and so on — should never hold the individual as the basic unit. It is a collective concern and the collective should have equal say and equal access. That is something that cannot be guaranteed by the market and, therefore, it should not be left up to the market.

The idea of two tiers assumes that private and public can exist side-by-side harmoniously. This is by no means clear. It is most likely virtually inevitable that some degree of blending must occur, as it does today. However, a complementary, non-antagonistic relationship is unlikely.

As the United Kingdom’s privatizing shift over the last decade has shown, the private system is just as likely to eat away at the public one. And because the private system is directed to maximize profit, service delivery is often focused in the more lucrative and relatively easily dispensed elements, such as laser eye surgery, leaving holes in the provision of care in other departments.

The privatization mantra holds that the market best knows how to direct the operation of health care delivery. But that unquestionably depends on how that delivery is evaluated. Privatization would undoubtedly be very good for some, and it would certainly make some people very wealthy. However, if the benefit to some is at the expense of others, it is not a step in the right direction. Basing the health of a society on an ideology which holds profits as primary is a dangerous move.

Andrew Lodge is a third-year medical student.