Recently, New Brunswick Premier Blaine Higgs and some doctors have pushed for more private involvement in the delivery of health services as one of the key solutions to the present crisis. They are proposing that more private companies be involved in providing private health care services to citizens, while being quick to specify that we would not have to pay out of our own pocket. These services would be covered by our Medicare card.
So, what is wrong with turning to the private system to solve our present problems? Let us remember that we had a private health care system in place before the advent of Medicare. Why did we change it for a public system? The answer is simple. It only worked well for those who could afford it. The majority of Canadians were left out. That is why we put in place in 1965, a publicly funded single-payer healthcare system based on five principles: universality of coverage, portability (access in each province and territories), accessibility to services, comprehensiveness and public administration.
The proponents of more private sector involvement in healthcare service delivery are saying that the private sector is more cost-efficient. Let’s look at the present proposal by Premier Higgs for allowing doctors to do cardiac and kidney stone procedures in their office. How is it cost efficient to have doctors buy the necessary new equipment, hire technicians (stealing them from the public sector) and then billing the public system for these procedures? And let’s not forget that they will want to make a profit on these expenses.
If the doctor wants to keep the hired technician on staff, a lot of exams will need to be scheduled to make it worthwhile. The billing will then mean an increase of administrative work for the public system. So, will any of this be more cost-effective? If we accept more health care services provided by the private sector, where will the employees be coming from if not from the public sector? If the objective is for citizens to have access to procedures outside the hospital setting, why not put in place community clinics run and administered by the public system? Why not have salaried doctors and other professionals in these clinics? I believe this would be more cost efficient.
Three key issues that are overlooked when looking at turning more of our health care services to the private sector are: loss of capacity, loss of accountability and increased influence by private health corporations. If the private sector starts taking a bigger role in the delivery of health services, the public system will lose key staff members and even entire services, so its capacity to offer the same will be severely diminished and could disappear altogether.
We all know that private companies are very secretive of how they run their businesses. Having more of our public dollars going to them will also mean that we will never really know the exact services we are receiving for the money we are paying. If we are not satisfied with the services, who do we go to? The shareholders? The board of directors? The owners?
Finally, the increase of private services will attract big corporations to start getting more involved in the delivery of our healthcare services, meaning a loss of control by the province.
The reasons citizens chose a public system over the private system in the sixties are still very valid today: universality of coverage, portability, accessibility, comprehensiveness and public administration.
What we need now is to put our minds to modernizing our public system so that it is able to adapt to the present and future situations.
Jean-Claude Basque is a long-time social justice advocate, based in Moncton.