Solving the health-care crisis, Part 1

Hey there, time traveller!
This article was published 17/06/2024 (554 days ago), so information in it may no longer be current.

Scarcely a day passes without a media story about the health-care crisis and the government response that it is “working” on the problem and has solutions.

The Conservatives attempted to overhaul Manitoba’s health care by adopting a deep cost-cutting strategy, believing that systems would adjust. They closed emergency rooms and introduced urgent care centres, hoping patients could select the appropriate services.

However, this approach was an abject failure, as everyone chose emergency care “just to be safe.” Wait times escalated, and this policy contributed to electoral defeat.

Conversely, the NDP is reversing course and intends to increase healthcare spending significantly. It acknowledges that Manitoba’s fiscal capacity has limits and seeks increased federal transfer payments to fund this expansion. This makes political sense since any shortfall in federal funding becomes a prophylactic excuse for failure.

Can the medical profession solve the crisis? Probably not.

When the press features a representative of Doctors Manitoba, usually in scrubs with a stethoscope to add credibility, it is crucial to remember that this is a union representative. Doctors Manitoba, the recognized bargaining agent for about 4,000 health-care professionals, will naturally prioritize the interests of its members over those of patients and taxpayers. This holds for those speaking on behalf of the Manitoba Nurses Union, pharmacists, and hospital management. Who speaks for the patient or the taxpayer?

Failure is inevitable because governments have limited vision and have adopted “no-go zones” in health policy. Extreme cost-cutting and flinging money will not work. Health care in Canada has institutional atherosclerosis, with fatty globules of self-interest clogging the system.

Canadians revere our publicly funded health-care system, often contrasting it with the perceived chaos of American health care. However, our global ranking has slipped from eighth to 11th over the past two decades. We desperately need a new direction.

And any revision to our health care must involve greater involvement from the private sector. Before everyone piles on and accuses me of being a shill for corporate care, consider reality.

In 2017, Canadians spent $6.5 billion on Complementary and Alternative Medicine (CAM), about $2.3 billion on natural health products, and over $2 billion on medical tourism (such as hip replacements in Mexico). While government programs and secondary insurance may cover some CAM, such as chiropractic, most of these expenditures are out-of-pocket. Private care is already a large part of how many Canadians organize their health services.

Many decry the increased role of the private sector, arguing that it creates a “two-tier” system where the rich will muscle out the poor. That horse has long left the barn.

Networks as diverse as bowling leagues, religious organizations, and coworkers often support personal connections to jump to the head of the line. Income is a factor in two-tiered health since the rich are likelier to know a doctor who can accelerate access to care.

Two-tier health care is the inevitable result of a publicly funded system that restricts access.

Most opponents of increased private sector involvement in healthcare ignore the role of the family.

Before the rise of the welfare state, immediately after the Great Depression, the family and local communities were the backbone of health care. Socialized medicine offered the promise of universal access to health care. Most Canadians bought into this promise, but COVID-19 exposed the structural weaknesses in the system and attempts to fix the problem by throwing money in the general direction of new facilities and as bribes to entice more workers to become nurses and doctors will not work.

(In part 2, I consider whether AI can replace the family doctor and how the family must step up to manage the tsunami of elders needing care.)

Gregory Mason is an associate professor of economics at the University of Manitoba.