Judge health care by results, not whether it’s for profit

The debate over for-profit delivery in Manitoba’s health-care system too often generates more ideology than insight.

The latest controversy over the NDP government expanding Dynacare lab services in Selkirk is a good example. Critics, including the Manitoba Health Coalition, are condemning the government for relying on a private company after years of political criticism of privatization. But this outrage misses a fundamental point about how medicare actually works.

For-profit companies have been part of Canada’s public health-care system for decades.

That is not a new development. It is not some radical departure from medicare. And it certainly did not begin with the Progressive Conservatives or continue solely because of the NDP.

Manitobans already receive a wide range of publicly funded medical services delivered by private companies and independent providers. Community lab testing is one example, but far from the only one.

Diagnostic imaging, including X-rays and other scans, has long involved private operators. Many physicians operate as independent businesses billing the public system. Yes, they make a profit.

Cataract surgeries, hip and knee replacements and other procedures have for years involved private-sector participation under medicare.

Canada’s medicare system is built on publicly funded access to medically necessary care. It does not require that every service be delivered exclusively by government employees inside government-owned facilities. That has never been the model.

Canada’s medicare system is built on publicly funded access to medically necessary care. It does not require that every service be delivered exclusively by government employees inside government-owned facilities.

Yet every time a private company is involved in health-care delivery, critics react as though medicare itself is under attack.

It’s a misplaced argument.

What should matter to patients and taxpayers is not whether a company earns a profit. What matters is whether Manitobans receive timely, high-quality care and whether public dollars are being spent effectively.

That is the test.

And by that standard, Dynacare has a strong case to make.

Many Manitobans are familiar with the experience. They walk into a Dynacare lab without an appointment, have blood work completed quickly and usually leave within 20 or 30 minutes, sometimes less.

Results are processed efficiently and appointments, when needed, are often straightforward to arrange.

Anyone who has spent time navigating parts of the health-care system knows speed and convenience are not minor considerations. They are central to patient care.

Timely diagnostics are often the front door to treatment. Delays in lab work can mean delays in diagnosis, specialist referrals and medical intervention.

Expanding capacity, particularly in rural and underserved regions, is not some ideological concession. It is practical health policy.

That is why the Selkirk expansion makes sense.

Expanding capacity, particularly in rural and underserved regions, is not some ideological concession. It is practical health policy.

Health Minister Uzoma Asagwara argues the new agreement with Dynacare includes clearer standards, expectations and service requirements than existed previously. It represents exactly the kind of accountability Manitobans should want from any contracted provider.

Governments should negotiate tough contracts, establish performance standards and demand measurable results. They should insist on quality, accessibility and value for taxpayers.

Those expectations apply whether the provider is public, private or somewhere in between.

The real issue is overall value and system performance.

If a private provider can deliver reliable service, shorter waits and expanded access at competitive cost while meeting contractual standards, governments would be irresponsible to dismiss that option solely because profit is involved.

Profit itself is not evidence of exploitation or failure.

Profit exists throughout the health-care system already. Drug manufacturers earn profits. Medical suppliers earn profits. Construction companies building or expanding hospitals earn profits.

Technology firms supplying health systems earn profits. Independent medical professionals operate businesses that generate income and earnings.

Nobody seriously argues that medicare has been compromised simply because these entities make money.

The suggestion that profit has no place anywhere in health care may work as a political slogan, but it does not reflect reality.

Even the NDP appears to recognize that reality now that it governs rather than campaigns.

Rural communities need access to diagnostic services. Patients need timely testing. Health systems need capacity.

Before taking office, New Democrats criticized private health-care services and emphasized investment in public delivery. Those arguments may have been politically useful in opposition. But in government, practical realities tend to replace ideological certainty.

Rural communities need access to diagnostic services. Patients need timely testing. Health systems need capacity.

Those needs do not disappear because the provider happens to be a private company.

If anything, the Selkirk announcement illustrates how governing forces political parties to confront real-world constraints and patient demands rather than rely on simple talking points.

There should always be scrutiny of health-care contracts. Governments must ensure transparency, protect public funding and enforce rigorous standards. No provider, public or private, should get a free pass.

But condemning private delivery on principle alone is the wrong fight.

Most Manitobans don’t care whether a lab company is incorporated as a public agency or a private business nearly as much as they care about getting prompt, dependable care close to home and that they don’t pay out-of-pocket for it.

That is the standard that matters.

And that is the standard governments should focus on.

tom.brodbeck@freepress.mb.ca