Misguided proposals for two-tier health care

The incoming CMA president Brian Day is for greater private involvement in medicare. It doesn't seem to matter that this is a conflict of interest since he himself is involved in a private clinic. Why the CMA elected this fellow is hard to fathom unless they themselves in a majority favor the same policies. Perhaps by now they do.
It is interesting that discussion of the controversial recommendations in Medicare Plus are not on the agenda for discussion at the upcoming meeting of the CMA. It would be healthier if they were!


Misguided proposals for two-tier health care


Aug 15, 2007 04:30 AM
Danielle Martin





What will the Canadian Medical Association do next?

Condemned by the public, editorial boards and politicians of all persuasions for its recent policy statement "Medicare Plus," the CMA will have some explaining to do to its members – and to Canadians – at its annual meeting in Vancouver next week, Aug. 19 to 22.

Few Canadians would disagree with CMA president Colin McMillan's speech releasing the recommendations in "Medicare Plus" calling for more doctors, nurses and other health professionals; for a broader spectrum of standards and a publicly funded guarantee to protect us against unreasonable wait times; and for the expansion of medicare to cover services like expensive drugs and long-term care.

These proposals recognize that our publicly funded system needs reforming to meet the needs of our aging population, the massive growth in pharmaceuticals and the shift away from a hospital and physician-centric model of health care.

However, conspicuously absent from McMillan's remarks – and from the CMA's Ipsos Reid poll on Canadians' attitudes towards "Medicare Plus" – was the proposal that doctors be permitted to work in both public and private systems (dual practice) and that patients be allowed to buy private insurance for some publicly funded services covered by medicare.

It's as if the CMA were embarrassed about this aspect of its policy and decided not to highlight it in public statements and surveys. And embarrassed it should be. There is a compelling body of evidence against parallel private insurance in the Canadian context. There is also an inherent conflict of interest for physicians working in dual practice since, as the public would understandably perceive, these physicians could have an interest in promoting longer wait times in the public system to increase use of the more lucrative private system.

This very evidence was reviewed in the CMA's own 2006 discussion paper "It's About Access!," which found that the introduction of parallel private insurance:

would not improve access to publicly insured services.

would not lower costs or improve quality of care.

could increase wait times for those who are not privately insured.

could exacerbate human resource shortages in the public system.

Indeed, the CMA's 2006 findings are in keeping with the recommendations of the Romanow Commission and the Kirby Senate Report against parallel private insurance, and with the experience of those few Western countries where it is actually permitted. Despite the repeated claims of incoming CMA president Brian Day, these countries do not include France and Germany. However, they do include the U.K., Australia and New Zealand, where experience has shown that parallel private insurance and dual practice reduces cost efficiency and increases wait times for patients in the public system. There is every reason to believe that this would also happen in Canada, particularly given our acute shortage of health professionals (which the CMA prominently and appropriately decries in "Medicare Plus").

At a time when our neighbours to the south are absorbing the lessons of the Michael Moore film Sicko – including that health care should not be left to the profit motives of private insurers – the CMA should reject any regressive attempt to turn back the clock here in Canada. This is especially the case since, in comparison with the U.S., the evidence shows that Canada has as good or better health outcomes at significantly lower cost.

We all know medicare needs reform. Issues such as wait times, the rising cost of pharmaceuticals and our shortage of health-care professionals are real challenges that must be addressed. But nothing has happened to the health-care system in the last year to justify the CMA ignoring the findings of its own 2006 study. Rather, as McMillan himself acknowledged, "the fact of the matter is that governments ARE making progress" (his emphasis). As the Canadian Centre for Policy Alternatives has documented, across Canada there has been significant progress in reducing wait times through better management and team-based practice.

As CMA members and physicians, we need to ask our association why, if some physician resources are being underutilized, isn't the CMA advocating for solutions that would increase patient care to all Canadians, on the basis of need, within the public system? Why is the CMA proposing dual practice and private insurance when this would pull nurses, technicians and other needed human resources out of the public system? Why is the CMA ignoring the evidence and separating itself from every other professional group on the issue of for-profit care?

During next week's meeting, the CMA will have a chance to show a more constructive approach to health-care reform when delegates debate proposals on the expansion of homecare, pharmacare and environmental health – proposals that will help expand and modernize our publicly-funded health-care system to meet the needs of all Canadians, not just a wealthy few.

The misguided recommendations of "Medicare Plus" on private insurance and dual practice – which are not scheduled for debate – are best discarded like the bad medicine they are.




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Danielle Martin is a family physician in Toronto and Chair of Canadian Doctors for Medicare.