Issues in Bioethics: Health Care Debate

Transcription

1 Issues in Bioethics: Health Care Debate Notes and Questions on: Sasha Lakic, Inside Canada's Health Care Privatization Movement, Vancouver Observer, Dec 20th, 2012 by Gabriel Tordjman (Winter 2015) 1. Background Knowledge: Key Names, Ideas, Events Politics left and right NDP (New Democratic Party of Canada) Liberal Party of Canada (Liberals) Paul Martin Conservative Party of Canada (Conservatives) Stephen Harper Brian Day Think Tanks Frazer Institute CD Howe Institute Royal Commission on the Future of Health Care in Canada (Romanow Report) Ray Romanow Health Care Items Canada Health Act extra-billing, user fees Chaoulli Case Healthcare Economics OECD per capita GDP 2008 Financial Collapse Other Names and Ideas Barak Obama, Obamacare David Dodge

2 2. Questions: Q1. Who is Paul Martin and what was his role in development of Health care policy in Canada? Q2. What is the Romanow Report and what does it recommend to improve Canadian health care? Q3. What is extra-billing and user fees? Q4. What is the main goal of the Canada Health Act? Q5. What are the key principles of the Canada Health Act? Q6. How is legal control over health care in Canada divided? Q7. What is the Chaoulli case and what it did decide? Q8. What is one possible reason extra-billing and user fees have increased in the last few years even though they are forbidden by Canada Health Act? Q9. What evidence does Lakic use to argue Canadian health care is mediocre and costly? Q10. What is the most expensive part of health care according to this article? Q11. Why is it incorrect to say that the Canadian healthcare system is a completely public system? Q12. What are some of the key recommendations of the Romanow Report? Q13. What are the think tanks Lakic mentions and whose interests do they represent according to the author? Q14. To what side does the present Conservative Party lean in the private vs. public debate according to Lakic? Q15. Why does Lakic see the Canadian healthcare system eventually heading toward Obamacare half way Background Information Left and Right: Refers to traditional categorization of political ideologies Left Center Right Anarchist CANADA: Communist Socialist Liberal Conservative Fascist NDP Liberal Party Conservative Party USA: Democrats Republicans More public (government) spending on social programs Greater commitment to economic equality Less public (government) spending on social programs Lesser commitment to economic equality More commitment to free market or private sector

3 Brian Day, BC surgeon who opened first private clinic offering knee and hip surgery in 1995, author of The Madness of Medicare, supporter of privatization Managed to establish his clinic despite left-leaning opponents and strong NDP presence in BC Paul Martin: former Finance Minister under Jean Chretien ( ) Prime Minister of Canada ( ), reduced federal government funding for health care as part of deficit reduction program Roy Romanow: Former NDP premier of Saskatchewan ( ) and head of Royal Commission on the Future of Health Care in Canada and Romanow Report (2002) which stated Canadians believe medical care is a moral principle not a commercial enterprise. Called for resistance to increasing pressures for privatisation and reorganization of health delivery to improve health care and reduce wait times. Also called for escalator clause to match federal funding to economic growth [and to increase federal government share of health spending gto 25%] See below for Recommendations of Romanow Report. Canada Health Act: 1984 federal law passed under Pierre Trudeau which established goal of Canadian public health insurance system (Medicare): the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers (section 3). key principles of Medicare, including: Public Administration Comprehensiveness Universality Portability Accessibility. (forbids extra-billing and user fees as threats to Accessibility ). Legal control: Health care is a provincial jurisdiction and compliance to the CHA is voluntary Federal government plays role by providing funds ( transfers ) in exchange for province s compliance to the CHA. But violations of the CHA, including extra-billing, rarely result in prosecutions by the federal government. Hence, the increase of user fees, private clinics and for profit services in the last 20 years. Chaoulli case (2005): Quebec court case. CHA and Quebec law prohibited private care for procedures that are insured in the public system Chaoulli case argued this was unconstitutional violation of section 7 of Canadian Charter of Rights and Freedoms. Decision criticized by advocates of public system

4 A costly public health care system OECD: Organization for Economic Cooperation and Development is a major economic research institution that ranks Canada as mediocre in healthcare. Article uses OECD figures comparing healthcare quality and costs among various other countries. per capita = per individual GDP = (Gross Domestic Product): value of all goods and services produced in a country in a particular time period per capita GDP = divides GDP over all individuals of a country (GDP/pop) According to OECD, Canadian public healthcare system: In top 10 for spending on health per capita of GDP at $4,363 In top 10 for share of GDP spent on health care at 11.4% Last in wait times to see a specialist: (59% wait 4 months or more to see specialist, in 2010) Elective surgery: 25% wait 4 months or more for surgery First in accidental puncture and lacerations Third in foreign bodies left in body 27th for medical grads (7 per 100,000 pop) GP salaries average 3.1 times average specialist average 4.7 times average Lakic argues Canadian healthcare system relatively expensive but suffers from serious problem of wait times and shortages in doctors. Parliament increased health care transfers by 6% annually but Harper government pledged to keep this only until 2017, after which spending would mirror GDP growth plus

5 inflation [probably represent reduction of about 3% or more per year (see graph]) According to Canadian Institute for Health Information (CIHI) most costly is doctor s wages and hospital care - 46% of the $207.4 billion spent on health care. Privatisation supporters like Brian Day and Fraser Institute blame administrative inefficiencies, elderly and block payments instead of payment per patient. CIHI estimates federal transfer to 11% with remaining 89% to be paid by provinces. Considerable Privatisation already exists: Every other sector but hospital care and doctor visits is already privatised (though these are costliest), e.g., optometry, ambulance services, dentistry, drug coverage (except Quebec), etc Future expectations Romanow Report recommended 47 changes including: periodic renegotiation of Canada Health Transfer, escalator system [to bring feds to 25% of funding for health care] electronic medical records national prescription drug coverage program 2008 Financial collapse put a dent in these plans Few politicians now care or dare to examine the deep structural problems of Medicare Think tanks like Fraser Institute and C.D. Howe Institute, financed by billionaires and corporations, provide much of the data Also advocate for increased privatisation and reduced federal government role; a difficult proposition since Canadians take great pride in public health care. But Lacic says, lobbyists are slowly working to change this No fix in sight

6 Present Conservative party has continued decline in federal contribution to health care [and has not prosecuted violations of the act] Few politicians providing any major plans to rehaul the system and conservative think tanks continue slow campaign to increase privatisation. Privatisation advocates closeness to Harper government Prime Minister Stephen Harper, admirer of Fraser Institute, former. former President of Fraser Institute, David Dodge was in Harper government as deputy Finance Minister before being Governor of Bank of Canada. Meeting Obamacare half way With public health care system being too costly and unsustainable and private health care - would could exclude many low-income individuals and families - is increasingly gaining momentum [sic.] Canadian health care will come closer to American system meeting Obamacare half way since the same kind of people that fight for economic freedom [more privatisation] in Washington D.C. are slowly capturing the policy decision process on Parliament Hill. NB: Obamacare (aka Patient Protection Act and Affordable Care Act ) maintains US, largely private (and most expensive system in the world) health care system while providing some degree of improved access to American public and cost savings to the government.