Kill the Canada Health Act

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Appeared in the National Post

The Canada Health Act is the single greatest barrier to the creation of a world-class health care system in this country. The rules, interpretations and principles of the Act have harmed Canadian patients and taxpayers by prohibiting a variety of beneficial policies being implemented in other developed nations.

Just how inefficient is the system mandated by the Act? Consider that of the world’s 30 most developed countries, 28 - including Canada - enshrine the right to health care regardless of one’s ability to pay. Of those 28, Canada ties with Iceland as the highest age-adjusted spender on health care. Yet Canada also manages to rank near the bottom in terms of access to technology and physicians, while Canadian patients wait longer than patients in most other countries. Overall, Canadians are healthy, yes - but not nearly so healthy as our level of spending would suggest.

Of the 27 other health care systems that offer universal health care access, several stand out as possible models for reform in Canada. Sweden and Australia both provide better health outcomes for their citizens. Five countries deliver health care without any significant waiting times: Austria, Belgium, Germany, Luxembourg and Switzerland. France and Japan actually manage to achieve both distinctions.

These countries all outperform the Canadian system by employing policies that have either been specifically outlawed by the Canada Health Act or that have been interpreted as inconsistent with the principles of Medicare.

Each of the countries that deliver superior health access or quality requires that patients share some of the costs of health care - a policy forbidden in Canada. The idea, as described by Nobel Laureate Milton Friedman, is simple: Nobody spends somebody else’s money as wisely as he spends his own. According to research and international evidence, when patients are responsible for some of the cost of their care - through small user fees, for example - they use fewer resources, making more available for other patients and saving money overall, and end up no worse off in terms of health outcomes.

These countries also allow private health care providers to deliver publicly funded health care - a policy that is generally forbidden by the federal government’s overly strict interpretation of the Health Act. In those countries where waiting lists are short, competitive private care providers are legally permitted to freely provide a full range of health care services to any patient. In Sweden and Australia, private providers have contracted with governments to provide care for patients in specific regions. Each of these countries has taken notice of the economic research on the benefits of competitive hospital service provision.

Finally, not one of the aforementioned systems has seen fit to prevent citizens from contracting privately for their own care - a freedom prohibited by the Canada Health Act. Canada is, in fact, the only developed country on Earth that denies citizens this right. Everywhere else, patients are free to choose when and where they will receive health care.

When an individual falls ill or is injured, the public-private distinction becomes irrelevant: What matters is the availability of high-quality care in a time frame that provides comfort and peace of mind. At the same time, taxpayers want that care to be provided at reasonable cost. The only way to meet both goals is through responsibility, competition and freedom: Responsibility on the part of the patient to cover some of the cost of their care, competition among private providers within a publicly funded system, and the freedom to go outside that system when it is not meeting the needs of its patients.

Ironically, the greatest barrier to all three policies in Canada is the same piece of legislation that is touted as the guarantor of quality health care. Abandoning the Canada Health Act and allowing provincial governments the freedom to emulate the success of other nations would serve the best interests of both patients and taxpayers. This is the first, and most important step, toward the creation of truly world-class health care system.

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