National Health Tax: Another Bad Idea

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Appeared in the Peterborough Examiner and the Vancouver Province, April 13, 2004
The federal government has floated the idea of introducing a new dedicated health tax to finance even more spending on healthcare, rumoured to be in the neighbourhood of an additional $2.0 billion annually. The last thing Canada needs is another tax increase in order to throw yet more dollars at a problem that has almost nothing to do with how much money we spend. What Canada needs is an honest discussion about reforming the way in which we deliver healthcare, discussions aimed at actually solving the problem.

The average family in Canada already works until June 28, almost half the year, to pay their tax bill to all three levels of government, and it will most likely get worse as most provincial governments raised taxes in their recent budgets. Canadians currently spend more on their taxes than they do on basic necessities: food, clothing, and shelter. The idea that hard-working families can afford to take yet another tax hit could only be contemplated in Ottawa, a city largely insulated from the real world.

There are already competitive tax issues to consider in that our southern neighbour enjoys a significantly lower tax burden. Specifically, Canada’s total tax bite is nearly one-third larger than the corresponding burden in the United States. And the tax difference between Canada and the United States cannot be explained by differences in health spending. The two countries spend nearly the same amount of money on public healthcare as a share of the economy. Canadians tend to forget that two of the U.S.’ largest expenditures are on health care insurance for the poor (Medicaid) and the aged (Medicare).

This leads us to the discussion of Canadian healthcare and the problems plaguing it. The general public and politicians continue to harbour the notion that what ails healthcare is a lack of money. The problem with this view is that it is entirely contradicted by the evidence. Canada currently spends more on healthcare as a share of our economy, adjusting for differences in ages, than any other industrialized country that guarantees access to care regardless of the ability to pay. In return for being a big spender, Canada is plagued with poor results on access to doctors and new technologies, worsening waiting times, and only moderate health outcomes.

Somehow other universal access countries, like France, Sweden, Australia, and Japan spend less than Canada but enjoy better results. These countries have been able to achieve better results at lower costs by better structuring their health sectors to achieve cost-effective outcomes. In other words, the answer to our healthcare dilemma lies in re-structuring our system.

Each of the aforementioned countries mentioned has a cost-sharing system in place that encourages patients to be more informed about their healthcare decisions. According to research and international evidence, when patients are responsible for some of the cost of their care, 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.

Each of these four countries also offers choice in the delivery of healthcare services by allowing, and in some cases encouraging, the provision of competitive private health insurance. They understand that shackling patients to a government monopoly with no alternative choices, results in a more expensive and lower standard of care than would be available otherwise. Finally, none of these countries is mired in a fear of for-profit care delivery, as we are in Canada. Patients in each of these countries can go to a private for-profit care provider and receive care financed through the public insurance system.

The solution to Canada’s healthcare problems and our ongoing underperformance needs more than the simple pedestrian solutions being offered by the mandarins and their lords in Ottawa. At the very least we need an honest and open dialogue about Canada’s healthcare system while recognizing the reality that Canadian families need meaningful tax relief rather than more tax increases. Such a discussion would inevitably lead to the recognition that we need to reform how we deliver healthcare not how much we spend on it.

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