Paying More and Getting Less: Romanow's Legacy

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posted December 3, 2003
Friday marked the first anniversary of Roy Romanow’s magnum opus on reforming health care. Romanow called for an expansion of the current system, more federal funding to supplement provincial expenditures, and a new commitment to the ideals of government monopoly health care. Romanow’s goal, shared by many Canadians, was to make the health care system better for all. But like many Canadians before, Mr. Romanow made the mistake of ignoring just what has been going on for years in this country under government health care.

Ten years ago Canadians were, on average, waiting just over 2 months for elective surgical procedures. Since then, despite numerous commissions on health care, and increased spending for the last seven years, we have managed to make the problem worse. Waiting times have reached an all time high of almost 5 months in 2003.

Some might say that it was the government’s fault for not providing enough money for health care. Indeed, Paul Martin, the incoming Prime Minister, agrees with that perspective and has already made a commitment to Canadians to increase funding for health care in an attempt to shorten wait lists. Mr. Romanow would be proud, since an increase in funding was one of his key recommendations for saving the health care system.

But the facts don’t support this argument: after accounting for our youthful population, Canada already spends more money (as a share of GDP) on health care than any other developed country in the world that promises it citizens universal access to care.

Increasing spending on health care in Canada will only result in Canada improving from its first place ranking to a first place ranking with a gold star for managing to outspend other countries by an even larger margin. Clearly, when compared to other OECD countries, the system is not cash starved or in need of more funds. Yet Canadians still experience exceptionally long waiting times, both by international standards and according to Canadian doctors’ perceptions of what is a reasonable time to wait for care.

Canada’s problem is not, as many critics contend (and as some politicians believe), a lack of funds for health services. The problem is a lack of everything that health care funds should purchase. Compared to other developed countries that promise universal access to health care (that is, all OECD countries save the US and Mexico), Canada has a relative lack of doctors and high tech diagnostic imaging machinery, mediocre health outcomes, and relatively long waiting times. If we already spend more money than any other country promising universal access to care and enjoy only middling health outcomes while our access to machines and doctors ranks among the worst, how can more money be a solution?

Lack of access to care in a high-cost system stems from the design of the system itself: Canada’s health care system is a massive, centrally controlled, government bureaucracy. And in the true tradition of government bureaucracies, it sucks up increased funding with almost no change in the functioning of the system or the outcomes from it. Mr. Romanow’s solutions of more money and a bigger bureaucracy will not and cannot solve the problem.

One solution can and could always be found abroad in countries like Sweden, France, Australia, and Japan, where universal access health care systems are functioning at lower cost and providing better access to care and better health outcomes for the population. These countries all embrace the “compassionate approach” to health services by promising all citizens access to care regardless of ability to pay, yet none has followed Canada’s model of health care delivery.

Each of these countries offers choice in the delivery of health care services by allowing, and in some cases encouraging, the purchase and provision of competitive private health insurance. And all have a cost-sharing system in place, since patients are encouraged to make a more informed decision about how they use health services when care is not free at the point of use.

Finally, none of these countries is mired in a fear of for-profit medical care, because they all understand that profits are what motivate health care providers to respond to patient needs.

One year after the $15 million final report by the Commission on the Future of Health Care in Canada, we find ourselves no better off in terms of health services than we were before. What Canadians need is a health care system that gets good value for the money already being spent, not a commitment to a report that condemns us to more of the same. The solutions lie in lessons from other far more successful countries in Europe and Asia; solutions like user fees and private provision of public health care. The Canadian health care system has the potential to serve patients and meet the demand for health care, but realizing that potential will require change not money.

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