Romanow Ignores Facts, Claims No One Told Him

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posted October 18, 2002
Roy Romanow, head of the Commission on the Future of Health Care in Canada, is either confused or just plain ignorant about the advantages of increased patient choice. After an alarming speech at Harvard University on Wednesday, where he claimed that Canada already has too much private health care, condemned people who use their own money to purchase health services, and called for more government spending on health, Mr. Romanow stated in a phone interview that Canadians should, “Show me the evidence, table it now. I have asked for this for 18 months. Show me the evidence that there is another way to proceed in order to provide the kinds of services and the wait lists that people want.”

The evidence he seeks is not held in secret vaults; rather it has been presented to him and published repeatedly for many years. Last spring, four Fraser Institute analysts addressed his Commission’s Vancouver public hearing. Subsequently, the Institute published a study of all developed countries with universal health care systems, showing that Canada’s is the most expensive and does not provide the best outcomes.

Just how expensive is the health care system in Canada? After accounting for the young Canadian population, Canada spends more on health care than any other OECD country that promises universal access to its citizens. That’s right. Canada spends more than France, or Germany, or Switzerland, or… well, you name it. Clearly, when compared to other OECD countries, the system is not cash starved or in need of more funds. What we do need is more of everything that our high level of spending should allow us to purchase. As seen in a recent Fraser Institute study, How Good is Canadian Health Care?, Canadians spend more than anyone else and get less access to high tech machines and doctors, wait longer, and end up with only a middle-of-the road performance in health outcomes.

Consider Sweden, where health spending’s share of GDP, after age-adjustment, was one third less than Canada’s in 1999: 7.9 percent versus 11.7 percent. Swedish patients have far better access to high tech diagnostic equipment, more doctors per capita, and fare better in measurable health care outcomes.

So how does a country spend less money on health care and do better than Canada in every measurable input or outcome? First, it doesn’t outlaw private health care for all. Second, it doesn’t ban user fees. Third, private health care clinics and hospitals are permitted to provide first-class health care for patients.

In Sweden, patients pay a fee for the health services they receive. This encourages patients to make a more informed decision about how they use health services, because the care is not free. Clinics and hospitals, most notably St. Goran in Stockholm, are allowed to earn profits. All of this, contrary to Mr. Romanow’s prejudices, has meant better health care for Swedes, because providers are able and motivated to respond to patients’ needs.

The problem in Canada is not a lack of funding for health care. The problem has always been the health care system itself. It’s 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. More money and a bigger bureaucracy won’t solve the problem.

The real solution to Canada’s problem can already be found in place in a number of other OECD countries, like Sweden or France. If Mr. Romanow wants to say that no one has shown him a better way in the 18 months he has been working on his report, then he hasn’t been listening or reading anything besides his own private memoirs. We’ve been telling him plenty.

Other OECD countries with universal access health care systems have managed to get better health care outcomes for their citizens with more technology and shorter wait lists without resorting to forbidding choice and responsibility for patients. Canada is the only OECD country where comprehensive private health care has been effectively outlawed. As a result, we get fewer doctors, less technology, and worse outcomes than countries that allow forms of health care that Mr. Romanow calls “potentially threatening”.

Mr. Romanow has spent over a year and about $15 million pretending to investigate alternatives to the status quo. Provinces that have decided to ignore his process and get on with their own reforms have made the right choice. Let’s hope the federal government does the same.

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