Cris LaBossiere

Cris LaBossiere
Strength training and mountain biking. My two favorites

Friday, April 29, 2011

Canadian Health Care: Next Fiscal Bubble?

It was a warm summer afternoon when I was T-boned by a pick up truck while riding my bike. My life flashed before my eye’s which strangely caused me to think humorously, “hey, your life really does flash before your eye’s when you think you’re going to die”.
Luckily my assessment of my death was inaccurate.  As I lie on the pavement in the middle of the road gathering my whits I see that my forearm is broken in half and bent at 90 degrees, but still intact.  I wasn’t worried though.
“They’ll fix me”, I thought. I didn’t contemplate, “how will I pay for this”, after all, health care is free.
Total health care costs for Canada in 2010 were projected at $191.6 billion. Alberta and Manitoba are projected to spend more per person than any other province, $6,266 and $6249 respectively. (1) 
A report from the Fraser Institute (2) projects 8 out of 10 provinces will have 50% of their total revenues swallowed by health care costs by 2028. Quebec is already there as of 2009/10 with 52.5% of total available provincial revenues from all sources going towards health care.
A Diabetes association of Canada report (3) suggests diabetes will cost the health care system $16.9 billion per year by 2020.  Alberta Health Services released a report in January 2010 (4) that cited “obesity translates into an economic burden of $1.27 billion (2005$) within the province of Alberta”. 
 The Diabetes Association report also says those at risk for type two diabetes can reduce their risk of developing the disease by between 58 and 71% depending on their age, by simply exercising and losing 5 to 7% of their body weight.
National estimates (5) show that obesity costs us 4.3 billion a year (2005$).
A large portion of our health care costs are caused by our own unhealthy habits.  This is something we can control. Everyone getting healthier would not save the system, but could be part of the solution.
Alberta eliminated health care insurance premiums in 2009, leaving Ontario, Quebec, and BC as the only provinces that charge for health care premiums that are scaled to ones income, with all such fee’s being forgiven in the case of financial hardship.
The Canada Health Act (6) says fee’s collected by the provinces can be deducted from the fed’s health transfers to provinces; meaning provinces that charge health insurance premiums might have equal amounts deducted from health transfers.
Quebec is scheduled to receive about $6.4 billion in federal health transfers in 2011-12,  no mention of penalties for collecting user fees.  Manitoba, with its much smaller population will receive about $1 billion in health transfers for 2011-12. (7)
Our system, heralded by many as a model of applied morality and scorned by many as a bureaucracy heavy welfare state that monopolizes services that could be better supplied by the private sector, is seen by both sides as one of the most critical government services that has yet to achieve a standard of delivery that appeases all.

Before publicly funded health care the cost of medical care was too much for many so they didn't seek care, or if they did many would go bankrupt or be burdened with heavy debt paying off medical bills.  Various attempts at private and public health insurance plans were practiced but none could deliver full benefits as the plans were poorly executed or were simply fiscally impossible to maintain.
In 1952, just before the polio vaccine was available, many families in New Brunswick who had payed into the Maritime Blue Cross medical service plan had their contracts cancelled when an outbreak of poliomyelitis would prove to be too costly for the plan to cover. (8)
When Canadians went to enlist themselves for military service at the beginning of WW1 it was found that many had active tuberculosis and infectious diseases that made them unfit for duty. Many people could not afford regular medical care and so illnesses would go unmanaged and unreported. (8)
In the 60’s the pro Medicare pundits argued the morality of a just society includes caring for all whether impoverished or wealthy.  Cue sound of happy music.
Those opposed argued that freeloaders overusing the system and layers of bureaucracy would combine to inflate costs of delivery and result in raised taxes and divert funds allocated to other programs to shore up health care. Cue sound of evil empire music.
I think both these suppositions are true and that we pretend we can resolve the dilemma either by charging that governments commit demagoguery by leveraging humanitarian needs to justify costs, or by demonizing private enterprise by assuming business is evil.  
Volleying tired talking points back and fourth hasn’t resolved anything.  Is this all our nations best elected intellect can muster?

Health care isn't getting any cheaper, but is becoming more effective in terms of being able to diagnose and treat illness and injury.  Research, high tech hospitals, and better educated medical professionals make this possible.

The humanitarian need for caring for the sick and injured compels us to pour recourses into public health care but there is only so much pouring our economy can handle.  Continuing to do things the same way won't solve the problem.  The challenge of cutting costs while simultaneously raising standards is tough and so far we keep raising taxes and throwing money at the problem without planning for the future.  

If the forecasters are right, if obesity, our aging population, and our mismanagement of public and privately funded medical care have a predictably serious financial crunch arriving within the next 20 years, then we better do something about it.
When we’re struck with an illness or injury, we need care, sometimes very expensive care, and we need it promptly.  I don’t think anyone should be denied access to health care, even if they have no money or have brought harm to themselves. Maybe if we can get passed the rhetoric we can find a way to sustain health care through a mix of private and public modes, better management, and taking personal responsibility towards getting healthier.
All we have to do now is elect people that can pull it off.  Good luck.

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