What Comes After the End of Public Healthcare?

Or: how do we get there in one piece?

Despite decades of initiatives, reorganizations, programs, legislation, and endless announcements of new rounds of funding, nearly all Canadian healthcare-related productivity and efficiency metrics are moving in the wrong direction. Costs are rising at more or less the same rate as wait times. And the proportional growth of Canada’s senior (= expensive) population is heading nowhere but up.

Repeating the same old “we just need more funding” mantra will probably work just as well next time is it has so far. Provinces are already spending more than one of every three public dollars on healthcare with no visible impact on the core problems.

A recent paper published by the Macdonald Laurier Institute proposed that neither brilliant management innovations nor infusions of new funding could come close to addressing the problems from which our single payer system suffers. We’re just fresh out of practical ideas.

Well, nearly fresh out. As the paper notes (and as I’ve written), most of our peer countries incorporate elements of private delivery into their systems. And by most metrics, they’re outperforming us. But Canada’s electoral realities make it impossible for any government to even discuss those alternatives.

Nevertheless, on the topic of funding, the Macdonald Laurier piece offers some intriguing possibilities, including:

• Allowing hospital foundations to use donations for operational and not just capital costs

• Offering full tax deductions for donations aimed at clinical service growth

• Simplifying the creation of new charitable entities to fund local medical services

• Exploring funding models like community funding, group/co-operative funding, or prepayment systems

For practical considerations, the article recommends avoiding direct advocacy for patient self-pays or user fees - even though, in the long run, those could end up playing an important role in any realistic fix for the system.

But there might be a way to sneak past the institutional minefield without having to sacrifice anyone’s political career.

Let’s assume that integrating some form of private delivery into our healthcare mix is something worth pursuing. Even if politicians can’t afford to discuss it, there’s another way to get there from outside the political domain. And it involves just 2.5 words (and a year): Chaoulli v. Quebec (2005).

That’s where the Supreme Court of Canada ruled the Canada Health Act’s ban on private delivery of healthcare was, for Quebec at least, unconstitutional. Based on that decision, More than 50 procedures can now be legally performed in private surgical clinics in the province.

For technical reasons, the ruling didn’t extend beyond Quebec. But there doesn’t seem to be any structural barrier that would make something similar impossible in other provinces. The trick would be finding the right plaintiff. That is, you’d need an individual whose medical suffering is being demonstrably extended or increased by the failure of a province’s healthcare facilities to provide timely service.