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The Commission on the Future of Health Care in Canada – a critical test of what kind of society Canada wants to become, with. special concern for British Columbia.    

Heralded under the banner of ‘worthy causes’ the forming of ‘politically visible’ commissions or committees is an old political method of avoiding controversial decisions and accountability. Members of the community volunteer time and effort to advise paid politicians, bureaucrats and consultants on what they should already have known and should have done many years ago. It is a good way to ensure that nobody is accountable. 

Will the Commission on the Future of Health Care in Canada be any different? Will the community embrace the commission, and will that allow everyone to dodge accountability?  

Canadian society in good democratic order decided that healthcare should be excluded from the private sector and pricing mechanism, and should be provided by government and financed through taxation. The decision is legislated in the Canada Health Act, that states: the primary objective is to protect, promote and restore the physical and mental well being of the residents of Canada and to facilitate reasonable access to healthcare without financial and other barriers.   

The decision was right. The Canadian Health Act has contributed immensely to improve the social conditions in Canada. Not only by ensuring access to health services but by supporting good public health which is a key element to building a more productive and competitive nation. A population with a high degree of poor nutrition and debilitating diseases such as tuberculosis, diabetes, emphysema, birth defects, or cancer is less productive and less competitive than a healthier population.

It has been known for decades that these types of problems are more prevalent among our first nation communities. So how could that be a surprise for the health Commission in their recent consultation visit to Nunavut?   

The problem is, whether in Nunavut, South Africa, Tennessee or elsewhere in the world, healthcare systems by themselves do not promote and restore the physical and mental well being of a country. Quality of life and good mental and somatic health also depend on investment in economic production in business and the distribution of real income in the community via employment. Economic production is also the only way to provide the tax revenues that finance healthcare and other essential public services. 

It is simply impossible to improve public health without solving the underlying interrelated socio psychological and socioeconomic issues.    

The problem is that resources and investment used in one direction cannot be used for other needs in the community.  Investment in the healthcare sector, social services, etc., can only be at the expense of investment in the factors that create economic production, such as education, training, research and investment in business.

Rising costs and excessive consumption of healthcare come at the expense of investment in economic production in the forest, IT, or any other sector that distributes real income in the community.  Unsolved that creates a vicious circle. Lack of investment in the factors that create economic production and distribution of real income inevitably erodes social conditions and living standards; having a negative impact on the physical and mental well being of society.  That in turn increases consumption of healthcare and calls for the allocation of more resources. Ask any GP what happens when the local factory or mill closes. 

A country that can recognize the cross-disciplinary nature of good healthcare will invest in solving the socioeconomic issues that hamper investment in the economic production needed to promote good health. That country will be far more competitive in the world marketplace than a country that allocates more and more resources to treat the symptoms instead of curing the disease.   

An aging population (including doctors and nurses), gains in science, technology, and how we prevent and cure disease, and the organizational issues and ever-rising costs are not happening ‘out of the blue’. The issues have been known for the past twenty years. Unsolved, the issues have been allowed to escalate, eroding economic production and causing irreparable harm to society, and even blackmailing society as demonstrated in BC.  

This is not one government’s fault. Federal and Provincial governments have been failing in their monitoring and intervening role for decades.  

Government’s most important role in a democratic governed mixed economy, such as Canada’s, is to correct the allocation problems before the problems cause adversity. That is not something that the private sector can, or will ever be able to do.

If the cost burden of the healthcare system erodes the factors that protect, promote and restore the physical and mental well being of Canadians, one could raise the hypothesis that the government is failing to meet the standard set out in the Canadian Health Act.

If policies and government intervention - including outsourcing and privatization - increases ‘disparity in opportunities’ for Canadians, that would breach Canada’s constitution.  

The question is, will the health commission recognize the culprits, address the underlying causes, and press for solutions, or will the commission simply bolster the lack of accountability.   

The latter seems to be what the Chair of the Canadian Senate committee on social affairs, science and technology supports.  

A recent report from the committee is another repetition of what has been known for the past decade. Instead of addressing the underlying issues that are causing excess consumption of healthcare at the expense of the factors that secure good health, their preference seems to be to embrace a private healthcare delivery system.  In reality, it is a politically packaged privatization and implementation of a multi tier system.    

There is no evidence that private managed delivery of healthcare is less expensive and better, or would contribute to solving the allocation problems. There is however, lots of evidence to the contrary, that shifts to private delivery will increase the consumption and cost of healthcare in Canada, and inevitably erode economic production and the factors that create good health.

The risk is that the community will fall victim to misleading assumptions that lack prudent analysis and wishful thinking that privatization will lower costs, improve service and public health.  

That can only negatively affect Canada’s comparable advantages and hamper investment in economic production in business and jobs. That will damage Canada’s competitiveness in the global economy.  

Small and midsize business and the lower and middle-income bracket will carry the brunt, not the political and social establishment that makes the decisions.   

The boosters of privatization seem to overlook that the US mixed public and private insurance system has the highest healthcare cost per capita in the world, which is a serious drawback for US business. It is a system that is the best in the world - if you can pay for it.  The drawback is that approximately 44 million people in the US lack health insurance and access to adequate healthcare. Applied to Canada, that would amount to roughly 3-4 million Canadians without access to adequate healthcare, which would reduce the quality of life for all.  

The driving force is of course that money can be made from P-3 privatization of healthcare.  It would rally the stock exchanges and make fortunes for some, but would offer little for most Canadians, small and midsize businesses, jobs, and quality of life in the local community.  Privatization does not require much intelligence. It is an easy way out; like saving the patient by amputation rather than by skilled surgery.  

Modernizing and securing the public healthcare system will require new thinking, and more strategic cross-disciplinary considerations.  

The British Columbia Government is facing the acute stage of decades of unsolved issues, not only in the forest sector and healthcare, but in virtually every corner of the economy. Reorganization of the healthcare system and controlling spending is vital for BC’s overall economy. The issue here is, there is no reason why the Canadian public healthcare system cannot be successfully reorganized; reducing consumption and simultaneously improving quality. Cost cutting in itself will not achieve that.

Reorganizing healthcare with the goal to secure the best and most cost-effective integrated public healthcare system in the world would immensely promote and improve Canada’s comparable advantages, attract and stimulate investment in economic production in business, and distribute real income via employment in the community. That would in turn fuel the stock market and create social satisfaction for all, while meeting the standards in our constitution.  

BC does have a choice to take a lead in Canada with an intelligent reorganization of healthcare within the broader context of our overall socio-economic conditions.   

As Albert Einstein said, the problems we face cannot be solved at the same level of thinking we were at when we created them.  Will the Commission allow new thinking into the commission, and ensure prudent analysis, logical truth and ethical action is applied to solving the issues?

Or will the commission continue the same thinking that created the problems in the first place? Ultimately will the members of the community and the taxpayer accept that?  

Respectfully submitted to the Commission on the Future of Health Care in Canada, and the Premier of British Columbia.  


May 2002