Should Canada Have Private Healthcare?

Do you think our healthcare system is failing? Have you or someone you know been let down as a consequence of ridiculously long wait times? I’m predicting that a lot of you will say ‘Yes’ to one or both of those questions.

As someone who has grown up in Canada and worked as a doctor in the UK for the last 2 years, my answer to the question, ‘Should Canada Have Private Healthcare?’ is a ‘Yes’ – and I’ll predict it is a ‘No’ for a lot of you.

Now, before you get scared thinking about “Two Tier Healthcare,” and “Only the rich get private healthcare!” – take a minute to read what follows. I hope to open your mind and debunk some myths.

One classical argument is “only the rich get private healthcare”.

Answer?

Not true

Many companies in the UK – where both public and private systems exist – provide private healthcare insurance for their employees and their families. This means that even though you might be a lower income earner, you may still be able to have access to private healthcare. I worked in what is regarded as one of the most deprived areas in the western world, the East end of Glasgow, Scotland, and I still made private referrals. Therefore, the private healthcare system can potentially reach even the poorest of neighborhoods.

Companies call these ‘benefits.’ Some people get raises, some people get bonuses. Some people get company cars. But I never hear someone muttering at another person, “Damn that person with a company car,” or “That’s not fair, my friend got a raise.” Businesses look after their employees in many different forms – private healthcare is one potential means of looking after employees.

Why would a company want to provide private insurance?  Well they understand that ‘a healthy workforce is a productive workforce.’ Interestingly enough, it has recently been reported that Canada lost over $16 billion due to sick days from work over the past year.

Being ill costs our economy.

If you’re having to wait 2 years to get that knee replaced, and you’re struggling at work, it’s no surprise that you won’t be as productive as you could be. If, however, that knee could be replaced in a matter of weeks/months, it might be beneficial to get that worker back up and working instead of taking sick pay. This doesn’t even mention the fact that you could argue it is inhumane for someone to have to suffer from illness or pain for that long, when a solution is out there and working in many different countries around the world – but not in Canada.

Therefore, if we can use the private system to offload the burden of the public system, resulting in people getting back to work more quickly, then it doesn’t only have direct personal benefits, but also widespread economic benefits as well.

One could even argue our current system is unethical. Let me use the analogy of a clinical trial. In a clinical trial, it is considered unethical if you provide a treatment that is substandard to a known treatment already available that is proven to be more effective.

In this case, another form of treatment (i.e. Private healthcare in a Mixed Public/Private system) that could be considered more effective (i.e. shorter wait times, less time suffering from pain) and is potentially available, is being withheld by our current system.

In other words, it could be considered unethical NOT to provide an alternative form of healthcare such as private healthcare which would inevitably reduce the suffering of those people waiting upwards of 2 years for certain operations.

Another common argument against private healthcare is that the “quality” will be better in the private system.

Answer?

Not true.

As a medical student, I assisted in operations in both General Surgery and Orthopedic Surgery in the UK.  The same surgeons would perform the same operation, use the same equipment, but just in a different hospital.  (OK – so you might get a duvet in a private hospital instead of bed sheets in a public one). In other words, the quality you receive will be pretty much identical in the private and public sectors. The preconception that “All the best doctors will go to private” is therefore not true.

In reality, they are often the same doctors.

Another myth debunked for you.

In fact, surgeons in Canada want more operating room time. Current inadequacies in Canadian healthcare provision however are preventing surgeons from the experience they need and desire.

We’re failing our surgeons.

If anything, the addition of a private sector is mutually advantageous – surgeons could get extra operating time in the private sector, and then bring this experience and quality back to the public sector.

As a patient, would you want a more experienced surgeon or a less experienced surgeon?

Obviously, you want the more experienced one. You also want it quickly. Private healthcare would enable both of these, and could improve the Public system by reducing waiting times.

I find a term which Canadians are afraid of, and in my opinion, miscomprehend, is the term “Two Tier.”

I hate this term.

Why?

“Two Tier” implies a vertical sort of system, like a league, implying that the Private sector sits at the top and the Public system sits below it.

I want Canadians to think laterally, not vertically.

So perhaps if we as a nation want to move forward, we should get rid of the term “Two Tier” for what it implies whenever we talk about private health care.

It’s not even debatable that our healthcare system is failing us.  Recent reports of waiting times in the “Emergency Room” (‘Emergency Room’ in quotations for obvious reasons) in Alberta have a goal of admitting patients through emergency in 21 hours. TWENTY ONE HOURS. They’re apparently aiming to reduce this to 19 hours by 2015.

A reduction from 21 hours to 19 hours? Is this the sort of ‘”change” that Albertans deserve?

This is simply unacceptable. I don’t think I need to explain myself here.

Furthermore, an Orthopedic Surgeon from Calgary has recently stated that he will leave the public system because of inefficiencies. Again, we are failing our surgeons. Wait times for consultations and procedures are upwards of 2 years. This is also unacceptable. With an adjacent system to offload the stress of the public system, we could improve our system which is currently in place.

At the moment, I see our healthcare system like an SUV – I use this analogy because I’m writing in Edmonton – home of big trucks and SUVs – and it’s something we understand. No matter how much gas you put in your gas guzzling SUV, it’s not going to make it drive more efficiently. You need to change the engine, or vehicle rather, to make it more efficient. Canada’s healthcare system is renowned for being costly and inefficient on a per person basis – something we need to change.

Canadians often argue that we have a ‘Free Healthcare’ system, even though we’re paying for it through taxes, yet, funnily enough, I don’t think Canadians actually THINK about that very much. Now, after reminding you that you ARE indeed paying for your healthcare, and considering the ridiculous situation that is presented above – do you feel like you deserve more in return for your healthcare? Is it acceptable to you? Are you happy as a taxpayer?

Lastly, I beg you not to equate the addition of “Private Healthcare” with the “Americanization” of Canada.  Sadly, I think most Canadians actually DO think this when they hear “private healthcare.” We want to be “different than Americans.”  Canadians hear the term “private healthcare,” and automatically – almost like we’re programmed – put up a barrier to any information that follows, in fear of becoming “Americanized.” There is a fundamental degree of hypocrisy to a perspective that arbitrarily discounts a concept solely based on the fear of Americanization. You’re still letting America win. You’re still, indirectly, letting America dictate your thoughts. If someone could present a well put together objection to privatization, free from fear mongering, my thoughts would be different, but I rarely encounter this level of thought.

Canadian sovereignty is deeply important to me. My fear, however, is that we’ve reached the point of placing more value on national image management than saving lives. I want to be different than America by having an even better system than we already do – and a better system than the current American healthcare system.

Instead, we should look to the well-rated healthcare systems of our friends and allies such as the UK, France, and Australia – where there are Public and Private systems that co-exist together.

Yes, I even said France.

Part of the problem is that I think Canadians are detrimentally polite – most of us recognize that our healthcare system is completely inadequate, especially considering Canada is amongst the most desirable and wealthy nations to live in at the moment – yet we are too polite to kick up a fuss and actually complain about the poor healthcare that we receive – but by no means deserve.

Sometimes I imagine what foreigners think of our system. What would the cynical British broadcaster Piers Morgan say if he had to wait 21 hours in Canada to be admitted to hospital? Or wait over 2 years to get a shoulder operation? I tell you what – he wouldn’t be as polite as I am – and I bet you he wouldn’t stick around to wait and see what happens.

Canadians have actually become content with underperformance.

If you can hop on a plane to England and get seen by a doctor more quickly than it takes to see one down the street in Canada…well, then, I’m going to go out on a limb again and say…something has to change.

This topic is often over politicized. In reality, I want good healthcare for all, and I’m sure all Canadians want good healthcare too. We have a massive problem. The problem requires massive fixing. So regardless of where you stand on the political spectrum, we need to change our healthcare system so that we can deliver proper healthcare to Canadians, care that we deserve – something our system is failing to do a the moment.

In other words, we need to stop being delusional, and come up with an actual solution.

I hope you’ve managed to get to this sentence and take in what I’ve said. You may still disagree. But I hope that at least now you may consider even pondering the idea of a private healthcare system, working alongside public healthcare, as a potential treatment for our ailing system – for the wider benefit of Canada – and not be afraid of preconceptions you undoubtedly hold against it.

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4 thoughts on “Should Canada Have Private Healthcare?

  1. Thank you for taking time to express your thoughts Dr. John. I respect your opinion and understand you have much more experience in the health care system than I, so the best I can do is (as you more or less point out),is react with my gut feelings. I have intended for some time to write on this topic from a ‘health care user perspective’, but it seems time and other tasks always cause me to postpone. Here are just a few thoughts from my perspective:

    I have always (always) found our health care system has provided me, my family and friends (as well as a good number of acquaintances) with excellent care. From broken bones and stitches, to open heart surgery and cancer treatments, the system has always been there. As a policeman, I made hundreds of trips to Emergency Wards with indigent persons and others needing immediate care. Not once in those hundreds of cases did the person not get treatment for their self-inflicted problems (alcohol, drugs) or because they suffered from mental illness. I do not mind paying taxes, even a substantial amount of taxes, to insure that the most vulnerable in our society receive care.

    If I could be certain a private system would be a administered by knowledgeable, caring Doctors such as yourself, I would vote for it in a minute. However, my impression is that private health care soon evolves into a business model administered by a CEO who is held accountable by shareholders or private interests who put up the front money. The system hires Doctors to provide service in their system. The bottom line of that service is ‘profit’ because profit is what drives private enterprise, not the collective good of society.

    Another side of this many sided coin, is that a private system that also is able to collect money from Government for providing certain services is not ‘free enterprise’, it is simply Government supported (or paid) free enterprise and there is plenty of examples to suggest that is not the most efficient system. I suppose the most glaring example is ‘big drug companies’. They are private health care providers and I don’t think anyone is under the illusion that any part of that system works in the public interest and it is our Government that contributes a vast sum of money to their bottom line through payments for prescription medicines.

    Also, I have used the private services of other ‘health care professionals’, with two examples being ‘hearing aids’ and ‘eye glasses’ The financial abuse of the vulnerable in this system is rampant. It is only because my family and I have the financial means to overcome the usurious rates charged (for example $3500 each for two hearing aids), that we can withstand the hit. I have acquaintances who simply cannot afford to get the care they need. It is sad to see someone go slowly deaf because they cannot afford a little thing to plug in their ear. As time permits, I will write about my experience over the past ten years. It does not paint a pretty picture of those involved in the business.

    As for supporting change, it will take some pretty explicit legislative guarantees for me to vote for splitting our system into private and public systems and I rather doubt a Conservative oriented Government such as that which presently exists in Canada and Alberta (over the past 1000 years), could be trusted to manage a dual system that did not slowly devolve into a user pay system.

    These are just a few, short, knee jerk responses to the subject. Always a pleasure wad in.

    All the best to you and your family and I really do enjoy your posts Dr. John. Keep up the good work and what-ever you do, remain idealistic in your outlook.

    Harold, Lynn and Family

  2. Hi Harold,

    Many thanks for your comments. I certainly appreciate your concerns, and your perspective is one that many Canadians ascribe to.

    I suppose our opinions are biased in a way, in that the current Albertan system is simply not coping with our demographics, whilst British Columbia is known to have the best healthcare in Canada. (You can also get private orthopedic procedures in Vancouver where you would have to wait 2 years in Alberta, so I suppose there is already disparity in Canadian provision).

    I must say from numerous family encounters, including the care of my father, the treatment has been rather shocking. Looking at it retrospectively – I don’t think the Doctors/carers were to blame, but rather there was a failure of our system – an ongoing, well known problem. For example, Canada is known to have one of the fewest numbers of MRI scanners per capita in the western world, as well as have surgeons sitting around fiddling their thumbs, whilst thousands of patients wait for scans and surgeries. These are a couple examples of how the system is failing.

    I honestly believe that most Canadians’ knee jerk response is indeed to site what’s going on in countries like America to support their opinion on private healthcare, instead of thinking of numerous, well functioning mixed systems like France, Australia and the UK, which still maintain universal coverage whilst providing a private stream. Another aspect to this knee jerk reaction is to assume Private Healthcare is putting profit over personal health. In reality, there is no difference between a private company seeking profit and a public government making cuts – functionally speaking it is the same process.

    It’s a difficult concept, but we must not forget the current public system uses ideas such as QALYs (Quality Adjusted Life Years) to make funding decisions on healthcare provision.

    In other words, regardless of what system is in place, you will never escape the concept of value for money.

    I will certainly maintain my ideologies. My ideologies include reducing the overall suffering of a population. Presently, I feel we are failing our patients. Those who require a joint replacement, for example, and are suffering in pain – everyday – for over two years (not to mention knock on effects like anxiety/depression,reduced income etc), is something I DON’T believe in, but is happening with our current system. This is particularly hard for me to see after coming from the UK where wait times are measured in months, not years – which is partly due to having a private system. An addition of a private system will reduce the wait time, and therefore overall suffering, of patients such as these – even in the public system – something I DO believe in.

    My core ideology is therefore a reduction in overall suffering – if a public model could provide this, I would certainly support it.

    I’ve witnessed wealthy people in the UK who choose the public system, and have heard of less well off Albertans flying to Vancouver to receive private care. Ultimately, we often make choices reflective of our value on our own individual health.

    Glad to hear your thoughts, Harold. I hope I have provided you with a different point of view to ones which you may have encountered before.

    Warm regards,

    Jon

  3. Ah, it is indeed a difficult challenge, but with the US so close and such a desperate state in terms of there health care, it is hard not to worry about following a similar path. To this point, I have not read anything that comes close to an even handed account of how we might approach the problem (the exception is, of course, your discourse. Cheers, Harold

    • Indeed – a difficult challenge. What I’m hoping with this article is that it gets people talking, thinking about ways we can improve the system. Your concern about the US is certainly valid, relevant,and shared by many – I urge others to realize there are, however, other systems/countries out there which are very dissimilar to the US, but still utilize private care to provide a better overall health status for their respective populations

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