The political right and centre right have a clear story on the medicare issues. A) Health costs are out of control and yet care is only fair and access is poor, B) Government can’t do anything to improve efficiency and we can’t raise taxes, & C) The only hope is to go private — with the centre right asking for more for profit care within medicare and the further right also demanding private payment through user fees and private insurance, so called “two tier medicine”.
On the other hand, the traditional left-wing position has defended some services but has failed to advance the debate: A) Everything was good with medicare 30 years ago but since then budgets haven’t kept up with demand, B) Many people have inadequate care in the community because we have closed too many institutional beds, C) The feds and the provinces aren’t cracking down on illegal user charges outside of hospital, & D) We need better funded hospitals and nursing homes, enforcement of the medicare legislation and bans on for profit care.
My position is: A) health care costs are near historic highs but have been trending down the past 2-3 years as a share of GDP and of government spending. The famous un-bending cost curve has bent, B) Canada does have access problems especially outside of hospitals but these have nothing to do with medicare or its underlying values, C) Our health system’s strengths (equity in access, relative cost control) are due to public payment, Tommy Douglas’s first stage of medicare. It’s weaknesses are due to the failure to implement Tommy Douglas’s Second Stage of Medicare — a patient friendly system that aims to keep people healthy. D) Canadians should expect same day access to family physicians’ care and within one week maximum for specialist care without spending a lot more money or using for-profit care. (See my October 14, 2012 Toronto Star op ed Canadians are ready for an adult conversation on medicare in the publications section for more details.)
I speak to 30-40 audiences a year representing Canadians from all walks of life and I find my position on medicare is absolutely mainstream Canadian. When Canadians get the facts, they are capable of making some pretty wise decisions. Let me know how you think we can advance the Second Stage of Medicare.
Toronto-based health policy analyst, Dr. Michael Rachlis is one of the leading experts on the Canadian health care system.
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