Vancouver Province
for August 18, 2000

  Medicare is founded upon five pillars – universality, accessibility, portability, comprehensiveness and public administration. All are crumbling such that the edifice itself barely stands. We’re in deep trouble. Herewith some questions and a suggested remedy.

  Question – does anyone seriously suggest that we don’t have a two tiered system already? Some of it, for reasons that defy logic, medicare permits - such as eye surgery where people with a couple of thou’ in their jeans get cataracts repaired almost instantly where the rest wait at least six months. If you think that athletes wait six months to a year for knee surgery you would buy the Lions Gate Bridge and if you believe that VIPs get in that lineup I’ll throw in the Ironworkers Memorial Bridge for good measure. Moreover, those with money bypass all lists by going to Bellingham.

  Question – does anyone, even the Health Minister, believe that we have good medical equipment in this province and that adequate reserves for its replacement are being set aside every year? The fact is that third world countries won’t take our used machinery nor will one Victoria veterinary surgery. The machinery is hopelessly out of date and in some cases downright dangerous, there are no reserves for its replacement much less the $150-200 million required annually, and if it weren’t for private foundations and fundraising much of the equipment we have wouldn’t be there.

  Question – if we believe (and most do) that non medical remedies are just as efficacious if not more so than traditional medicine, what is the rationale for paying doctors in full yet depriving these alternate practitioners and remedies full access to the system? Logically, if alternative practices don’t work, they should be denounced as quackery. If they do work, they should be fully funded.

  Question – what is the “healthcare” we’ve agreed to fund out of the public purse and give every Canadian access to? What’s in and what’s out? And why? At present we seem bent on fully funding whatever medical science discovers without any regard for the costs. Is our criterion a decent standard of morbidity and mortality, or is it whatever comes down the pike? If we have no definition and no accepted method for amending it, how can we ever hope to determine the costs much less contain them?

Question - there is already a substantial amount of private money in the system so the “public administration” pillar is to some degree eroded. Do we need more outside capital?

  There are scores more fundamental questions we must ask. The answers will only come in one way – a national debate followed by political accountability to the decisions reached. In having that debate we must permit every solution to be canvassed. As it is, the very mention of private involvement has the left setting its collective hair on fire. If we so much as whisper such a notion, why we’ll have the “American-style-system” and all the bodies lying writhing in the streets which that phrase conjures up. All the left needs do is resurrect the ghosts of Tommy Douglas and Emmet Hall, who founded medicare,  and that’s deemed sufficient to close the debate.

  It is not an either/or issue. There are many jurisdictions in Europe and elsewhere that accept private medicine as part of the overall system.

  I think there are two problems. First we’ve brainwashed ourselves into believing that we cannot fundamentally change our system but must throw ever increasing gobs of money at it. We’re in a philosophical straitjacket which permits no new lines of debate. Second, we measure other systems not simply by asking if they’re better than ours but whether they’re perfect.

  To launch the debate I would suggest a fact finding commission led by someone outside the healthcare industry (which has a huge interest perpetuating the status quo.) This commission should look at all jurisdictions without any prejudgment. It must also consult with Canadians across the land and find out what they want. If the debate is constrained by holding immutable the five pillars of medicare (all of which are honoured more in the breach than the observance) then it will be of no use at all. If, on the other hand, all involved, especially the consumers, get a proper hearing then and then only can we begin to develop a system that is affordable – and works.