Goodbye, Europe. Hello, USA.
Alberta headed for USA-style health care system
By Diana Gibson
Parkland Institute
Originally published February 21, 2006
Ralph Klein has wasted no time challenging the election promises of Stephen Harper’s Conservative minority government.
In early February, Alberta Health Minister Iris Evans presented the first phase of Alberta’s health care reform plans to the provincial cabinet. Evans, who plans to announce additional reforms this month, acknowledged that the reforms will potentially violate the Canada Health Act.
Harper solemnly pledged to uphold the Canada Health Act, which requires, among other things, universality, comprehensiveness and public administration.
Yet Klein has announced that he is rolling out an agenda to dramatically expand private health insurance and delivery. Carefully crafted rhetoric like “third way,” “increasing access,” “medicare plus,” “increasing choice”
and “European model” is used to shroud the fact that he is talking about privatization, and taking Alberta toward a US- style, corporate health system.
There is no “third way” or “European model.” As the Supreme Court’s Justice Marie Deschamps pointed out in the Chaoulli decision, “There is no single model; the approach in Europe is no more uniform than in Canada.” There is, rather, a spectrum of health care models ranging from purely public to purely private.
Canada already has significant private-sector involvement on both the funding side (insurance) and the delivery side (private surgeries, labs and diagnostics). In fact, Canada is already farther down the path to private insurance than most European countries.
In most European countries, private insurance covers less than 10 percent of health care costs, whereas Canada is already at approximately 14 percent.
In fact, Canada is already fourth among OECD countries for private health insurance spending.
European health care is more comprehensive. Among members of the EU, health insurance tends to be more universal and more comprehensive than Canada’s, covering a wider range of benefits such as pharmaceuticals, dental care and long-term care.
If there is a trend in OECD countries, it is towards less, and not more, private funding. Between 1994 and 2004, the private share of health spending was either constant or decreased in more than half of OECD countries.
European countries protect the publicly funded system. Health care practitioners can’t be in two places at the same time. So creating a parallel, for-profit system will simply take doctors, nurses and radiologists away from the public sector, where there is already a shortage.
For this reason, many European countries have instituted regulations that protect the public sector from such erosion. Examples include requirements that doctors and even patients must opt in or out of the public system; and limits on what practitioners can charge and insurance companies can pay in the private system. For example, in Austria, private insurance can only pay 80 percent of the cost billed by professionals practising in the public
sector.
Alberta currently has a provision that doctors must opt out of the publicly funded system if they want to offer services covered by the public system on a for- profit basis. As the bulk of the work is in the publicly funded system, this presents a disincentive to doctors practising outside of the publicly funded system; they can’t do both.
Such protections are precisely what Ralph Klein is proposing be eliminated. He has already clearly said that the requirement for doctors to opt in or out will be eliminated.
There have also been hints that the protections for the public system introduced in Bill 11 will be reversed - for example, the provision that private, for-profit surgical clinics could operate but not private, for-profit hospitals.
These changes take us down an American path, not a European one.
There are other reasons to believe that Klein is taking the US path and not the European path.
First, Canada is integrating our economy with the US, not with Germany, Sweden or France - and Canada has clearly become part of a North American health care market.
Second, it is US health care corporations, not European ones, who are pushing for access to the Canadian health care system.
Not surprisingly, the US has the world’s largest health insurance industry.
The influence wielded by US health insurance corporations is reason enough to carefully scrutinize Klein’s choices.
Witness the Alberta government’s decision to hire US-owned AON Corporation to design health care options for Alberta.
This choice speaks volumes; AON will be intimately familiar with the US model.
And yes, this is the same AON whose American parent recently paid out $190 million following a probe into allegations of fraud and anti-competitive practices.
Once the door is opened to further privatization in Canada’s health care system, it will be difficult to turn back to the principle of universality - equal access to health care regardless of ability to pay.
Private interests will be heavily invested, and NAFTA’s infamous Chapter 11 may open us to lawsuits if we try to make our system public again.
We are embarking on a critical debate about the future of our health care system, a system that represents the fundamental values of equity and justice at the core of Canadian society.
Will Harper stand up for Canada? Will he stand up to Klein?
Diana Gibson is the Research Director for the Parkland Institute. She has an extensive background in public policy research and as an educator. Prior to joining Parkland, Diana worked as staff and a consultant to various community organizations, colleges, government agencies and trade unions on topics ranging from health care policy and water security to international trade.