The Bottom Line

Diana Gibson

Description

The Alberta government is looking to the private sector – and in particular to private health insurance – to solve health care problems. However, private health insurance is mired in myth and misunderstanding. The Bottom Line summarizes a huge body of evidence to get to the truth: private health insurance is more expensive and actually reduces access to health care. Evidence reveals that a manufactured cost crisis is driving the push for more private health insurance. This book examines the implications of the recent Supreme Court Chaoulli decision in Quebec, and offers vignettes of life before medicare. The Bottom Line concludes that the Alberta Conservative government is needlessly pursuing a US-style health system. In this highly readable and well-researched book, Diana Gibson and Colleen Fuller get to the real story behind private health insurance and offer viable solutions for strengthening Canada's public health care system from within.

Sujets

• Médecine
• Médecine Générale
• Health Policy
• Medical

Informations

• Publié par: NeWest Press
• Date de parution: 01 avril 2006
• Nombre de lectures: 0
• EAN13: 9781927063071
• Langue: English

Extrait

The Bottom Line
The truth behind private health insurance in Canada
Diana Gibson & Colleen Fuller
Copyright © Parkland Institute 2006
All rights reserved. The use of any part of this publication reproduced, transmitted in any form or by any means, electronic, mechanical, recording or otherwise, or stored in a retrieval system, without the prior consent of the publisher is an infringement of the copyright law In the case of photocopying or other reprographic copying of the material, a licence must be obtained from Access Copyright before proceeding.
Library and Archives Canada Cataloguing in Publication Fuller, Colleen, 1952- The bottom line : the truth behind private health insurance in Canada / Colleen Fuller, Diana Gibson.
Co-published by: Parkland Institute. Includes bibliographical references. ISBN-13: 978-1-897126-10-3 ISBN-10: 1-897126-10-7
1. Medical care--Canada. 2. Insurance, Health--Canada. 3. Privatization-- Canada. I. Gibson, Diana, 1967- II. Parkland Institute III. Title.
HD9399.C32F85 2006 362.1'0971 C2006-900879-5
Board Editor: Doug Barbour Cover image: istockphoto.com Cover design: Amber Rider and Katherine Hale
NeWest Press acknowledges the support of the Canada Council for the Arts and the Alberta Foundation for the Arts, and the Edmonton Arts Council for our publishing program. We also acknowledge the financial support of the Government of Canada through the Book Publishing Industry Development Program ( bpidp ) for our publishing activities.
NeWest Press 201–8540–109 Street Edmonton, Alberta T6G 1E6 (780) 432–9427 www.newestpress.com
Parkland Institute Faculty of Arts, University of Alberta 11045 Saskatchewan Drive Edmonton, Alberta T6G 2E1 www.ualberta.ca/parkland
1 2 3 4 5 09 08 07 06
printed and bound in canada
To Dave, Eva, and the Parkland Institute: Dave, my incredible husband without whom this book would not have happened and Eva, my toddler who was so strong and patient with my absences. And the Parkland for working so tirelessly to open spaces for creative public debate in the province. —Diana
To John: To John Calvert, who shares and enriches my life beyond measure. And to the ones who, generation after generation, fight for a health care system based on the timeless principles of fairness and equity. I am in awe of their enduring commitment to the common good. —Colleen
Contents
Acknowledgements
Introduction
The Path to Private Insurance Unfolds
Myth 1: Private insurance is a ‘new’ model for health care
Myth 2: Private insurance will increase access and choice for individuals
Myth 3: Private insurance will be cheaper for individuals
Myth 4: Expanding private insurance is part of a ‘Third Way’; a European model, not the American model
Myth 5: The public system is unsustainable; costs are growing out of control
Myth 6: Private insurance will save the public system money
Myth 7: Public funding and universality are behind the wait list problems; expanding private insurance will reduce waits
Conclusions and Recommendations
Glossary: Insurance terms Canadians might have to become familiar with
Endnotes
About the Authors
Acknowledgements
We are unable to individually thank all of those who had a part in ensuring this book came together so well and so quickly. The researchers, reviewers, editors, publishers, and designers worked as a perfect team. The advisory committee provided advice, guidance, and expertise that was invaluable—thanks Gillian Steward, Wendy Armstrong, Keith Wiley, Ricardo Acuna, Steve Patten, Steven Lewis, and Tammy Home. We would also like to acknowledge Gordon Laxer, John Whittaker, Armine Yalnizyan, David Thompson, and Nancy Gibson, for their insightful comments on various drafts. Finally, thanks to Robert Evans, Michael McBane, John Calvert, Shelagh Day, and Abby Guthrie for research support.
A special thanks goes to the individuals, unions, researchers, and community organizations that have been at the forefront of the struggles to defend public health care in Alberta. This book benefited from their moral support, ideas, articles, and most of all, their unwavering commitment to the values of equity and universality.
—Diana Gibson and Colleen Fuller
This bracing review of the facts puts the lie to the arguments that are regularly trotted out to explain why more private health insurance is “the answer” to our healthcare woes.
—Armine Yalnizyan, economist
Introduction
Over the past decade Canadians have witnessed concerted initiatives to expand the role of private for-profit health care across the nation. Alberta has been a leader on this front for many years; the petri dish for experiments with private for-profit health care. Other provinces have been quick to follow and even to move beyond Alberta down that path.
Once again, Alberta is taking the lead on health care privatization. The province has clear long-term plans for expanding the role of for-profit health care on both the delivery (surgeries and hospitals) side and the funding (insurance) side. There has been significant debate and controversy in recent years about private for-profit hospitals and surgical clinics, especially in Alberta, bc and Quebec. However, there has been little public debate about how those services are paid for—by private or public insurance.
Though the issues of who pays and who provides are closely related, this book's emphasis is on funding because the universal, public, single-payer model is the crux of our health care system. This debate cuts to the core of Canadian values—whether a patient accessing health care will be using their public health care card or their credit card.
The issue of private insurance has been brought to the fore by the June 2005 Supreme Court ruling that Québec's restrictions on private health insurance violated the Constitution if wait times in the public system were “unreasonable.” This appeal was brought by Jacques Chaoulli, a doctor with a private practice in a wealthy Montreal suburb who has long had a beef with public health care. This decision has sparked renewed efforts to expand private insurance across Canada.
Six Canadian provinces including Alberta have an explicit ban on private insurance for services covered under the public system. Alberta also requires doctors to opt in or out—they cannot bill in both the for-profit sector and the public sector for service covered under the public system. Even in those provinces that do not have an explicit ban on private insurance for medically necessary services, the role of private insurance has been very small, partially a result of policies that protect the public system such as the requirement that doctors opt in or out. This landscape is changing, with serious implications for the future of health care in Canada.
Exposing the Myths and Translating the Rhetoric
This book journeys through the historical, current, and international experiences with private health insurance. First we look back to Canada's pre-medicare days. Then we turn to Canada's present experience with private insurance for supplementary health care. Finally we look to Europe and the United States. This book will illustrate what private insurance could look like for the average Canadian. This journey reveals that the path to private insurance is paved with myths and rhetoric—specifically around the issues of wait times (access and choice) and costs (sustainability).
Doctors, nurses, technicians, and other front line workers bear the brunt of funding and human resource shortfalls and poor coordination while working incredibly hard to deliver overall excellent health services. They and the Canadian public deserve a better analysis of wait times and sustainability. Both deserve to know the real story behind private health insurance.
Life before Medicare
After the operation, and despite pleading, the full price was charged. This ended the family's self-sufficiency. When they went to the city of Montreal they were told to spend any remaining savings accountably, and they would go on the dole. The husband died, leaving a shattered family.
Jack Martin—Wakefield, Quebec p.73
Source: Heeney, Helen, Doug Sneyd, Susan Charters, L ife B efore M edicare: C anadian E xperiences (Ontario Coalition of Seniors Organizations: Toronto, 1995)
The purveyors of private insurance maintain that it is necessary because costs and wait lists are out of control in the public system. Of course, those same parties, including the Alberta government, then offer private for-profit health care delivery and insurance as the solutions. These myths are prevalent though they are contradicted by the evidence. There are seven key myths that this book explores in detail, each in a separate chapter. Private insurance is a ‘new’ model of health care. Private insurance will increase access and choice for individuals. Private insurance will be cheaper for individuals. Expanding private insurance is part of a ‘Third Way’; a ‘European’ model, not the American model. The public system is unsustainable; costs are out of control. Private insurance will save the public system money Public funding and universality are behind the wait time problem; expanding private insurance will reduce waits.
This book looks at the reality under private insurance pre-medicare and illustrates why Canadians have already rejected it. Experiences with private insurance in Canada and elsewhere make clear the lack of access for those with medical conditions or who are unable to pay, escalating premium and individual costs, and the downloading of costs onto individuals and businesses.
The Americanization of Canadian Health Care
You either want a single payer system in this country or you want an American-style health system. And don't kid yourself that there's anything in between .
—Shirley Douglas 1
With careful terminologies such as ‘Third Way’ and ‘parallel system’ the Alberta government and other fans of private health insurance disgui