Health Care Summary

First off, a few links I forgot to include in my list of health care reading:

This series by Ezra Klein which looks at 5 different national health care systems (France, the U.K., Canada, Germany and Japan) is well worth reading.

This presentation has some good slides comparing how different national health systems work

And finally, this pair of posts from Jonathan at No More Shall I Roam looks at why the health care market fails, explaining why any country that can afford to has instituted some sort of government run / managed / regulated health care program.

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Looking back at my series of posts on health care, I thought it might be worth clarifying my position on allowing private insurance in the Canadian health care system:

My first point is that there are a number of arguments people use in favour which I think are bogus, including:

• It is inevitable - Not really an argument, so much as an attempt to avoid having to make an argument


• The current system is unsustainable - This claim is normally supported by some misleading, irrelevant figures such as the percentage of provincial spending which goes towards health care, but is not supported if you look at our historical spending compared to our ability to pay (GDP).


• The pragmatic-selfishness argument: We could have better health by spending more on health but people aren't willing to pay higher taxes - but they are willing to spend money directly on themselves. - Given the reductions in taxes over the last decade or so, especially for the wealthier members of society who are affected, I am unconvinced that we are incapable of paying higher taxes (i.e. the same taxes we paid a few years ago) if that is what it takes to make the health system work


• It will be more efficient because the private sector is more efficient than the public sector. - Any study I've ever seen suggests the opposite, that private systems are less efficient (more paperwork, higher salaries, etc.)

That is not to say there aren't any valid reasons to do it, although so far, I can only see one (if you have more, let me know):

• The personal freedom argument (as made by Andrew on an earlier post). The default position in our society (which I fully support) is that people are allowed to spend their money as they see fit - provided the negative consequences of this spending are not too severe. Where I take issue with this argument is when people leave off the second part, and try to claim that freedom to spend money as you wish trumps all other values in our society.

With that in mind, it is worth considering the potential drawbacks to allowing a parallel system of privately insured health care to flourish in Canada:

• Shortage of medical personnel means that a parallel private system just increases wait times for those in the public system


• Private insurers provide inferior coverage (per dollar spent) due to increased costs for administration, advertising, salaries or simply due to a focus on profits over patient health, leading to inefficient use of society's resources and poorer health outcomes than could have been achieved by spending the same amount of money overall, but not allowing private insurance.


• With wealthy, influential people no longer dependent on the public system, political support for the system declines and health outcomes for those dependent on the public system decline


• Inefficient use of insurance by people due to irrational decision making creates waste (hat tip to Laura for bringing this up)


• Increased disconnect between the population and the politicians who govern us. A public health system being controlled by people who use private health care is not a great idea


• Loss of equality in society, and a resulting drive by people to make enough money to be able to afford private health insurance, at the expense of less financially rewarding work such as volunteering.


• Lack of common standards between provinces creates imbalances in the national system (such as doctors in certain fields all moving to one province).

Is people's personal freedom to spend money however they like important enough to trump all these potential drawbacks? Can these drawbacks be mitigated in some way, so that we are not faced with this tradeoff?

Personally, I'm not convinced.