Guyatt: Want sustainable health care? Go public

Why is it we celebrate the production of 10,000 SUVs or 10,000 television sets as economic growth but don’t do the same for 10,000 hip replacements?

Dr. Gordon Guyatt points out that there is likely more merit to the hip replacements than the SUVs, yet we are conditioned to think otherwise.

Dr. Gordon Guyatt

Dr. Gordon Guyatt

Public health care is not a drain on the economy, but part of the economy.

Speaking at a “Students for Medicare” conference in Toronto March 31, the McMaster University professor and recent recipient of the Order of Canada made the case that the road to sustainable health care is in publicly funded health care.

Guyatt was critical of the mainstream media who only look at the sustainability of public health care costs, ignoring total health care costs.

At one time Canada and the U.S. spent about the same percentage of their overall economies on health care. After Canada introduced Medicare, costs in the U.S. escalated much faster by comparison. Today Canada spends about 11 per cent of our economy on health care compared to 17 per cent in the U.S.

Guyatt notes that a significant portion of those U.S. costs is tied up in administering the private insurance system. In the United States, depending on the insurance company, there are between 14 and 35 employees administering the system for every 10,000 enrollees. In Ontario, there are 1.2 employees at OHIP for every 10,000 Ontarians covered by the public insurance scheme.

Despite the sustainability hysteria, public health care costs have barely changed as a percentage of Canada’s economy, rising from 7 per cent to just under 8 per cent over a period of about 20 years. That share rises during recessions and usually drops afterwards as the economy grows in relation to health care spending.

Guyatt points out that Canada has among the lowest level of publicly funded health care among wealthy nations. Only Switzerland and the U.S. have a lower rate among comparator countries. While Canada has about 70 per cent publicly-paid health care, France covers 76 per cent of health costs and Germany 78 per cent. While Canada has among the highest level of coverage for physicians and hospitals, the European countries do a much better job of covering pharmaceutical costs and dentistry.

Canada’s spending on health care was second in the world in 1992, we have dropped to the middle of the pack compared to other advanced nations. Growth of health care spending has been much more limited in Canada than virtually anywhere else in the world.

While health care is accused of swallowing up the budgets of other sectors, the reality is we didn’t get into deficit by rising health care costs, but through continual tax cuts. The same size fish looks a lot bigger in a smaller pond. That said, costs relative to provincial spending are currently dropping. Unlike the private sector, it is much more possible to bring about savings in the public sector.

Tax cuts have resulted in a significant decline in the public sector. Whereas Canada once had a much more robust public sector than the U.S., the two countries now spend about the same amount on government services. The big difference is the U.S. spends a lot more of it on the military.

“Sustainability is the bludgeon the right wing is using to convince Canadians to give up on universal health care,” Guyatt said. “It’s a big lie.”

Guyatt notes a study by Jeremiah Hurley at McMaster that proves that not only are the opportunities for cost savings in private care are very limited, but they are also unlikely to reduce wait times. When comparing the public systems around the world to the U.S., more studies show better outcomes for cancer, cardiovascular, renal dialysis and cataracts in the more public systems.

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