Critics of a single-tier public system continually point out that the U.S. spends more of its GDP on health than Canada. They do, but only slightly. And it is no great thing when fully one-third of Americans have no medical insurance. In America health care is a luxury. In Canada it is a right. There is reason for great pride in that, we should make no mistake about that. Naturally the system needs more money, not only for equipment and facilities, but also for salaries to insure that we keep our best and brightest here. But a two-tier system is not the answer. Unfortunately, human nature being what it is, every two-tier system in the west evidences massive discrepancies in care. There is one level of service for the rich, another for the rest. We must not desert our great experience of national compassion at the altar of mammon.

Abandonment of our system will result in tragedies of the American experience. Working poor who cannot afford doctors or hospitals, and middle-class families living in the fear that one serious illness can wipe out a lifetime’s savings since even private insurance only covers 80% of inflated hospital costs and procedures. It is not generally known but in the U.S. only about 80% of hospital beds are filled, since so many Americans have no insurance, and of those some 75% are Medicaid or Medicare patients. On the remaining 25% American hospitals create bill charges of up to 1,000% on everything from Saline solutions to Tylenol tablets.

Abandonment of our system for a two-tier one will inevitably create a segregated two-class hospital system. Private hospitals with modern technology and personalized care for the rich and insured, and understaffed public hospitals with beds in the halls and crowded benches in the clinics for everyone else. We will be at the mercy of institutions motivated by greed creating ever growing outrageous costs for the best care. Health care will be reduced to a scarce commodity to be sold at a profit rather than a basic societal right like education.

Abandonment of our system will lead to Canada being at the mercy of insurance and drug companies who are most responsible for health-care cost inflation in the United States. The drug companies, who now specialize in the development of the $1billion “first pill”, 75% subsidized by government tax and R&D credits, have over the past thirty years ranked ahead of tobacco, mining and oil companies in return on total capital. That is the true face of the menace that drains our health resources.The drug companies have exaggerated prices, negotiated cartels on patents and manipulated fears created and heightened by slick advertising. They can get away with this because for all the thousands of drug and biotech companies in the world, the top 2% sell more than half the drugs.

Aside from funding, which is the primordial need, several initiatives could be started that would help ease some of the pressure on the system over the long term:

1. Preventive medicine. This should become a higher priority throughout our system. Everything from vaccination programs and school lunches to research into the causes and treatment of drug addiction comes under this heading. So too are mobile testing units, diagnostic bus services in rural areas, prenatal care, screening programs and decent salaries for paraprofessionals. Equally important are the priorities in medical research undertaken in this country. Profit motivates research done by pharmaceutical firms, so that all their work is drug-related. But profit need not and should not motivate government-funded efforts to find causes for existing diseases.

2. Professional openings. We need quality doctors. The government needs to assume a more activist posture with regard to the Provincial governing bodies of the Medical profession to make it easier for doctors from countries having similar medical standards to ours to gain admittance to the practice of medicine in this country.

Beryl P. Wajsmann

President

Institute for Public Affairs of Montreal