Canadian Medicare: The Lion at the Gate
Many Canadians think that our health care system, more affectionately known as Medicare, is a fair system. This is supported by the belief that a government-run health care system serves the “public good” by allotting medical care based on “need” rather than “ability to pay”. In theory, a health care system serving the collective “public good” sounds ideal but when we look beneath its altruistic aim we find that the needs of the individual patient are soon lost.
Who really determines a patient’s medical needs in the Canadian health care system? The federal government takes the tax revenues from its citizens and distributes money for health care to the provinces and territories through a global or block funding arrangement. The provincial/territorial governments perceive their patients’ needs in relation to their health care budget. They then provide block funding to their local health regions, networks or service boards who in turn allocate specific amounts to their hospitals. The hospitals perceive the needs of their patients in relation to the money received from their provincial/territorial government and the amounts they have budgeted for specific “medically necessary” services. This helps them determine equipment and supply purchases, the number of procedures and surgeries that will be performed annually, the number of operating hours allotted to doctors and the number of beds available for patients. Doctors then perceive the needs of a patient in relation to the needs of all of the other patients they are treating. Patient names are then added to various waiting lists for medical care.
Does this Medicare system sound frightening? It is deadly. There are patients who die while on waiting lists for medical care. In most of Canada it is illegal for a patient to financially contribute to meeting their own “medically necessary” needs covered under Medicare. The province of Quebec is the only exception due to a 2005 Supreme Court ruling that opened the door for its residents to purchase private insurance for medical care when the province fails to provide timely access. However, the Quebec government only legalized private insurance for three procedures with the longest waiting lists including knee, hip and cataract surgery. Our government often tells us that a shortage of health care providers is a contributing factor for waiting lists. In many cases the shortage of health care providers is due to governments capping the number of employees because of funding restraints.
How is our system fair to its citizens? Is it fair that an individual is prohibited from making financial contributions towards accessing medical care for their own “medically necessary” needs? Is it fair that foreigners can come to Canada and pay for private medical care provided by our best doctors while our own citizens continue to wait on government imposed waiting lists? Is it fair that our government has designated a number of groups, including politicians and prisoners, as falling outside of Medicare and therefore not subject to the same waiting lists as the rest of us?
Our government attempts to meet the “medically necessary” needs of all of the people all of the time through its nationalized health care system called Medicare. It is an altruistic goal and one that, despite the lion’s roars, cannot be met by government.