No Payor System

Preamble

The recent Supreme Court of Canada decision¹ places a difficult challenge before the Canadian Healthcare system. The Court upheld the contention that when government imposes delays in access to treatment in order to sustain the Public Health System it violates the individual’s right to life, liberty and the security of the person. Although rationing of resources was the primary concern, this decision threatens to provoke a series of challenges which will seriously weaken the political and economic viability of the single payor system. The Canadian Government’s response to this challenge will critically affect its ability to preserve the goals and principles incorporated in the Canada Health Act.

Implementation of Plan

A. Shift to tax preserved funding of health care

1) The current level of health care funding in Canada benchmarks the country’s fiscal commitment to health care. There should be an active review of the adequacy of this funding before the level of tax-preserved funds available to each household is established. The objective should be to establish a level of funding sufficient to provide a comprehensive health care system without the need to ration services.

Synergistic Benefits of this reform

1) Each physician-partnership which acts as a primary insurer answers the Supreme Court’s concern that patients, when faced with inequities in the distribution of care, should have access to an independent source of health care. Independent physician-partnerships obviate the need for government to introduce private health insurance companies. In turn, this eliminates the possible introduction of an ancillary profit motive which would siphon funds away from the delivery of health care.

Effect on Government Programs

1) Once these changes are implemented the Canadian health-care system should continue to evolve, guided by predictable and fiscally justifiable demands for increased tax-preserved healthcare access. The need for tax-based revenue for other purposes should not be affected.

During its many decades, socialized medicine in Canada maintained an enviable record of healthcare access for its people. But its commitment to access took a toll. Over time medicine evolved into an ever more complex and expensive proposition. To sustain universal care, choices had to be made. As in all healthcare systems cost containment became a major issue.

Controlling healthcare cost seems to be impossible. Attempts at constraint imposed by government or managed care fail to show any indication of success. In their wake access to care becomes more difficult. What is the problem?