It would be nice, as Canada heaves its way through another debate about the provision of health care by for-profit companies, if politicians were more honest about what is being proposed. We’re looking at you, Jagmeet Singh.
The NDP leader tweeted this week that Prime Minister Justin Trudeau is failing to stand up to premiers who are trying to bring “U.S.-style for-profit health care to Canada.”
He also recently said he might end his party’s continued support for the minority Trudeau government if it did not ensure that health care funding from Ottawa is not used for “enriching private companies.”
Which is odd, given the fact the NDP leader is a vocal proponent of pumping vast quantities of health care dollars into private companies commonly known as “dentist’s offices.”
Mr. Singh has (commendably) pushed the Trudeau government into creating an interim means-tested dental benefit program for children under 12, but his long-term goal is the inclusion of oral health in the medicare system.
If that ever came to fruition, it would mean that instead of handing, numb-lipped, our credit cards to the receptionist on the way out the door and then hoping to get a portion of the three-figure sum back through private insurance, we would flash our health cards and walk away unscathed.
To achieve this, provincial governments would have to negotiate a set of fees for various medically necessary services and treatments with the dentists operating in their jurisdictions.
The fees would pay for more than the treatments themselves, because they would have to help cover office costs and salaries for receptionists and hygienists, and leave enough for the dentists to pocket as personal income.
In other words, profit-taking would be built into the system – just as it is now for doctors.
Is Mr. Singh aware that 72 per cent of physicians in Canada work on a fee-for-service model, which means they are paid a negotiated sum for each consultation and treatment, rather than collecting a fixed salary? Does he know that those doctors operate as private, for-profit corporations?
The Canadian Institute for Health Information says the average gross payment to physicians in 2020 was $354,000, with 20 to 30 per cent going to cover costs. The excess, a form of profit, served as the doctors’ pre-tax personal income.
Those doctors can presumably find efficiencies that will increase the revenue they pocket. They can form a group with other doctors to create economies of scale, or move to a smaller office with lower rent. They can also opt to see more patients and work longer hours, in order to collect more fees.
And there is nothing wrong with that. Nothing at all.
At the moment, Ontario and Alberta are making news with their plans to move some surgeries out of hospitals and into privately operated clinics. The dual goal, and it’s an important one, is to relieve the pressure on hospitals and to clear out of a backlog of non-urgent but still important procedures such as joint replacements and cataract surgery, both of which are covered under medicare.
Canadians need to understand that their health-care system is not some gigantic, state-run, cradle-to-grave hospital system but is instead a single-payer, first-dollar (meaning no co-payments) insurance program that covers medically necessary hospital, diagnostic and physician services.
We pay the premiums in the form of taxes. Doctors, hospitals and diagnostic services collect their payments in the form of fees from the government-as-insurer.
If dental care ever became part of medicare, patients would no longer be reliant on a multitude of private insurers to cover medically necessary procedures, but they would still be getting treated in the same private dentist offices, by the same private businessperson who hangs the same curious art on the walls, and who has the same impetus to find efficiencies in order to maximize revenues.
Can this work for clinics that specialize in other parts of the body, such as crunchy knee joints and cloudy eyeballs?
Absolutely. As long as governments ensure that patients are out-of-pocket exactly as much for their procedures – i.e., zero dollars – as they would be in hospital, and they can’t move to the front of the line by pulling out their credit cards, this will never equate to “U.S.-style” privatization.
Mr. Singh should be honest enough to admit it might even improve Canada’s health care system.