Mises Wire

Universal Health Care in Canada: A Colossal Government Failure

[This is Part Two of a three part series. See Part One and Part Three.] 

Tom Kent was the senior government policy person in Canada when the Medical Care Act was passed in 1966. He described the government’s objective:

The aim of public policy was quite clearly and simply ... to make sure that people could get care when it was needed without regard to other considerations.

After half a century, the government has still not honoured its commitment, and its performance declines with each passing year, despite increased spending. Furthermore, the government made it illegal for citizens to pay private parties for the health care which the government fails to provide.

Waiting, Waiting, Waiting for a Doctor

According to a Fraser Institute survey, for medically necessary treatment, the median waiting time for patients in Canada from referral by a general practitioner to consultation with a specialist, and then to the date of actual treatment, was 21.2 weeks in 2017.

This year’s [2017] wait time — the longest ever recorded in this survey’s history — is 128% longer than in 1993, when it was just 9.3 weeks.

Research has repeatedly indicated that wait times for medically necessary treatment are not benign inconveniences. Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish. In certain instances, they can also result in poorer medical outcomes — transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities.

Or even death! From a 2014 study by the Fraser Institute:

Justices of the Supreme Court of Canada have noted that patients in Canada die as a result of waiting lists for universally accessible health care.

Our analysis estimates that between 25,456 and 63,090 (with a middle value of 44,273) Canadian women may have died as a result of increased wait times between 1993 and 2009.

If we conservatively focus on the lower value, we still have an average of about 1,500 women who likely died each year between 1993 and 2009 as a result of increased wait times across Canada.

The Toronto Star published a letter, dated May 12, 2015, addressed to Cancer Care Ontario (CCO), a provincial government agency responsible for funding. The letter was signed by five stem cell transplant directors from across Ontario, clearly frustrated with the lack of government funding (emphasis added):

... the net effect of growing waitlists, patients relapsing and dying while waiting for a transplant, patients getting extra cycles of therapy to try and buy time to get them to a transplant, stress and burnout of transplant team members is a pan-provincial problem.

... Previous estimates by CCO of needed transplant capacity have not taken into account all factors operating, the result being under-capacity, apparently surprising and sudden but which has in fact been anticipated or experienced by transplant centres for several years.

... The transplant programmes require resources that would allow capacity ... to increase immediately by at least a third to perhaps as much as a half in order to eliminate backlogs and have medically appropriate times to transplant.

Political and Bureaucratic Indifference

Politicians and bureaucrats show little concern for the tens of thousands of victims of their failed universal health care scheme. The case of 18-year old Laura Hillier, a mere statistic to the government, is a classic example. Laura was suffering from acute myeloid leukemia, and in desperate need of a stem cell transplant. Multiple matching donors were available, but a hospital transplant bed was NOT available. The Toronto Star reports:

In July [2015], Frances [Laura’s mother] sent letters to Premier Kathleen Wynne and Health Minister Eric Hoskins on behalf of Laura and every other patient subjected to the “cruel, inhumane and potentially deadly” waiting times for stem cell transplants. Neither Wynne nor Hoskins replied, Frances says.

In July, 2015, federal Health Minister Rona Ambrose also refused to comment on the matter when contacted by CTV News.

The silence from Ambrose, Wynne and Hoskins speaks volumes, but sometimes a reply is worse than no reply. In July, 2015, in a statement to CTV News, Shae Greenfield, spokesperson for Ontario Health Minister Eric Hoskins, said:

It is our expectation that hospitals will prioritize patients based on medical urgency, however those decisions are made by each individual hospital.

This callous remark seems intended to ‘pass the buck’ to hospitals, but the issue is a lack of resources, not prioritization. There are numerous patients who are a priority because their needs are medically urgent, yet they are all stuck on a waiting list. The fault lies not with hospitals, but with the government, which has failed to provide hospitals with the necessary funding to make good on its promise of making “sure that people could get care when it was needed without regard to other considerations.”

Forced by the government to wait, Laura’s condition deteriorated and she died six months later, on January 20, 2016, still waiting for a bed.

From stem cell transplant surgery, to other cancer surgeries, to cataract surgery, to joint replacement surgery, to bariatric surgery, to heart surgery, etc., the health and well-being of many Canadians suffers — and many die — as the government forces them to wait an inordinate amount of time for the care it promised to deliver on a timely basis.

Government Failure was Predicted

Health care expenditures are constantly rising, but this cannot be sustained:

After years of increasing health care spending at an unsustainable pace, it seems as though provincial governments have started to reach their limits over the past 5 years — understanding that a continuation of such increases would result in either reductions in other spending, or higher taxation, higher deficits and debt, or some combination of these three.

Regarding universal health care in Canada, William Gairdner noted that (p. 288):

Ontario’s 1970 Commission on the Healing Arts prophetically warned that “society would not regard as sufficient, the amount of health goods and services that could be produced, even if all society’s resources were devoted to the provision of health care.”

All of society’s resources are not devoted to the provision of health care. Nevertheless, the 1970 prediction appears accurate. It is an undeniable fact that as increasingly more resources (taxes) have been devoted to health care spending, the actual provision of health care has declined, as revealed by longer wait times. The more the government (supposedly) tries to help us, the more it hurts us.

Economic Effects

Estimated government expenditures for universal health care in Canada in 2016 were about $4,000 per capita. (This does not include private costs for dentists, alternative practitioners (e.g., naturopaths), prescription drugs, private health insurance for non-hospital/physician services, etc.) Additionally, there are unseen costs which fall disproportionately on the backs of the poor.

If we consider the hours of a normal working week, it has been estimated that the cost of ‘waiting’ per patient in Canada was approximately $1,759 in 2016. Even half that amount, say $900, would be felt most severely by the poor when they are unable to work because they are stuck on the government’s waiting list for health care. And remember (Part 1) that the government’s justification for imposing medicare in the first place was that (according to them) “many poorer people just did not get care when it was needed.” Thus, the government has not only reneged on its health care commitment to poor people, but in so doing, it is making poor sick people even poorer.

Many Canadian consumers of so-called universal health care are left wanting, as they have universal access to waiting lists, but not to actual health care. This is a result of the perverse economic incentives embedded within the coercive institution of government versus the positive economic incentives embedded in the free enterprise system, a system from which the provision of health care is outlawed by the monopolistic government. This will be further explored in Part 3.

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