Better Treatment, Better Care (1)

Welcome to Danielle Smith's Fraser Forum, this program is part of a series

of podcasts doing in-depth interviews on free enterprise and personal liberty i'm

your host Danielle Smith president of the Alberta Enterprise Group. Go to

fraserforum.org where you can subscribe comment on the program and see links to

the studies we discuss you will also find archives of previous episodes our

email address is danielle fraserforum.org we'd love to hear from

you. [Music]

One of the interesting arguments that we often hear in canada is well if we if we

allow private hospitals to exist in canada the americans would immediately

come up and create an American health care system so we're afraid of the mayo

clinic coming to Toronto we're afraid of johns hopkins setting up in downtown

calgary uh we're afraid of cedar sinai coming to downtown vancouver what are we

afraid of when we have world-class healthcare facilities delivering some of

the best healthcare in the world south of the border yes there are issues in

the american universal the american system but there is some incredible

health care down there and some incredible knowledge and wouldn't it be

wonderful if we had the opportunity to access some of that in this country

[Music] well hello again i am delighted for this

edition to be speaking with nadeem esmel senior fellow at the fraser institute

about a topic i have been following for literally decades now a lot because of

the work of my guest as well as other scholars at the fraser institute we're

talking about healthcare and how we're going to fix it nadeem thank you so much

for your time today i sure appreciate it thanks for having me on i'm not kidding

when i say i've been watching this for decades uh i was a an intern at the

fraser institute in the mid 90s when i first got

got to see the waiting your turn hospital waiting list survey and so i

have watched it every single year coming out hoping and hoping that we were going

to see trends going in the right direction and why don't you share the

bad news what's actually happened uh year over year in that waiting u-turn

survey the trend continues to go in the wrong direction we're reaching peaks and

highs continually year after year and we've tried to dig into this and try

to understand why is this happening as spending is growing in fact even when

you do a statistical analysis the more money we put into the health care system

in canada the longer the waiting list get which is exactly the opposite of

what the oecd has found occurs in europe where a hundred dollars of extra per

person spending brings waiting lists down and canada brings them up that's

how dysfunctional the healthcare system is so when can you talk a little bit

about what that survey shows just so people know where the problem lies

because you look at a couple of things and if i remember how you do it you

actually you ask real doctors frontline doctors and frontline specialists how

long it's taking between between treatment diagnosis and as and when they

get their their actual treatment can can you just sort of elaborate a little bit

so people understand why it's getting so bad

so the survey goes out to medical practitioners physicians in 12 major

medical specialties across the country we contact every physician we're able to

contact and we ask them how long it takes for a

patient to see the doctor on an elective or routine basis and then we ask about a

special specific set of surgeries and how long a patient would wait from today

for those surgeries or treatments and we also ask about the weight test for mri

ct and ultrasound and the weight to see the surgeon or the specialist plus the

weight to receive those treatments on a weighted basis gives the total wait time

nationally so we're going physician but we're going

specialty by specialty treatment by treatment and then aggregating up based

on the number of treatments actually performed to get the aggregate number

and if i recall this you started this at fraser institute before anyone else but

there have been other waiting list surveys that that that validate and and

replicate the findings that you have right

that's right this was started in the early 1990s dr michael walker professor

stephen globerman got together they created the survey it started in british

columbia moved national the first national i think was 1993. i stewarded

from the 2000 to about 2012. and we have gone every year out to the uh to the to

the medical literature to the economic literature to try and verify the numbers

that we have and what we found is that if anything waiting your turn actually

understates the actual patient's experience in canada

certainly governments have gone unmeasured if you look at the oecd's

charts of how governments measure the canadian official stop watch starts

later than every other country in the developed world stopwatch begins and we

still record officially wait times that are competitive with our colleagues who

start their stopwatch much earlier it's a terrible state of waiting

it's it is a terrible state and i guess the the part i need you to unbundle a

little bit is is it doesn't make sense to a regular person looking at this

saying okay we've got waiting lists you would think the right answer would be

well let's just give more money to health care and so governments dutifully

have given more money to health care the federal government has given more money

to health care so why would it be that giving more

money is resulting in worse outcomes that just seems to be upside down

it's it's a very interesting setup and what few people realize is that we

actually have one of the developer world's best funded universal access

healthcare system uh the canadian healthcare system ranks among the most

expensive in the developed world and yet international surveys show that we

actually have some of the longest waiting lists for access to healthcare

in the developed world and it all comes from the structure of the health care

system itself the incentives that are ingrained in a system that has a lack of

user fees that does not have activity-based funding for hospital care

that does not have private parallel provision of medical services and that

does not have private competition in the delivery of hospital services we've

taken a very unique policy construct and as a result we're doing a terrible job

for canadian patients and for the taxpayers that are funding their care

we're going to talk about each of those in detail i want to know if the canada

health act itself has created these structural problems

because if you're in a position where the federal government ties funding to

provinces based on these five principles and there's something wrong with one of

the five principles then you're in a position where you're kind of locked

into never changing the system so let's see if we can go through these one at a

time and you can and you can tell me if if we our starting point needs to be

throwing out the canada health act so we've got public administration

universality comprehensive accessible and i have transportable i

think that's the the the final one let's talk about public administration

and when i think about that that says to me

essentially that you have a single insurer for the services that are

covered which on the surface i don't necessarily object to because i can

imagine it there's probably a lot of streamlining that you have of having a

single insurance plan everybody understands what you can cover

what you can't what gets paid as opposed to having hundreds or even more

private insurers that you would have to deal with is is the public

administration the problem or um should i be looking at that some other

way i think public administration is not is

not one of the central concerns with the canada health act but there is a

peripheral one and that is by locking us into a single insurer and it's

interesting public administration says it can be a non-profit authority

assigned by government it doesn't have to be government but by locking us into

a single authority we immediately under the canada health act disallow a policy

approach followed by a country like germany switzerland the netherlands

where we have multiple competing insurers inside the universal construct

those countries understand that competing insurers allows individuals to

tailor insurance policies to their own unique circumstances and needs to adjust

deductibles and premiums to go into managed care because it might save them

premium by restricting choice of physician it gives all sorts of options

specialization for particular medical conditions someone who's a diabetic

might prefer an insurance an insurer that specializes in that someone with a

heart condition might prefer that sort of a specialized insurer this blanket

one size fits all approach that's that's almost demanded by that particular

principle or term in the canada health act does disallow one policy construct

but it doesn't stop the system from being better a better functioning health

care system okay that you know that's good to know and

when we get into looking at some of the individual systems as well let's explore

that a little bit more let's talk about universality because i think

universality should mean this it means should mean that nobody

loses their house or goes bankrupt because of an inability to pay medical

bills it should be the coverage for catastrophic you don't

want anybody making a choice not to receive essential treatment

because they're they're worried about the cost of it so

that's fine but i don't know that this system where we have um we have to pay

for every little thing in the hospital and physician services i don't i don't

know that that's the best definition of universality and i think you've

you've looked around the world and universality means a lot of different

things in a lot of different places what's the essential component of

universality for you i think universality is the normal goal

but it's a common goal it's shared by just about every developed nation around

the world it's the goal of ensuring access to care

regardless of ability to pay i think there also needs to be in a time frame

to provide that provides comfort and peace of mind waiting for health care is

not a benign process health conditions advance people deteriorate the

medications we have to take for pain while we're waiting for the joint

surgery have an impact on our livers and our livelihoods it impacts our ability

to earn a living to look after our families to enjoy our time with our

loved ones so to me universality is care uh regardless of ability to pay in

a time frame that provides comfort and peace of mind that's not what the canada

health act says canada health act says 100 of the insurable population on

uniform terms and conditions so again disallowing this opportunity for people

to tailor their universal health care experience to their own unique

circumstances and needs but generally a fairly benign goal or an important goal

but a fairly benign piece of the canada healthcare do you do you think in canada

we can re-interpret universality the way you

described or do you think that that principle needs do you need a

legislative change this is what i'm trying to to sort of sort through as we

have this conversation is how much of a straight jacket some of these principles