The Real Risks in Two-Tier Medicine

Browsing at a magazine rack not long ago, I happened to notice a cover promo for an article: "Facing Cancer Without Insurance." Odd, I thought to myself, I didn't know you could insure yourself against cancer. I made a mental note to stock up on some of that.

Only a Canadian would make such a dumb mistake. Any American would instantly understand the point of the article - getting cancer is a nightmare, but getting it when you don't have health insurance is a nightmare plus a massive financial problem, often leading to personal financial ruin.

Scrambling to convince doctors and hospitals to treat you when you have no money but desperately need their services - the gist of the personal story related in the article - is an idea so wild that it's hard for us Canadians to get our heads around it. But for about 43-million Americans who have no health insurance, it's a possibility always lurking just around the corner. About 500,000 Americans declare personal bankruptcy each year because of medical expenses.

All this is worth contemplating, given that Ontario Premier Mike Harris is planning to make privatization the focus of the upcoming debate on the future of Canada's health-care system. In a televised interview last month, Mr. Harris said we shouldn't fear looking to the private sector for solutions.

Mr. Harris is trying to suggest that our resistance to privatized medicine has something to do with fear of the unknown. On the contrary, we resist privatized medicine precisely because we know a great deal about it.

We have only to look south, where the mostly private U.S. health-care system provides ample evidence of how to spend tons of money on health care while leaving lots of citizens without basic coverage. (Americans spend roughly 40 per cent more per capita on health care than we do in Canada, even though we insure everybody.)

Nobody in the United States even bothers to deny the charge of two-tier medicine. The only disputable point is whether it's more accurate to call it three- or four-tier medicine.

At rock bottom, for instance, are the 43-million Americans who have no health insurance. Most of these are lower-middle-class families or middle-class families whose breadwinner is between jobs and therefore also between health insurance plans.

These people actually end up worse off than the real poor, who at least qualify for a federal program called Medicaid. If that sounds pretty cushy for the poor, it's not. Medicaid pays doctors such low fees that few doctors will accept Medicaid patients.

Then there are millions of other Americans who are neither poor nor completely without insurance. But they have skimpy coverage or coverage that doesn't include all medical conditions. A serious illness in the family quickly exhausts their minimal benefits.

While those without insurance are theoretically entitled to treatment (for a fee) at public hospitals, gaining access to that treatment can be extremely difficult, and many simply go without. Or, as in the case of 57-year-old Larry Causey, they find other innovative ways to get treated. As reported in the Post last month, Mr. Causey went into a Louisiana post office, slipped the teller a robbery note and then went outside and waited for police to arrive. He was taken to jail where he was able to get treatment, otherwise unavailable to him, for his colon cancer.

Not everyone is so lucky. Roughly 100,000 Americans die each year because they can't afford necessary medical treatment, according to Vicente Navarro, a health policy professor at Johns Hopkins University in Baltimore.

Considering all this, it would be downright irrational for anyone of modest means not to be afraid of the kind of private medicine practised in the United States.

Of course, Mike Harris - and Ralph Klein, the Alberta Premier - are politically astute enough not to suggest a U.S.-style privatization that would leave some Canadians without insurance. Instead, they talk about privatizing hospitals, which sounds harmless and still promises to open up plenty of investment opportunities for their corporate supporters.

But if the goal is to save money, as they suggest, once again we have the benefit of the long experience of our southern neighbour to shed some light. The authoritative New England Journal of Medicine (August 5, 1999) included a study, based on the evidence of fifty states, which found that costs were 13 per cent to 16 per cent higher in profit-making hospitals than in non-profit hospitals. A special editorial in the same issue of the Journal pointed out that decades of research had found profit-making hospitals are consistently more expensive.

No doubt, there are countless right-wing think tanks churning out studies to the contrary. But as the Journal editorial pointed out: "No peer-reviewed study has found that for-profit hospitals are less expensive."

Now, perhaps it is too much to expect political leaders, or their staff, to check out the findings of scientific studies before foisting private medicine on us. But what is more difficult to explain is the reaction of these political leaders when they are actually presented with such findings.

How would we expect Ralph Klein, for instance, to react when studies about the higher costs of private hospitals, reported in the New England Journal of Medicine, were raised in the Alberta legislature in December 1999? With concern? With curiosity?

Here's how he actually responded. "Mr. Speaker ... it is that kind of information, that kind of fear-mongering that leads to public confusion, relative to this issue."

So let's get this straight: Fear-mongering by the New England Journal of Medicine is leading to public confusion. Thank God we can look forward to a national debate where we can count on Ralph Klein and Mike Harris to clear up the confusion.

Originally published by the National Post. Linda McQuaig's column appears every second Monday.

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