The Fraser Institute bangs its well-worn drum on health care

Bill Maher once asked: if your ideas are stupid, how can you call yourself a think-tank?

Bearing that in mind, let's talk about the Fraser Institute's latest bit of propaganda (they like to call it "research") pushing for the privatization of health care.

In their latest political pamphlet, "Paying More, Getting Less: Measuring the Sustainability of Government Health Spending in Canada [2]", the FI frets over increasing health care costs, breathlessly concluding that Ontario will spend half of its revenues on health care costs starting next year.

The FI worry further that the average increase in health spending for all provinces is 8.3% while revenue only grew by 5.2%. They fail, however, to mention that excessively cutting individual and corporate taxes, something that gives the FI warm feelings, is a key culprit in declining provincial fortunes.

The FI sees little merit in taxation, so don't expect this to be a solution to pay for increasing health care costs. Indeed, whenever they mention the word "tax" the word "burden" often follows. Oh, the power of words. Taxes aren't about redistributing wealth, about creating an egalitarian society. Nay, they are burdensome, crushing, destroying nuisances that "hinder economic growth (p. 6).

While the FI seems to know the cost of some things, they know the value of nothing.
Their recommendations fit within their narrow, privatization-focused approach to all things social services-related.

The FI advocates a co-pay "for all publicly funded medical goods and services" (p.7). This despite findings by Tuohy et al [3] (2004) who noted that there is a "deterrent effect of co-payments on utilization, with negative effects on health outcomes for some lower income groups and some types of illnesses" (p. 377). Indeed, New Zealanders, who rely on a co-pay system, had comparatively worse health outcomes on certain measures than many other developed countries.

But let's not hold our breath waiting for the FI to spend pages concerning itself with lower-income Canadians.

Almost laughably, and clearly without much by way of evidence, the FI thinks paying for care out-of-pocket is a "moral right" (p. 7). I'd be interested to read a whole paper by the FI on "moral rights".

Finally, there is a recommendation that "for-profit and non-profit health providers...compete for the delivery of publicly insured health services" (p. 7). Whenever we open that Rogers bill, who doesn't wish for a bit of competition, right? Except we're talking about the health of human beings and not something, when viewed in the grander scheme of life, the universe and everything, useless like a cell phone.

The FI also fails to mention from whence these health care providers are coming who will work in the private and public systems.

Never mind the lack of health professionals in the current system (we cannot just count heads; also important is how many patients are being seen), what else could happen under the FI's supposed competition model?

We might see an increase in wait times because providers leave the public system for the more lucrative private system, thereby starving the public system of needed health care professionals; and/or providers might increase waits for publicly-financed services to drive demand for privately-provided services (Tuohy et al).

We have enough examples in health care literature and in real-life experience for the FI to draw on to find that their competition model, while enriching a few of their supporters and funders, could result in worse health outcomes for the rest of us.

To note: "Not only do parallel private systems not appear to reduce pressure on the public system, but they may also have the perverse effect of increasing the apparent inefficiency of the public sector. Evidence from the United Kingdom suggests that parallel private systems may attract healthier patients and perform relatively less complicated procedures, thereby increasing the average complexity and dependency of patients continuing to use the public system. Martin and Smith (1996: 294-295), for example, found evidence that length of stay in NHS hospitals was longer in areas with high levels of private inpatient facilities, suggesting that the private facilities "cream off" the less complicated cases, leaving the local NHS facility with a relatively complex case mix" (Tuohy et al, 2004, p. 376).

The FI's entire argument for reining in health care spending is not based on any serious cost-benefit analysis. The authors spend no time actually discussing the ramifications of privatizing health care; it's merely a scare-piece to say "taxes bad, competition good".

Despite the burgeoning evidence that, while health care is expensive, caring for a nation's citizens reaps many benefits such as longer life expectancy, better quality of life, more productivity (the FI should like this -- more able, working, productive bodies leads to more production, more consumption and more profit).

The FI, meanwhile, continues to hammer away at their ineptly supported message that health care is taking over all government spending and the only way out is to call in that solver of all public-sector quandaries -- the private sector.

The FI may bristle at taxes being raised to support our health care system, but taxes can indeed be raised without damaging the economy (I cannot abide by the notion of limitless growth, but that's a comment for another day); but more importantly, ensuring our health care system is well-funded offers rewards and benefits for all Canadians now and in the future.

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