Can a health care system change?
Online posting: July 25, 1997
Published in print: September 1, 1997 CMAJ 1997;157:507
Re: The times they are confusing: What lies ahead for the new health minister and
physicians in Canada?, by John Hoey and Kenneth M. Flegel, CMAJ
1997;157:39-41 [full text / résumé]
Drs. Hoey and Flegel's comments about the sustainability of the Canada Health Act are confusing
and ambiguous. If they mean that, under the present federal and provincial funding framework and
commitments, it will not be possible to maintain the principles of the Canada Health Act because
of underfunding, we agree. If, however, they mean that the principles do not deserve to be
sustained, we have serious concerns.
The principles of the Canada Health Act outline the framework in which the provincial
governments, in concert with the federal government, provide health care to the people of
Canada. The principles of universality, accessibility, comprehensiveness, portability and public
administration should not be readily discarded because of cost; we should do our best to preserve
them. The analogy would be to say that democracy or justice can be dismantled because the
requirements to maintain these principles are too expensive. Rather, we are willing to fight foreign
wars and send in Canadian peacekeepers to defend these principles.
In the same way, those who support the principles of the Canada Health Act must oppose its
dismantling for fiscal reasons and use our collective creativity and ingenuity to find ways to
provide the levels of care commensurate with a high-quality system while funding care adequately.
The costs of health care will be borne by the Canadians, either through a publicly funded system
or through increased privatization.[1] The market-driven system exemplified by the US is not the
direction we want to take,[2] and the two-tier system in the UK will probably lead to more
problems than it will solve.[3,4] Other funding arrangements, such as a use-based taxable benefit,
administered through the income-tax system, could be used to continue to fund the our public
system without compromising the important principles of the Canada Health Act.
Let us not too readily discard important principles that form the basis of a just society for
financial reasons, certainly not in one of the wealthiest countries in the world, acknowledged year
after year as being one of the finest places to live, partly because of the excellence and
accessibility of its health care system.
Michael Gordon, MD
Vice-President
Medical Services
Head
Geriatric and Internal Medicine
Baycrest Centre for Geriatric Care
Head
Division of Geriatrics
Mt. Sinai Hospital
Professor of Medicine
University of Toronto
Philip B. Berger, MD
Chief
Department of Family and Community Medicine
Wellesley Central Hospital
Assistant Professor of Medicine
University of Toronto
Toronto, Ontario
m.gordon@utoronto.ca
References
- Gordon M, Berger P. The alluring myth of private medicine. CMAJ
1996;155:404-6.
- Woolhandler S, Himmelstein DU. Extreme risk — the new corporate proposition for
physicians. N Engl J Med 1995;333:1706-7.
- Currie D. BUPA subscription? That will do nicely. BMJ 1996;313:431.
- Coutts J. Private care no cure, British say. Globe and Mail [Toronto] 1997 June
24; Sect A:1,10.
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