22 May Newspaper Column: Private sector top cost driver for health care

Thursday, 22 May 2008

* This column was printed in the Chronicle Herald on May 22, 2008  *

 Private sector is top cost driver for health care system

By Bill Swan, Masters of Health Administration, Incoming Chair of the Nova Scotia Citizens Health Care Network.  For more information about public sector solutions to the problems in the health care system see our website at www.nshealthcoalition.ca

Over the years, I’ve noticed that promoters of health care privatization will take startling liberties with facts and data in order to support their arguments. When they don’t have careful peer-reviewed research, they’ll depend on the time-worn tactics of repetition and misdirection to add “truthiness” to their arguments.

Nadeem Esmail’s opinion piece (May 14 2008) is a condensed regurgitation of the same arguments we’ve heard year after year.

Comparing national health care systems is a difficult task, as I’ve found out from personal experience. Deber & Swan 1999 (http://www.cmaj.ca/cgi/content/abstract/160/12/1730) outlined the problems with different measures for international comparisons. There are many ways to slice the data, so different approaches can result in very different results. Often whoever is using this information in a policy debate will use whichever metric best supports their argument.

For practical policy purposes though, these comparisons are almost useless given the substantial differences in the systems being analyzed. Comparing various countries requires such broad generalizations and interpretation that the results look good in a table, but add nothing valuable to the debate.

That being said, the commonly accepted approach is to compare health care costs as a percentage of GDP. Under this approach – the preferred method used by the OECD (whose figures, incidentally, Mr. Esmail gerrymandered for his comparisons, although he fails to mention this) – total health spending as a share of GDP in Canada (9.8%) is comparable to that of Australia (9.5 %), lower than in France (11.1 %) and Germany (10.7%), and significantly lower than in the U.S. (15.3 %).

This is not the only problem. Mr. Esmail’s tries to frighten the reader with unsubstantiated proof of the increasing costs of caring for the elderly, a factoid often trotted out by privatization zealots. Many accept this as an article of faith, but it simply isn’t true. The Canadian Health Services Research Foundation has an easy to understand review of the issue (http://www.chsrf.ca/mythbusters/pdf/myth5_e.pdf). A September 2007 report by the Canadian Centre for Policy Alternatives showed that over the past decade the impact of population aging on health care spending was only 0.8% per year. Moreover, the growth in costs due to the greying population is expected to be quite modest and sustainable (http://www.policyalternatives.ca/Reports/2007/09/ReportsStudies1712/index.cfm?pa=A2286B2A).

Finally, Mr. Esmail tries – ineffectively – to raise the alarm about the wait times in Canada. This, despite the fact that the wait list data used for these analyses is highly disparate and suspect. Even provincial governments have criticized it extensively.

Mr. Esmail plays a great game of three-card monte with the reader. He compares Canada’s health care system to other nations with universal coverage, jiggers with the figures by adjusting for age – all (no doubt) to try to make the case that Canada’s problem is insufficient privatization. Canada already has a universal health care system with one of the highest proportions of privatization. Contrary to what they would like you to think, the cost drivers are primarily from the private sector – NOT the public sector – so we should not be shocked that costs continue to increase. Other countries have broader coverage than Canada and include pharmaceutical and dental coverage. I am sure Mr. Esmail and his supporters would rather not have you think that investing in these services and expanding coverage might reduce costs because he doesn’t like those facts.

Promoters of privatization have an ideology that they want to force on the rest of us. It doesn’t matter if universal coverage is cheaper and leads to better life expectancy. They’d rather get you angry and try to convince you that paying more money to insurance companies for less effective health care is in your best interest.

Clearly, though, the problems in our health care system can only be solved in the public sector.