Demography is Medicare’s Destiny: Baby Boomers will vote for competition in healthcare once they are regular healthcare consumers

Commentary, Healthcare & Welfare, David Seymour


With its financial system in crisis, its air travel paralysed by Iceland’s volcano and Britain’s political situation gridlocked, Europe might seem a good candidate for pity. Any lament for Europe should stop, however, when their healthcare systems are considered. Recent evidence suggests Europe has superior performance in that field. It’s something Saskatchewan should pause to reflect upon, especially if the provincial government wants to achieve its goal of three-month surgical wait times within four years.
The evidence on Europe’s health care superiority is drawn from the Euro-Canada Health Consumer Index, which tests healthcare systems in five areas, all from the perspective of the patient: what rights and information are given to patients, how long are long wait times, what health outcomes are achieved, what is the range and reach of services provided, and what’s the access to medicines (particularly new ones)? 
Canada ranks ties at tenth against thirty-three European nations for the outcomes category, it is last for wait times and finishes middling-to-bottom in the other three categories. Overall, Canada’s rank is #25, barely ahead of Slovakia, a country half as wealthy as Canada. In a provincial breakdown using the same methodology last year, Saskatchewan ranked ninth, with only Quebec faring worse.
The intriguing part of any story, though, is never the facts of the case but the reasons why. Canadians who view Europe as a land of high taxes, pervasive economic regulations, and frequent strikes and protests—often true– might be surprised to learn that European countries don’t achieve better health care results by spending more than Canada. Countries such as Slovakia simply couldn’t afford to. In fact, only the uber-rich Luxembourgers (banking), Swiss (banking), and Norwegians (oil) outspend Canada per capita on healthcare.
Perhaps even more surprising, almost all European countries use private insurance and provision extensively in their healthcare systems. If you have an MRI in France, it will likely be paid for by your employer’s insurance scheme and performed at a private hospital. Those same insurers are required to accept unemployed people with the help of tax-funded subsidies. 
It would be wrong to stop at the observation that some European health systems are more open to private competition than Canada’s and get better results. Within Europe, countries like France and Germany (who more closely adopt this multiple insurer-multiple provider model) generally outperform countries like Britain and Sweden, who have systems closer to Canada’s. It’s not a fluke, it’s a trend.
If the structure of European systems surprises Canadians, one suspects that Europeans–used to a variety of providers that compete for health dollars—would be flabbergasted at the overblown fears inherent in the Canadian healthcare sector. In this province, even the suggestion of tendering out healthcare information services is faced down by an apoplectic advertising campaign from the union of the workers currently doing the work. (“You don’t know me…”)They claim the public interest can only be served by their continued monopoly.
If you accept the empirical fact that the European systems with their competitive insurance and service delivery are outperforming Canada’s, there are then good reasons to believe Canadians are in for a sea change in healthcare policy. The OECD predicts that by 2050, Canada will have two working age people (the 20-64 year old cohort) for every person over 65. That will be down from five workers per over-65 in 2004. This tsunami-like demographic shift will shock the Canadian healthcare model.
Political parties win power by forging coalitions of voters large enough to give themselves a majority of seats, and the boomers are the biggest voting bloc in town. Just as surely as they’ve voted and lobbied their way into being the monopoly providers of public services like healthcare in their working days, they will look across the Atlantic and demand competition when they are primarily consumers of healthcare. There will be little resistance from generations X and Y, who’ll be happy for any improvement they can get as they labour to support half a retiree each.
If this sequence of events comes to pass, Saskatchewan will play a particularly special role because of its historical importance in the Canadian healthcare system. At one level, Saskatchewan is the home of Medicare, but Medicare in its current form could be seen as the logical response to the circumstances and the best knowledge of the day—48 years ago. At that more abstract level, Saskatchewan is the home of innovative healthcare policy. Perhaps it is time for Saskatchewan to lead again.