It seemed as if the devil has arrived. The sad days predicted by the old-time Medicare religion are upon us, in the shape of officially sanctioned two-tier health care. In the same week in December, two of medicine’s worst mythical demons – multi-national drug companies and private, for-profit clinics – were welcomed into the fold at Manitoba Health. Yet the sky did not fall. In fact the consequences will be positive, perhaps not for ideological nitpickers, but certainly for the province’s healthcare consumers.
That’s the rub that faces our healthcare regulators. The clock is ticking loudly for the largest, richest generation in the world’s history, the years fast approaching in which they will need efficient, high-quality medical care. If they can’t get what they need here, you can bet they will get it elsewhere.
Imagine that you are a middle-aged professional woman with assets, say, of a quarter million dollars, not that unusual a scenario. You are stricken with a fast-moving breast cancer. After wasting several days, perhaps weeks in our system of perpetual delays and waiting lists, you are told by CancerCare Manitoba: “There is a new chemotherapy treatment that might work, but it is too expensive and has not been approved for use here.” What would you say, if you were still sane?
Fugghedaboutit. That’s what you would say, as you boarded an airplane for Rochester, Minnesota or New York City. So next month, in frosty downtown Winnipeg, a giant drug company, its distributor and a team of doctors will open an infusion clinic where you can buy the latest, cutting-edge IV cancer therapies, and pay for them out of your own pocket.
What is gained? Most importantly, perhaps more years of life for a person at the height of her productive years, and all the associated value she will continue to provide her family, her fellow citizens and the public purse that taxes the added wealth she creates. Second, her consumption of medical services will stay in Manitoba, with the expansion of specialized facilities, employment and the tax base all that implies, instead of representing a dead-weight loss of value.
What is lost? Very little, except for ideological purity. Ideally, says Alan Katz, a researcher with the Manitoba Centre for Health Policy, whose principals have led the campaign against any more privatization, “What we really need is a process that allows people to be able to pay for these drugs in the system . . . . But that opens the two-tier Pandora’s box.”
In fact, decisions to allow Roche Canada and its counterparts to open for-payment infusion clinics across Canada – eighteen of them so far, with nine more on the way – do construct a second tier, and it’s about time. In a very real sense, the clinics do allow people to pay for treatments in the “system.” Once they’re up and running, they’re just as much a part of our healthcare “system” as every other facility. The fact that the government doesn’t control or pay for them doesn’t make them evil or less important.
In the case of the Maples Surgical Clinic, the schism between real-world benefits for many and the philosophical needs of the few looms even wider. The contract that enabled Dr. Mark Godley to open the facility in the first place was with the Worker’s Compensation Board, another arm of the same government so eager to fight Godley’s plan to sell private MRI scans to other willing customers. The Board’s mandate entails getting injured employees back on the job quickly, and waiting weeks and weeks for a broken public system to do that is simply not acceptable.
That the government of Manitoba should now square this vicious circle by simply buying all of the clinic’s capacity reeks with irony, but it’s what decision-makers should have done in the first place instead of wasting their time with pouts, snits and jeremiads against the good Dr. Godley.
The government of British Columbia responded in an equally unproductive manner to another gauntlet dropped by him and his colleagues, a promise to sell primary services directly to a frustrated Vancouver public. As it turned out, the False Creek Clinic’s prices were too high to make a go of it, but that’s not the point. They should not be regarded as anti-social agitators, but as healthcare heroes. They want to help people get better faster.
Rather than panicking or retreating into principled opposition, enterprising public officials should consider what their counterparts have managed to accomplish in many European countries with no waiting lists. The government’s job is to make sure that services are available and to do their best to pay for what they can with compassionate public funds. It is not a core service of government to own all the means of producing those services, nor to level us all down to a lowest common denominator – that if everybody can’t have access to a service, that nobody should.
The horn has sounded and the walls are tumbling down. The boomers are turning sixty and have the resources to buy whatever medical services they want. Politicians and bureaucrats who choose to stand in their way have as much chance as they fuddy-duddys of the 1960s who warned about the Beatles. They should turn their energies to measuring and reporting the performance of all providers in a diversified system, whether public or private.
