Push Toward American-Style Health Care Rooted in Myth and Distortions, According to York U. Co-Editors of New Book Health Reform: Public Success, Private Failure

TORONTO, May 31, 1999 -- With the Ontario election entering the home stretch, recent polls have shown health care to be the most important issue for Ontario voters. But with wide-spread media reports of Canadians facing waiting lists for specialty care and medical treatment, a two-tier health care system is being touted by the Fraser Institute and others as a way of adding more money to an over burdened public system.

Unless Ottawa and the provinces rededicate efforts to restore confidence in a publicly regulated payment system, and until we have a better way to manage waiting lists and home care services, the argument for a two-tiered system will continue to resonate, according to York University professors Daniel Drache and Terry Sullivan, co-editors of a recently released book, Health Reform: Public Success, Private Failure.

"It is doubtful that the balance between publicly and privately funded health care will remain what it is today without a complete recommitment to health care from Ottawa and the provinces," said Drache, director of York University's Robarts Centre for Canadian Studies and a professor of political economy. "Social cohesion is again becoming the priority of government, and this requires them to spend carefully to restore confidence in Canada's health care system."

Said Sullivan, President of the Institute for Work and Health, and adjunct professor in Sociology at York University: "Health care in Canada is a hallmark of citizenship and we need to preserve the unique features of our system in the face of pressures to harmonize with a dysfunctional health care system to the south of us dominated by failed market solutions to comprehensive care. Private enterprise has failed in the organization and financing of health care services which is why we began national health insurance in this country. This book demonstrates that the need for publicly funded health care systems is paramount."

With studies submitted from 26 leading health care experts and practitioners from across Canada, the U.S. and Australia, Health Reform lays bare the limitations of market-led health reform and argues for a renewed role for governments in modern health care funding. Among the book's findings/myth debunking:

Some have argued that hundreds of millions of dollars are being siphoned out of the health care system through abuse. Yet much of the argument centres on the anecdotal; there is little hard evidence or agreement about how widespread or costly health care abuse is. Indeed the problems of abuse are more on the supply side in private markets than they are on the consumers side in public systems. As a result, Canadians have imported the language of consumerism from the United States, transforming the patient into a consumer for the ostensible purpose of redressing health care abuse and contributing to a uniquely American conception of citizenship. This conception of citizenship is based upon unequal buying power, not equal democratic standards. (York University Centre for Health Studies Director Gina Feldberg and University of Toronto Political Science Chair Robert Vipond, "The Virus of Consumerism")

The majority of Americans rely on private health insurance. But private insurers are reluctant to cover people who have high health risks and few resources because it is more profitable to insure healthy people. That leaves the poor, the elderly and people requiring costly or long-term treatment reliant upon U.S. government health plans such as Medicaid and Medicare. These plans cover only a portion of the population, but the United States still pays a large share of the total health care bills. The government also ends up covering the cost of the tax subsidies given to private insurers -- to the tune of $100 billion per year. (Economics Prof. Robert Evans, University of British Columbia, "Health Reform: What ëBusiness' is it of Business?")

Health care providers who think that more resources will be available through privatization and that markets will make the system more efficient fail to understand or accept that a nation's total resources have limits. A two-tier health system (private and public financing) changes the equity in the system since some patients will be unable to afford care or will have less than desirable service, thereby weakening a community's sense of social cohesion and trust. (J. Fraser Mustard, Founding President, Canadian Institute for Advanced Research, "Health, Health Care and Social Cohesion")

Myths cross the Canadian boarder from the U.S. regularly through the media, including the recent notion that the management skills of for-profit firms would right Medicare's troubles. But the most important point is truly simple: Medicare is Canada's post-war public miracle. It is an example of success in bringing access to decent care to most of the population and at a price that, while comparatively high, is 40 per cent less than the U.S. pays per capital for its very uneven system. The American diagnosis of Canadian health care as troubled and threatened is quite distorted and worth protecting against. (Political Science Prof. Ted Marmor, Yale University, "The Rage For Reform: Sense and Nonsense in Health Care Policy")

Published by Routledge, the book grew out of an earlier seminar organized jointly by York University's Robarts Centre and the Institute for Work and Health.

Sullivan is available for interviews by calling (416) 927-2027, ext. 2118, or by email: tsullivan@iwh.on.ca.

Drache, who is also co-editor of States Against Markets: The Limits of Globalization, is available for interviews by calling (416) 736-5415, at home: (416) 921-3332, or by email: drache@yorku.ca.

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