Editor: I agree with the general thesis of your editorial regarding the current status of Medicare in Canada: the unwavering commitment of the federal government to the cult of the private market suggests ever more health care privatisation is likely to come.
Two points the editorial addresses need qualification. First, you say that the idea that allowing wealthy Canadians to purchase desired services will shorten waiting lists for the rest of us “seems compelling.” On the contrary, unless those purchasing medical services can somehow buy completely new services not presently available in the system, they are consuming services that otherwise would be available to us all. Allowing some to purchase services is queue jumping, and will surely make the waiting lists for the rest of us even longer.
Secondly, your editorial says that current inefficiencies in the health system are attributable to burgeoning bureaucracy. Although in some instances this may be the case, the far more likely cause for the present malaise is the complete and utter failure on the part of the federal government to provide any leadership or incentive for things to change for the better. Instead of taking an active role in improving the system, the federal government has washed its hands of it. There is no coordination, no incentives to adopt best practices; in a word, no leadership. Research shows clearly that the public sector can and does innovate when the conditions encourage it. Unfortunately, in Canada for the last couple decades of shrinking federal involvement, these conditions are too rarely found.
Medicare – as a universal public service – can be made to work, but it won’t be through the magic of the market. It will be through our federal government rolling up its sleeves and helping territorial and provincial governments get on with delivering the kind of health care system Canadians want and deserve.