Just in time for an election: Heath Care

There must be an election coming up. When health care is discussed, Canadians listen, and it seems every party is trying to get the attention of all Canadians. Last week, the Minister of Health, Pierre Pettigrew said:

“If some provinces want to experiment with the private delivery option, my view is that
as long as they respect the single-payer, public payer, we should be examining these
efforts” — Pierre Pettigrew, April 27th 2004

When comments such as this one are made by the Conservative Party they are labeled as cold-hearted, American, vile etc. etc. etc. However, when a Liberal cabinet minister raises the issue of “private delivery”, the Liberals chalk it up to open constructive debate concerning health care. Indeed Anne McLellan, our Liberal deputy PM, asserted that concerning the Canada Health Act, �It’s important to put everything on the table.�

The NDP’s position on the issue is clear on the surface, yet misleading underneath. On their website, claiming that we must protect “free” access to healthcare, the NDP quotes Pettigrew “You can go with your slogans and say [private, for-profit delivery of health care is] wrong and it�s bad, fine” (square brackets added by the NDP). The NDP underlines its position by then stating “Voters get to decide which party really wants to improve public health care with new ideas and investments � not privatization”.

Where does the Conservative Party stand on this issue? After being flogged by the Liberals for years for mentioning any “new ideas” about health care delivery, the CPC takes one step back and plays the same game as everyone else. From their website, the party supports “universal public health insurance, regardless of ability to pay” and criticizes the Liberals on “confusion on private delivery � Ann McLellan is for it; Pierre Pettigrew is for it sometimes, and not against it other times; and Paul Martin, well, wouldn�t it be good to know”

So what is this game that all of the parties are playing? The parties assume that the average Canadian doesn’t know the difference between privatization and private delivery, and to their credit, they’re correct. When Canadians hear “private” or any derivation of “private” they all think the same thing: “You mean there’s going to be a line for rich people and a line for the rest of us? How am I going to afford treatment?” This is privatization. When you have to pay for an MRI out of your own pocket, this is privatization.

When we talk about private delivery, what is meant is that as Canadians, as a collective of tax payers, we have this big pile of cash. From this pile of cash we establish a competitive bidding process between private companies who compete for a contract. Since this process is competitive, the process drives down the cost of delivery; if Company A is charging too much, Company B will try and beat their price. The key principle out of all of this is that any private company that provides service is paid out of the public pot, not out of the pocket of the patient. This is private delivery of services from the public’s (ie. the government’s) pocket. The question that we must ask ourselves is do we want our government to pay a private company, one that specializes in its field and one that can provide the most competitive price, or do we want our government to pay a bureaucratic unionized public delivery system? This is the choice between private delivery and public delivery. In an analogous comparison one might ask, “Do we want the government to buy its light bulbs from Canadian Tire/Home Depot/Zeller’s/Walmart/Costco/Shopper’s Drug Mart/A&P or would we rather that our government manufacture their own light bulbs in its own factory when they need replacing?

Every party is playing on this very distinct difference between privatization and private delivery by blurring this distinction on based the linguistic similarity of the two terms. The Liberals did it last week (here) (and have attacked the conservatives on it over the past decade or so), the Conservatives does it here and the NDP does it here.

On misleading the public based on this key difference, the Liberals are guilty, the Conservatives are guilty and the NDP is guilty. Perhaps we need to rename “private delivery” to something which is linguistically different from “privatization”. These terms are not interchangeable. May I suggest the following terms: “Efficiency-based delivery” or “Government-administered private delivery (GAPD)”

The Conservative party should emphasize this distinction and provide debate for GAPD as they have always done. This is a better strategy than trying to stake a vague position on “universal access”. To the credit of the Conservative party, they are pointing-out the flip-flopping of the Liberal Party. While the CPC does believe in universal access, they should point out that Pierre Pettigrew was originally correct. Pierre got it right. Conservatives should fight for a clearer definition of terms instead of for perpetual policy ambiguity which is propagated by all three parties for the sake of political positioning.

Private delivery is a cost-saving measure that provides cheaper and higher quality, government regulated, health care and therefore I say let’s do it. It may be the best opportunity that we, as Canadians have, for health care that is publicly funded.