The perils of free-market medicine

>> In Clear Answers, author Kevin Taft takes aim at privatizing health care

by MATTHEW HAYS

It was a fairly shocking sight, watching as Albertans rallied in large numbers to protest Premier Ralph Klein's plan for their health care system. Not because there was anything distinctive about the protests themselves, but shocking by their very existence. Albertans are, after all, notorious for jumping on bandwagons and not making loud fusses.

But nothing gets Canadians tied up in knots like that part of our rapidly evaporating social-safety net commonly referred to as health care. Once widely considered to be the envy of virtually every nation on earth, Canada's status as a competent health care provider has slipped dramatically in recent years, due to a commitment to fiscal restraint which has led to slash-and-burn budget cuts.

Along with the cuts, which have made health care the number-one issue among Canadians in the polls, has emerged a bit of conventional wisdom: that somehow, some way, Canadians will be far better off if we hand much of our health care system over to the private sector. There will be less duplication; waste won't be tolerated; lengthy lineups, as well as costs, will finally be reduced.

Mitigating the myths

Not so, says author Kevin Taft, an Albertan dissenter who has consistently proven a thorn Klein's side. In Taft's latest book, co-authored by Gillian Steward, Clear Answers: The Economics and Politics of For-Profit Medicine (University of Alberta Press, $9.95), the authors take aim at virtually every argument made by governments across the country--governments hungry to unload the responsibility of health-care providing onto the private sector. And though the Albertan model does figure prominently in the text, Taft's and Steward's careful research and analysis have obvious lessons for people in other parts of Canada--in particular Ontario and Quebec--where Klein's health-care model is being studied, embraced and copied.

While most critics of privatization of health care argue about the threat of an encroaching two-tier system, Taft and Steward go beyond that basic threat and undermine the cost-effectiveness thesis. "The delivery of health care has been studied extensively and exhaustively," Taft says from his Edmonton home. "Clearly and consistently, one thing has emerged: health care is not a good product for the market place."

Taft contends that too often the costs of health care are discussed in the same terms economists might discuss the sale of bananas or Pontiacs. And one can't really use the same model to distribute and sell automobiles as one can to provide basic health services, he furthers. In one contrasting example he and Steward employ, they point to a telling difference in services in Edmonton and Calgary. With aging populations, both cities had a sustained demand for cataract surgery. But in Calgary, the marketplace was opened up, allowing for widespread competition among private clinics, while Edmonton's cataracts remained handled by a government-run hospital.

The difference, as Taft points out, was astonishing. With one major centre, Edmonton was able to offer the service smoothly and efficiently. Meanwhile, Calgarians had numerous places to choose from, but each centre had to have its own pricey eye surgery equipment, effectively driving the cost of the operations up. Each centre also had to hire its own receptionists, nurses and doctors, again creating duplication that was avoided in Edmonton by sticking with one major centre for the specialized procedure. The example is a telling one: duplication, the charge of inefficiency long made against the public sector, here clearly took hold and encumbered health care provided by the private sector.

The importance of not selling out

"In the past 10 or 15 years," says Taft, "we've forgotten a basic lesson of economics: the free market is good for some things and not for others, especially health care. Health care, in fact, represents the limits of free enterprise. That's precisely why we got into Medicare in the first place. We'll pay a terrible price if we don't relearn it."

Taft argues that Canada's health-care system has fallen victim to "vested interests who will benefit greatly by the switch to a for-profit health-care system." So many public issues, he goes on to say, "are real dilemmas. Where do we cut services? But the evidence in health care is clear. Patient-doctor care is not a good thing to commodify."

Taft suggests there are good-news stories about health care. He points out that over six months ago, the Manitoba government was grappling with overbooked emergency rooms, filled with stressed-out staff and patients forced to wait for hours and hours before getting treated. The government sent in a task force, who was told there would be no extra money, and asked for recommendations on how to improve service. They figured out ways to fine tune the system, making minor and major adjustments--all within the same budget--to improve the system. Sure enough, the recommendations helped to put an end to Manitoba's emergency-room crisis, with waiting periods cut down dramatically.

"In many cases, this is not an issue of money," says Taft, whose '97 book Shredding the Public Interest drew the ire of Klein, who labelled Taft a communist. "It's a matter of political will. And in the case of Klein and Mike Harris, I simply don't think it's there."

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