Transcript
Speaker: Hello and welcome to today's episode of Red Eye. I'm Jane Williams. On the podcast today, Laurentism speaks with Dr. Saad Ahmed about the threats to Canada's public health care system.
Speaker: This week the BC Health Coalition will hold a town hall event in Vancouver on public health care. They say public health care is in urgent need of reform and innovation and that we need brave conversations about what the future of health care must look like.
Speaker: Meanwhile, the Canadian Medical Association is sponsoring a cross -country conversation about the role of private health care read for profit health care. One of the speakers at the BC Health Coalition's event is Dr. Saad Ahmed of Canadian Doctors for Medicare, and he joins me to talk about the myths of privatization and what it means for health care in Canada. Hello, Saad. Hi, thanks for having me. So great to have you.
Speaker: When the healthcare system in Canada is trained, we typically hear these calls for expansion of private healthcare. Let's take that apart a bit. What types of privatization are being promoted by for -profit advocates?
Speaker: Yeah, I'm glad you made that distinction actually right off the bat in terms of I think the word privatization is oftentimes opaque and vague. And, you know, there's nonprofit providers as well in the mix. But really, when advocates of privatization advocate for it, it often means for -profit providers.
Speaker: And so really, I mean, I think they're asking for a bigger share of public funds to go towards private for -profit diagnostic centers, as well as surgical centers, outpatient surgical centers. Those are the two big
Speaker: places that we're kind of seeing a big push happening. And certainly there are examples in Ontario, the government of Duck Ford, so the progressive conservatives have opened up that situation with for -profit surgical centers outside of public hospitals. And there are a number of provinces across the country where we already have for -profit private diagnostic centers. So you can purchase your way into getting an MRI or a CT scan and jump out of the public waiting line.
Speaker: Let's examine some of the assertions that privatization will help the medical system for everyone, which your organization is calling a myth. First of all, we hear a lot about alleviating wait times. Will private pay alleviate wait times in the public system?
Speaker: Short answer, no. Long answer, it is our position. It came doctors for Medicare that when we have looked at the cross comparative evidence from a number of countries that have explored two tiered healthcare and bringing in for profit providers so that certain people can buy their way out of the line, that it actually hasn't worked as advertised.
Speaker: And this experience, as you look at Australia, they actually introduced an entire second tier parallel private pay system in 1997. And what that has done over time is as expected, it has made the public system worse off. So it shouldn't be any surprise for people that staff, physicians would go into the private system, which is perhaps more lucrative.
Speaker: Perhaps the caseload is also easier. There's a lot of research showing that. And we can talk about this notion of cream skimming. I'll just put a pin in that. But when we look at Australia, the wait times have actually increased for people who are in the public system. And these are people who really, if we are creating a system based on need, they're often the people who are in the most need. So Australia is an example. But I mean, there's examples all over the world around what happens when you introduce a second tier.
Speaker: let's just go right to skimming the cream off the top. Yeah. Yeah. So it's this idea that the private system, so once again, for profit centers and organizations would basically take the easier patience. And we've seen that the best example would be the United Kingdom, which actually
Speaker: in the early 2000s introduced, they're called ISTC, so independent sector treatment centers. It's a bit of a mouthful, but basically just for -profit surgical centers like Ontario is embarking on and really negligible impact on wait times in the UK and for the national health system.
Speaker: But the bigger problem actually is there's been a lot of reviews and researchers looking at mortality rates and morbidity rates, and there seems to be a slight increase associated with the introduction of this parallel private system.
Speaker: Now, keep in mind in the UK, it's exactly as Ontario is doing it. The government is paying investor -owned for -profit facilities to do it, so there aren't people necessarily buying their way to the top of the line or out of the line with that particular setting. But what seems to happen is that the private for -profit facilities will take the easier caseloads
Speaker: and leave the public sector saddled with really challenging cases. And then you have all the other issues that we've talked about where perhaps there's more consultants going into the private system. There's more resources going there. And then it just becomes kind of a vicious cycle for the public system. So that's what cream skimming means. It's the easier caseloads that end up with the for -profit providers. You can just turn it out, make a quick buck and then move on.
Speaker: I understand that the Commonwealth Fund, which publishes comparisons of healthcare systems in high income countries, have found some consistent features that lead to higher quality health outcomes. What are those factors?
Speaker: So when you look at the Commonwealth Fund's recommendations and what they found in their reviews across the world, really the big thing and one of the main things that we advocate for at CDM, became doctors for Medicare, is interdisciplinary care that's coordinated and that really leverages a lot of the advances we've made in digital health.
Speaker: So if you look at the example of Norway, which features actually pretty high in the rankings for the Commonwealth Fund, there's a lot of digital health. Like people, physicians have access to secure apps where patients can message them. The physicians themselves don't work in a solo practice just by themselves and maybe a secretary. There's often four to five physicians who work together.
Speaker: cooperatively with nurses, with physiotherapists. So this entire model of team -based care that really leverages not just electronic health records, but also the best kind of in -class digital health apps is probably the reason that Norway is doing quite well with their primary care services in particular, as noted by the Commonwealth Fund.
Speaker: Now it's been said that private financing will make healthcare more quotes efficient. And the Canadian doctors for Medicare says that's a myth. Talk about that. So public healthcare is more efficient than private healthcare in that a single payer system helps keep costs low. So really the fact that we have one insurance system,
Speaker: Really, in BC, we have MSP in Ontario. It's OHIP. That really simplifies the administrative costs. And in fact, I mean, people will say that there's a bloated healthcare bureaucracy, et cetera, et cetera, in Canada. But it's not like, imagine if you had multiple insurance systems, like what doctors in the States have to deal with, what doctors in a lot of the Central European countries like Germany and Switzerland have to deal with as well. You spend a lot of time negotiating with insurance companies and haggling over bills.
Speaker: So, from a purely administrative perspective, it's actually the way we've organized it in Canada, single payer is the most efficient. And Taiwan actually is a really good example of that. They have one of the lowest administrative costs in the world, less than 2 % of total healthcare spending. And they have a national health insurance model that's single payer quite similar to Canada's.
Speaker: Of course, they've really doubled down on digital health and electronic health records. And they also cover things that we don't cover in Canada, such as prescription drugs and dental care. We often hear calls for private financing when public health care is supposedly unsustainable. Is it true that we can't afford publicly funded health care?
Speaker: No, in fact, we don't actually spend as much as our peer countries on publicly funded health care.
Speaker: And I think I was just alluding to that earlier in the sense that Canada covers certain services, almost all of them are physician services, completely free, but we don't cover things like medications, physiotherapy, psychotherapy, and more. So we have what's called a narrow but deep insurance system.
Speaker: compared to countries like Norway, Sweden, Netherlands, where they do, and particularly the UK actually, they do cover medications. So this is really important because the lack of, for example, pharma care coverage means that there's one in five Canadians who are struggling to get their prescription medications, which as can be imagined intuitively and also in the research,
Speaker: The literature shows that people have worse outcomes because they can't take their medications. Same thing with dental care. I know we do have a fill -in -the -gap system now, but I can tell you as someone who's done a fair bit of emergency medicine, the amount of tooth decay and just horrible things I'd see when I was working in northern communities across Ontario, which were completely preventable,
Speaker: and probably ended up costing us as a nation a lot more in the long run, not to mention the suffering that the individual person went through. It's staggering. So to me, we can't afford privatized healthcare. We need to have the government more involved to help everyday folks who don't have access to things other than just physicians, right?
Speaker: Why are these myths that promote bringing in privatization and private healthcare, why are they so prominent and available? Who's promoting privatized healthcare in Canada?
Speaker: I mean, it would be the usual suspects, I guess, or the folks who might benefit from these private for -profit facilities and their sort of allied institutions. So you'll often see think pieces coming out from places like the Fraser Institute, which has been criticizing Canadian Medicare and our single -payer system from the get -go.
Speaker: And I would just say, you know, just be very cautious about some of the claims that they're making. And there's many places in the world that have experimented with a parallel system. They've experimented with investor -owned, for -profit healthcare, and the benefits really haven't borne out. So just be really careful about who's kind of making some of these claims and how they're framing the so -called issue.
Speaker: I know a lot of people really want to continue to have a strong Medicare system in Canada, but people are also worried and stressed about the healthcare system now. What would you advise people to do to make sure that we're going in the right direction? Yeah, so there's a number of things.
Speaker: from a political angle, really making sure our elected officials are held accountable and ensuring that healthcare stays publicly funded, publicly delivered in this country and that they make improvements to the public system.
Speaker: It's one thing to underfund the public system for decades and then throw your hands up and say, well, the public system is not working. Well, it's not working because we haven't funded it. There's a lot of specific policies that people have talked about. I think the team -based care thing specifically I brought up earlier because that's something we at Canadian Doctors for Medicare have been pushing.
Speaker: been talked about by the College of Family Physicians, lots of different groups, as something that we don't do well in Canada. And we need a better mix of various kinds of providers, nurse practitioners, nurses, physician assistants, all working alongside physicians to help people and help and heal people in this country. So definitely I think pushing our elected officials
Speaker: And then being cautious about some of the stuff that you might be fed in the media, making sure you look at what their sources are, who exactly saying it will be important, and then challenging perhaps each other when someone does repeat some of those talking points so that we collectively remain committed to Medicare and keeping Medicare and healthcare in this country public. Well, I really appreciate your joining me today. It's really been great. No, thanks for having me.
Speaker: I've been speaking with Dr. Saad Ahmed. Dr. Ahmed is with Canadian Doctors for Medicare. He'll be speaking next week at BC Health Coalition's Town Hall event on public health. That's on Monday, November 20th at 7 p .m. That will be at SFU Harbour Centre and will also be streamed online. You'll need to pre -register at bchealthcoalition .ca.
Speaker: The Red Eye Collective is based in Vancouver. You can check us out at coopradio .org slash redeye.
