110 years ago this month, the man who would lead the fight to bring public Medicare to all Canadians was born. Tommy Douglas, Canadian’s greatest Canadian, had a fundamental belief that health care should be provided equitably to people based on need and not ability to pay. Unfortunately, today we have a premier of Saskatchewan – Brad Wall – who is considering introducing a two-tier and pay-per-use MRI service – i.e. one system for those who can pay and one for the rest of us.
Let’s be clear, what Brad Wall is talking about is queue jumping for the rich and further stepping away from universal, publicly funded health care for the people in Saskatchewan. Perhaps this isn’t surprising as Brad Wall continues to not seriously push his friend Stephen Harper to renegotiation a Health Accord ($100 million more in costs and risks every year over the next 10 years in Saskatchewan, or to put it another way $1.1 billion less for Saskatchewan health care). This government is planning a new P3 hospital in North Battleford full of hidden costs (and likely large expense overruns) which will end up costing our public system resources that should be going to patients. Lastly, this is the same Brad Wall who said in 2009 that, “his government’s health reforms would not allow anyone ‘to use a bulging wallet to jump the queue’”.
Back to private MRI services in Saskatchewan. As we speak, it is being reported by a health ministry spokesperson, “an unnamed company has applied to have a diagnostic imaging centre licensed in Saskatchewan, and that the application is under review. The ministry won’t release the identity of the company, or say when it filed the application.” It is no surprise then that the Premier is speaking to the media as a pitch man for the interests of these private companies and spreading myths.
Yet, we know that when you have a two-tiered system with private clinics for the rich, it makes staff shortages even worse as health professionals are poached from the public system. Moreover, with private MRI clinics we have seen that they are located in urban centres (where the wealthiest clients are), removing scarce health care professionals, capacity and funding from rural areas. These clinics are not interested in access to care for patient or health equity, they are located where they can make the most money in large cities. And while Wall has said companies would not be allowed to poach workers from the public health care system, it is amazing he could keep a straight face while lying through his teeth. It is preposterous to say that the Saskatchewan government can legally, or would, enforce private companies not hiring workers from the public sector.
As well, let’s dispel the myth that more machines does not necessarily equal shorter wait times (correlation does always equal causation). The limited number of technicians to run the machines is a serious factor which increases wait times. Investing in human capital for public health care – which in the absence of a renegotiated Health Accord is increasingly difficult for provinces – is an issue we can’t ignore and perhaps a place the Saskatchewan government could put some focus. We only have to looks as far as Ontario and Manitoba where studies have shown that the introduction of private clinics for MRIs increased wait times in local public hospitals because they poached scarce technologists and radiologists; this reduced the number of hours that the local public hospitals’ MRIs could operate. When Alberta introduced their private MRIs, it is has been highlighted that one Calgary hospital lost three of five diagnostic technologists to a new MRI clinic that offered signing bonuses of up to $10,000. Similar pressures are being reported in Nova Scotia and technologists and radiologists working in Ontario’s hospitals are already being approached by companies hoping to open up private clinics.
So, what about wait times? Perhaps the biggest myth proponents of two-tier health care spin are that it reduces wait times. This pay-per-use model of care for the rich has been shown in study after study to increase wait times for the majority of patients (the ordinary people in Saskatchewan). It is telling that when this is pointed out the pro-privatization crowd takes to twitters and pulls out slogans and ad hominem attacks saying you’re ‘anti-progress’ or ‘a communist’ and so on… We need to talk about real solutions to wait times, which are out there and being implemented as we speak. There are places to improve and new solutions that do need to be implemented: these solutions involve us protecting, strengthening, and expanding out public medicare. For example, Gordon Campbell, President of CUPE Saskatchewan’s Health Care Council has explained that, “In the last 12 years, MRI waitlists have gone from 22 months to 3 months, so we are obviously doing something right… We need to keep investing in public solutions.”
At the same time that Brad Wall is pointing to Alberta as the promise land for MRI wait times, it has been pointed out that, “while Premier Wall is looking to Alberta as an example, the Government of Alberta has moved away from the policy at great cost. Alberta was forced to repay patients for medically-necessary MRI scans that were in contravention of the Canada Health Act, and moved virtually all MRI and CT services back into the public system. Alberta has since built public MRI capacity and cracked down on the practice of extra-billing. The government of Saskatchewan should look to other provinces and learn from their experience in exploring this decision.” The evidence is quite clear in this case, unfortunately the Saskatchewan government seems to be more interested in playing political games than finding real solutions and innovations for better health outcomes.
Moreover, the CCPA recently outlined that, “According to the Canadian Institute for Health Information, Saskatchewan posted typical waiting times for MRIs at 28 days. Whereas in Alberta, even with pay-for-service private clinics, typical wait times for a MRI scan was 80 days… the Alberta experience with pay-for-private clinics has devolved into a litany of queue-jumping and preferential access to such an extent that it is undermining public confidence in the health system.. the College of Physicians and Surgeons of Alberta has proposed to ban private imaging diagnostic clinics altogether because of the damage it is doing to the public system in that province.“ The Saskatchewan government is aware of these figures and that privatizing MRIs in the province will lead to diminished public health care for the people of Saskatchewan, but as is often the case with the Wall government this is about dirty politics and not the needs of people.
We do face many challenges to our public health care system as populations and their needs change. And, it is understandable that when faced with a health issue people want quick and quality care, who wouldn’t? But, even a cursory look at the results of private MRI clinics in Canada and the research done on two-tiered health services shows that this privateering hurts the majority of us and reduces the speed and quality of care we receive. Again, there are challenges, but there are also public solutions to address problems that maintain a medicare system based on equity and need. To play politics with our health while spinning lies and rhetoric in the media is both is unconscionable and repulsive. The people of Saskatchewan deserve better.
Please join Maude Barlow for a town hall to learn about some of the issues associated with P3 hospitals and what you can do.
North Battleford P3 Hospital Town Hall
Where: The Dekker Centre, 623 Carlton Trail, North Battleford, SK (map)
When: October 22, 2014, 7:00 p.m.
· Maude Barlow, Chairperson of the Council of Canadians
· Paul Moist, National President of the Canadian Union of Public Employees
· Simon Enoch, Director of the Saskatchewan Office of the Canadian Centre for Policy Alternatives
· Len Taylor, former MLA