Canada has an enviable record of
providing universal, quality health care at a reasonable price for the last half
a century. But, as in every other country, our health care system is
facing several strains:
Soaring health care costs, driven by astronomical salaries
paid to senior medical practitioners by competing private health-care
providers in the US
Disproportionally high usage of the health care system by
Canada's exploding immigrant population
Ageing population needing more health services
The answer of US-worshipping Canadian neocons is two-tier health care.
Why, cries John Tory, the new leader of the hapless Ontario
Conservative party, shouldn't Canadians have "choice" in their health
care services? This is classic conservative re-framing of public
debate. "Choice" in health care means choice for those who can afford
it, which means doctors who want to make obscene amounts of money
(including many of the best ones) would work for the higher-paying
private-tier system and the rest of us would be stuck with long waits
and second-class service, just like we face in every other private
sector of the economy.
Fortunately, and to the chagrin of the Canadian neocons, the vast
majority of Canadian's aren't buying this Orwellian deceit. Recent polls say support
for a public, single-class health care system is as high as ever.
So
what's a civilized country to do to deal with the three great
challenges of 21st century health care bulleted above? I recently
listened to a talk show featuring the federal Minister of Health,
discussing how these problems should be solved. Caller after caller
said the same two things:
Much of the work done by doctors should be transferred to
paraprofessionals and to self-diagnosis and self-treatment. Much more
information, expert systems and self-service equipment needs to be
provided to enable this. [I spoke to two doctors who said they would
love to do this, since the majority of the work they do does not
require a licensed professional to do it competently -- but that the lawyers wouldn't let them do it.]
There needs to be a massive shift in the health care system from treatment to preventative care.
When the moderator asked the Minister whether he had learned anything
from these recurring messages, he 'summarized' the discussion by saying
that better measurement systems were needed to ensure hospitals were
operating as efficiently as possible, and that the government was
looking into ways to do public-private partnerships without allowing
competition or giving up control over pricing and access. The
interviewer was incredulous: Had the Minister not heard the two
messages that the public had been bombarding him with for the past
hour? Of course these things would be considered, he replied, but the
first priority was to find ways to increase access without increasing
cost. His deafness to these two obvious solutions to the malaise of the
system was astonishing.
What one listener of this talk show said about neoncons' true
motivation for wanting two-tier health care was also telling: "The
reason rich politicians want a two class system is that they're embarrassed
to have to wait in line
for health services the same as 'ordinary' Canadians, when their US
business colleagues can jump the queue so easily and have their company
write off the extra cost as a business expense. They're also
embarrassed that, to jump the queue, they have to fly to the US and pay
out of their own pocket". So in fact there is a choice for the very
rich to jump the queue: Pay for treatment in the private US system.
Is Canada's health care system the best in the world? Far from it.
Health care in Canada's cities is much better than in rural areas. The
bureaucracy in much of the system (notably the blood collection system
and the 'walk-in' clinics) is suffocating, and needlessly so. And because of
its zeal to protect jobs in the system, Canada, which ranks first in
the world in per-capita patents of medical technology, ranks forty-first in the world in the use
of modern medical technology in its hospitals (MRI equipment is as
scarce as gold, for example).
But it's still an excellent system, and one that a two-class health
care system won't improve, at least for 95% of the population. If only
the politicians and bureaucrats only had the intelligence and vision to
listen to the Wisdom of Crowds and make the two changes (more
paraprofessional/self-care, and more prevention instead of treatment)
that the public is already starting to make themselves, our system
would be the best in the world.
Oh -- a word about prescription drug costs: You may have heard that
many Americans come up to Canada to buy prescription drugs much cheaper
than they can buy them in the US. Now, US municipal and state
governments are fighting for the right to buy their drugs from Canada,
too (and Kerry wants them to have this right). The funny thing is, the
companies selling them are essentially all the same companies, since
the Canadian pharmaceutical industry is dominated by the same handful of global corporations
as the US industry. Why do these companies charge more in the US than
the rest of the world for the same drugs? Not, as the neocons and the
pharma industry are telling Americans, because Canadian drugs are
inferior (perhaps, it is implied, dangerously so) -- they are the
identical drugs. They sell them for higher prices in the US because
they can.
Drug companies charge as much as the market will bear, and in the
bloated US health care system where if you have enough money you can
buy anything, the market will bear a lot. In the rest of the world
money available for drugs is much less, so to sell their products
pharma companies lower prices by 30, 50, even 70%, and still make a
good margin. This is a case where globalization threatens to backfire
on
some of the corporations that most benefit from it. Couldn't happen to
a nice bunch of guys.
This is the first of a
series of articles discussing some of the remarkable ideas in a new
book called The Global Ideas Book.
The book, with a forward by Charles
Handy (pictured right) is the brainchild of the UK-based Institute for
Social Inventions,
and is a compendium of some of the 4000 ideas in the Global Ideas Bank, ideas and
germs of ideas submitted by the public for free use and development by
others. Described as "part suggestion box, part ideas network and part
democratic think-tank", what impresses me about this collection is the
sheer ingenuity of the ideas. Thanks to Nick Temple, one of the book's
editors, for bringing it to my attention. You can buy the book here.
One of several concepts that grabbed my attention immediately is
described
by its inventor, Bradley Hall, as "A currency created to limit
people's exploitation of the environment". I had been kicking around
the
idea of putting some constraint on the ability of the very rich to
spend profligately without restriction, and Bradley's proposition meets
that
difficult need and more. Basically how it works is this:
Every individual would be given a flat, fixed,
non-transferable amount of a new Environment and Social Currency (ESC),
say, 10,000 units per month.
A regulatory body would assign an ESC 'price' to each
product and
service sold, reflecting its negative environmental and social costs.
So gasoline, for example, would have a high ESC price, while a service
that has no negative environmental or social impact would have a zero
ESC price. Theoretically, goods and services that actually improve the
environment or social welfare could even be assigned a negative ESC price.
Sellers would be required to charge users both its normal
market-demand price and its ESC price. So there would be a strict
limit, no matter how rich you are, on how much you could damage the
environment and social welfare through your purchases. If you've
reached your 10,000 ESC quota for the month, you're simply not allowed
to buy any more 'bads' that month -- you'll have to spend the rest of
your money on 'goods'.
As with any novel idea, its development will need a lot of thought and
planning, to minimize bureaucracy (much of it could be done
electronically) and minimize the risk of fraud (people buying in the
'black market' from vendors who don't charge ESC). But what appeals to
me about it is its extraordinary simplicity and egalitarianism. The
fact that it challenges the presumption that money gives you the
unlimited right to cause environmental or social damage is just the
icing on the cake.
What do you think? Are there some other obvious problems with the idea?
Any thoughts on how to implement it and avoid bureaucracy and fraud?
Would you welcome it or see it as another undesirable imposition of
government?
I'll be describing some other ideas from the book on these pages in the
coming weeks.
MADE IN CANADA
trust your
instincts 
This is the first of a
series of articles discussing some of the remarkable ideas in a new
book called 
