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More Money Is No Cure for Health Care


Originally published in The Edmonton Journal, February 14th, 1999


Lorne Gunter

 Author Notes

Regular columnist with The Edmonton Journal, and frequent contributor to the National Post, National Report, and other publications.

 Essay - 2/12/1999

During the week past we learned that purple Teletubby Tinky Winky had come out of the closet, and B.C. hospital patients were being put in closets.

Given the popularity of "coming out" parties on the left coast these days - they’re not just for 16-year-old debutantes any more - I assumed the B.C. bed assignments were part of some elaborate new social ritual for post-operative transsexuals. But apparently I was wrong. Patients in a Victoria hospital were being assigned to a linen closet because there were too few beds elsewhere, not so they could later emerge triumphant to celebrate their changed sex.

Turned out, too, that poor Tink didn’t volunteer the information on his orientation. He was "outted," by televangelist Jerry Falwell.

All week, national newspapers and newscasts were filled with stories about hospital bed shortages. Only a tiny minority failed to categorize the situation as a "crisis."

"Quebeckers line corridors of overflowing hospitals," blared The Globe. "Health Minister blames provinces for hospital crisis," declared The Post. On Wednesday, this paper led with "Health authority needs $100M; Cancelled surgeries, long waits continue to be a problem."

Ontarians, we learned, are being flown in record numbers to the United States, at taxpayer expense, for treatments none of this country’s hospitals can provide. Hospitals frequently go to "code red," a warning to incoming ambulance drivers to take their cargo elsewhere. Waiting lists nationwide lengthened in 1998, again.

Much of the overcrowding of recent days is the result of the time of year: It’s flu season. At some point almost every winter, Canadians by the thousands have to be hospitalized to treat their influenza. Until the outbreak peaks, many are moved from their beds in nursing homes, reducing the number of hospital beds available for the routine parade of injuries, diseases and surgeries.

In B.C., the flu came on the heels of strikes and work slowdowns before Christmas that had already generated a backlog, especially for surgeries.

Never being ones to let the facts get in the way of a good demand, though, advocates of state monopolized health care annually use this temporary overcrowding to argue for more tax dollars.

The trouble with their reasoning, though, is that even an anecdotal examination of the headlines points out that lack of public funding is not the culprit.

For instance, B.C. spends the most per capita on health of any province ($1,950 in 1998); 24 per cent more than Alberta (ninth, at $1,575 per capita). Yet B.C.’s overcrowding at present is next-to-worst, exceeded only by Quebec’s, which is in eighth place in per capita spending ($1,578).

There is also little correlation between per capita health care expenditures and the level of care generally available.

The longest waiting lists in the country are in Saskatchewan. There, a resident whose family doctor feels he or she needs specialized treatment, must wait an average of 17.1 weeks (four months) from the day of diagnosis to the day treatment commences. Yet good old socialist Saskatchewan, the birthplace of Canada’s universal, government-run medical plan, spends $1,757 per capita, the third-most in the country, behind only B.C. and Newfoundland.

And while Saskatchewan spends nearly 12 per cent more per person on health than Alberta, waiting lists here, at an average of 12.4 weeks, are only three-quarters as long. Alberta’s waits are also marginally shorter than big-spending B.C.’s.

Indeed, while the Canadian Institute for Health Information calculates that the Alberta government spends eight per cent less than the per capita national average on health care, waiting lists in the province are almost precisely at the national average (12.1 weeks here versus 11.9 weeks in the country as a whole).

The shortest waits are in Ontario (10.2 weeks), which is only the fifth-highest spender on health. Meanwhile, Newfoundland, where spending. ($1,781 per capita) is second only to B.C, is also second only to Saskatchewan in length of waits (13.7 weeks).

In other words, throwing more money at the public health care system is no guarantee of better or faster service. Indeed, the incentives that drive the public system are such that more money may retard progress.

Typically, public sector managers are motivated to preserve their bureaucracies and avoid crises. Large bureaucracies are the source of their power and funding, and nothing threatens this status quo faster than a crisis. Thus there is little benefit from increasing efficiency, so few are interested.

This works in health as well as in the post office. New money may postpone the crisis, by reducing the incentives to delivered more care per dollar spent.

There are problems with private health care, too, especially the kind practiced increasingly in Canada, which is structured too much like a regulated monopoly, with private-sector rewards and public-sector incentives.

However, piling new money on the current health care system is certainly not the answer.

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