Should Canadians be able to use after-tax dollars to purchase health services that are already covered under the provincial health plans schedule of benefits?

There is a tendency to discuss healthcare privatization only in terms of what's best for consumers without asking how much of the debate is driven by profit motive. This makes me wonder who the stakeholders are that actively call for privatization in healthcare. Are they consumers, suppliers, or both? It would be useful to know how much of the pressure is from private citizens, doctors, and nurses genuinely concerned with quality of care and how much pressure is from suppliers with a financial stake in a competitive healthcare industry. The answer, if it can be found, would help focus the overall debate, since the question of Canadians using after-tax money to purchase health services should be centered squarely on consumers, not suppliers.

Addressing the original question then from the consumer's point of view, I ask why would Canadians want to purchase services that are already covered under provincial health plans? The answer is most likely that they could purchase better and/or quicker services than are offered by the province. One problem with this scenario—and it's by no means a new argument—is that some Canadians can afford to purchase better services via private insurance or out-of-pocket while others cannot (just look to the US healthcare model for an obvious example). Those who can't afford better services will continue to rely on provincially funded suppliers. What then will opening healthcare to competition mean for suppliers, public and private?

From the supplier's point of view, privatization would in many cases be perceived as a positive move. The insurance industry would enjoy new markets. Those of us who service healthcare providers would undoubtedly find new sources of revenue. And private clinics providing diagnostic, surgical, and treatment procedures would thrive in a competitive healthcare industry. But whom would they compete against (besides one another)? The answer is: provincially funded suppliers. As in any competitive market, much of the top talent—doctors, nurses, management, and others—would quite naturally gravitate to the better-equipped private facilities and more competitive wages. At the very least, there would be strong incentive to perform procedures in private clinics instead of public ones. This would serve to deplete provincially funded hospitals and clinics, thereby further weakening the public system.

Therefore, privatization would be good for insurance companies, good for private service providers, good for top-tier healthcare workers, and potentially bad for provincially funded hospitals. This covers many of the "supplier" stakeholders in the privatization debate. But where does it leave our healthcare consumers? Particularly those without the after-tax dollars to buy private health insurance or to pay out-of-pocket for services. It means the provincially funded services they rely on will potentially be worse off than before privatization. And these consumers are the stakeholders who should be best served by changes to the healthcare system.

In conclusion, I don't believe Canadians—i.e. only those who can afford to—should be able to use after-tax dollars to purchase health services. Not when it means weakening the publicly funded system we all depend upon. The challenge, therefore, is to achieve and maintain a standard of excellence in provincially funded healthcare that rivals or exceeds what the private sector could offer{/styleboxop}. This is not a small challenge, and will require commitment, innovative thinking, and strong leadership from healthcare practitioners and administrators to academics and politicians. While privatization will benefit many of us—consumers and suppliers alike—an improved public healthcare system will benefit all Canadians in the long run.