There has been quite a debate about the sustainability of Canada’s health care system for a very long time. Some people say that it is sustainable as long as GDP keeps increasing as necessary and as long as we look for efficiency and use health care resources more carefully. Others disagree and believe that failure to address the issue of sustainability in a pragmatic way will lead to a crisis in care for Canadian citizens.

Claude Castonguay, the father of Quebec’s health care system and one of three knowledgeable people tasked with the job of recommending changes to that province’s public system, fits in the latter group.

“Getting Our Money’s Worth ”, the report produced by the Castonguay-headed task force was released February 20, 2008, with a variety of recommendations.

Some recommendations stand out. The report called for doctors to be allowed to practise privately as well as in the public system; for some hospitals to be run by the private sector; for a fee to be paid for use of family clinics up to $100 per year; for a 1% increase to the Quebec Sales Tax to go to a health stabilization fee; and for an expansion of private insurance to more areas than are currently permitted.

Needless to say, the usual backlash occurred and Quebec Health Minister Dr. Philippe Couillard and Premier Jean Charest appeared to be concerned that the major recommendations made by the task force were just too hot to handle.

Too hot to handle or not, it looks very likely that Canada’s health care system is going to have to learn to juggle private provision with public provision better than it already does with its 30/70 split. Provinces other than Quebec are staggering under the health care load too.

In British Columbia, Finance Minister Carole Taylor has been warning about the rising costs of providing health care there. In a Vancouver Sun article from February 21, 2008, “The health care monster continues to gobble up more budget dollars”, Minister Taylor is quoted as saying in last year’s budget speech:

“The budget for health (in BC) is now $13 billion, up more than seven per cent from the year just ending,”

“Total health spending is up over 50% since 2000. That rate of increase is not sustainable over the long term.”

The article reports that the 2008 budget did not show much evidence of progress:

“I would not say to you that this is sustainable in the long term, that one sector can grow at more than twice the pace of the economy, three times the pace of inflation, and expect that it wouldn’t crowd out all of these thing that we have to do,” she is reported to have said February 18, 2008 during the budget lock-up.

The real issue is that while we are paying substantial amounts of provincial dollars for health care across Canada and despite billions of dollars for health care from the federal government, patients are still not getting the care they need. The politics of health care are a complex matter but must be overcome if beneficial change is to occur for patients.

Patients with cancer are not getting the care they need. James D. Gowing, chairman of the Cancer Advocacy Coalition of Canada comments on The Report Card on Cancer in Canada saying that “thanks to outmoded thinking and organization, your odds of surviving cancer in Canada depend on where you live”. The report describes the cancer system across the country as a postal code lottery overdue for a rethink and one of the conclusions is that Canadians are getting a “raw deal”. A pan-Canadian forum with a mandate to plan a funding program that gives all Canadians access to the best quality care is suggested as one solution.

Keeping this in mind, it is important to consider where this funding would come from. If other areas of provincial budgets are getting squeezed to make room for more health care, is it reasonable for the federal government to pay more for a responsibility that is constructed to be primarily provincial? If it is reasonable, then how much should this proposed federal health care “umbrella” cover?

In 2004, the federal Liberal government promised $10 billion to prop up health care and fix it for a generation. Since this infusion of cash doesn’t seem to be working, should the provinces just ask for more?

Once health care takes up over half of provincial budgets, should the federal government be required to provide funding for the other provincial areas that are being neglected while health care takes more of the provincial pie or should federal monies only go to health care?

This kind of arrangement of ongoing federal bail outs for provincial responsibilities has the potential to become unworkable.

While more private provision is resisted from many groups, we should consider whether the 30/70 split between private and public is the correct combination now. It is quite possible that the 70% of public provision should include more prescribed medications while the 30% of the private provision should include more options for preventative medical care for those individuals who want to spend on their own care. A rebalancing is required for the short term.

In the long term, as our aging population increases, consumer demographics will change leading to more people not spending on new kitchen gadgets, new cars, power tools or eating out but who want health services and medical care-acute, chronic and preventative. One way to offset the economic repercussions of this trend is to allow more purchasable services for personal care and for health services rather than for new consumer retail goods. How can this best be accomplished in combination with a supportive public health care system? That is the question.