The never-ending public/private health care debate

A new round of opposition to the Ford government’s ongoing desire to supplement the current health care model with more private alternatives recently kicked up again in earnest. If you listened to the activist groups, you would think that all the current system was in public hands. Yet, about 40 per cent of health care services in Canada are already private sector. Photo credit: CTV News London/Brent Lale


The Ford government’s plans to introduce more private clinics into the overall mix in Ontario has riled up the usual suspects who are mounting a major public relations campaign to oppose it.  Other provinces such as Saskatchewan, BC and Alberta have had a greater proportion of private providers for years without this amount of backlash, but in Ontario everything always seems to be bigger and more fraught, and the unions involved more militant. 

The organization at the forefront of the main anti-private campaign is the Ontario Health Coalition (OHC), which purports to be a widely representative group fighting to preserve public health care for all, but is really just a combination of the usual public sector unions and related groups. 

The OHC has recently been ramping up its campaign and plans to hold a referendum on May 26 and 27 on the “privatization” issue. They will undoubtedly make much hay with the results, which I imagine will be predictable from the start as it will be run by volunteers and unscientific in nature. They are inaccurate with their definition of privatization, however, as true privatization would mean you would be paying out of pocket for health care whereas what the Ford government is proposing is private clinics paid for from OHIP. 

A recent personal experience of mine was instructive. One of my sons had a hernia operation at the Shouldice Hospital, a private facility with procedures paid for by OHIP. Shouldice is somewhat of a legend in Canadian health care history as it was established in 1945 by Dr. Earl Shouldice, who also invented a particularly successful technique for treating hernias. 

It has always been a private facility, despite various leftist politicians threatening its existence over the years. It is internationally known as one of the best if not the best hernia treatment centre in the world, and it attracts people from all over the world. It has perfected an efficient, specialized, high-quality process which likely permits it to perform these procedures at a comparable or lower cost to the public system. 

My son, who has had intermittent experiences in public sector hospitals, could not believe how positive the experience was. The fact that he is young and fit didn’t hurt, of course, but he could not stop raving about the almost spa-like nature of the facility, the professionalism of all staff and even the high quality of the food. He was almost sad to leave. 

Shouldice represents a perfect model that could be replicated for other procedures that are necessary but not an emergency. Most of the long waiting lists in Canadian provinces are for joint replacements, cataracts and other conditions that lend themselves to the Shouldice model, which is quite regimented, very efficient, and almost cookie-cutter in nature. 

Although the opponents of any form of private care always claim that any “for-profit” facility would have to be more expensive because the profit element must be factored in, that is not true. All a private provider must do is be more efficient than the public system, which is sadly not much of a challenge. 

For instance, doing one or two more procedures a day than the public system means additional funds that can constitute a decent profit without increasing overall costs to the system. For those folks who fundamentally oppose any sort of “profit” in health care, what do they think of the ridiculous wage and benefit agreements some of the public sector unions achieve, if not a form of “profit” for those workers. As well, it is basic economics that introducing competition into areas that are now health care monopolies will encourage all participants to up their game in response. 

The debate over private provision of health care in Canada will not end anytime soon, especially with the well-funded public sector unions leading the charge to oppose it as they understandably don’t want to lose their monopoly stranglehold on taxpayers and actually have to compete for business. 

If you listened to the opponents, you would think that all the current system was in public hands, yet about 40 per cent of health care services in Canada are already private sector (doctors’ offices, walk-in clinics, diagnostic labs, etc.). Increasingly, those fighting private care are compelled to be more and more dishonest to defend their position. Anyone who has studied international comparisons of health care is aware that the best systems in the world are composed of a public/private hybrid that cost less per capita and have better health outcomes than Canada.

The debate will surely continue, but it seems inevitable that we will see more private players and it will be a positive development for Canada. My son will vouch for it. 


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