Il est venu le temps des cathédrales


This could prove to be a very symbolic moment in the evolution of Canadian health care. Last month the Université de Montréal’s troubled (that’s the gentlest available word) new research-hospital project failed to land the $100-million CFI grant it had been hoping for. (Fun historical note: the news conference where Stephen Harper announced an equivalent grant for McGill was the one where he first said he might have to call his own darned election, so not a lot of people covered the story of the research grants. Which is a very interesting story.)

Anyway. No $100 million federal taxpayer-funded research grant for the big classic hospital. And now: across the street from the UdeM hospital, in the old Medley bar — Montrealers my age or older will remember it as the Old Munich beer hall — pop singer Garou plans to build a $100 million private clinic, with parking, condo-hotel, state-of-the-art services, and more.

As we head into a federal election, watch everyone be quiet quiet quiet quiet quiet about the prospect of a private health-care Disneyland in the middle of Canada’s second-largest city. Including Jack Layton, who gets distracted at non-fixed intervals from his usual positions by the prospect of an electoral breakthrough in Quebec.


Il est venu le temps des cathédrales

  1. Aha! Oho!

    What a question for the leadership debates! Especially for the Maoist guy (hint: not Layton). Who knew that Quebec would be on the front lines of dismantling socialised medicine? Turns out the Quebec model and venture capitalism go hand in hand.

    I wonder what Denis Arcand has to say?

  2. To be clear: I’ve long favoured greater private-sector participation in the delivery of health care. I just wish that it would happen through debate and decision, not self-interested conspiracies of silence among leaders who claim to value the public single-payer model.I single Layton out only because he’s the most extreme case; as Jack points out, Duceppe’s been the MP, for 18 years, of the riding where Garou’s health-care Disneyland will go. No word yet on whether Paul Martin’s private clinic will move into the new facility. And Tony Clement? Soft as a mouse!

  3. Let’s not forget Layton’s excuse in election 2004 for using private clinics himself: “I didn’t realize the Shouldice Clinic was private because it had such good service!”.

  4. Couldn’t agree more on the silence of the lambs. Talk about a failure – a black hole – of national leadership on this important file.

    For my part, I simply don’t understand the opposition to private delivery, as long as there’s a single payer (= the government). Or should I say, I don’t understand the public’s Know-Nothing opposition to even discussing it.

    Of all the things for our national identity to get woven into, the mechanisms of funding health clinics is by far the weirdest imaginable.

  5. Garou: the modern-day Tommy Douglas.

    I don’t care one way or the other how private care is introduced. Neither do the people who need the care, who would otherwise be languishing in waiting rooms or on waiting lists.

    The socialist ideologues will not notice either, unless of course the politicians start talking about it, in which case the media will start talking about it, in order to attack the politicians.

    Some of the socialist ideologues will also notice the new clinic if they get sick, in which case they will abandon their ideology and be thankful that there exists a way for them to get well in a timely manner, rather than suffer long term.

  6. But will Ed Stelmach take on Ralph Klein’s usual forced role, as the premier most likely to gut health-care, independent of evidence?

    Paul, I don’t suppose you’d like to Blog about the $100 million McGill received (or did I miss it?)

  7. Let’s be clear here. Increasing the private delivery of health care services will inevitably increase pressure to allow greater private *financing* of health care services. Private health institutions will *inevitably* demand greater ability to charge private patients what they can pay. Right now we are on a 70-30 split. 30% of all health care services are privately financed, much, much more than all the so called mixed systems in Europe. Britain for example, has something like an 80-20 split; only 15% of its health care services are privately financed.
    Expanding the delivery of private services in Canada’s public health care will *inevitably* increase the private financing. Soon, we will be moving from a 70-30 split to a 60-40 split and inevitably to a 50-50 or a 40-60 split. That’s the opposite of all those mixed systems in Sweden, france and Britain that privatizers often hold up.
    Do not pretend that adding private delivery services to health care is only related to adding capacity, increasing innovation or reducing costs. This is about enabling the upper class to exit the public health care system and pay for their own Cadillac health care leaving scraps for the rest.

  8. Simon

    ‘The rich’ already exit the health care service when they want to, as do many middle class people when they fly to India for timely health care.

    Why do you think in Canada it’s slippery slope to private health care but the same slide hasn’t taken place in European countries you focus on. And I am also curious to know why you think we should emulate Cuba and North Korea, the only two other countries with a similar system as ours.

  9. It seems that public health care is only supported by the people who actually use it.Oh,and by every serious (omit the Fraser Institute)study over the past forty years.
    It’s never had the support of physicians,the political elite,or the media market mavens.
    Full disclosure: I’ve worked in the system for thirty-odd years and I could go on and on.But I won’t because “the debate” is never about facts.

  10. Sisyphus: “public health care is only supported by the people who actually use it”

    I use public health care and I do not support it. The same can be said for many people that I know.

    Most supporters of Canada’s health system cannot see the forest through the trees.

    Fortunately, the Canadian Medical Association is proposing increased involvement of the private sector in the health system.

  11. Sisyphus

    I think the only people who support public health care are the people who don’t use it because everyone I know who has health problems bitches and moans about how it works.

    The elites, who don’t actually have to use health care system like the rest of us, are the ones who have turned health care funding into a national identity issue.

  12. Considering the sources,I expected no less.

  13. Sisyphus

    I should have made a distinction between people who work in our health system and the system itself. I have a chronic health problem that has meant I’ve been in/out of hospitals for years so I have experience with the system. Doctors and surgeons get up my nose, that’s due to their arrogance, but the nurses and other support staff are absolute saints.

    However, there are major problems with the system because everyone who gets sick is viewed as a cost, not as someone who needs help. It seems to me that our health care system is set up to keep people away as much as possible due to all the hoops you have to jump threw to get have a family doctor, to see a specialist or have a surgeon perform.

    Here in Ontario, some bright spark decided a good way to reduce health care costs was to reduce the number of doctors who graduate medical school. So now there is a shortage of all types of doctors, waiting lists a mile long and I am supposed to think this is just great while the elites, see Chretien’s heart scare last year, get timely service.

  14. To be clear: I’ve long favoured greater private-sector participation in the delivery of health care

    The media seems awfully unwilling to make distinctions between private (and corporatist) for-profit and private not-for-profit health care delivery.

    Most of our health care is already delivered privately. What a lot of us are concerned about are the development of cadillac services that will erode middle-class support for public health care, something that’s already happened in Québec, with the lowest per-capita funding of public health care in Canada.

  15. The focus on cost is directly due to a decision in the 80’s to manage the system to market goals and principles (HMO clone).But it’s a mug’s game when cost control has limited influence on the components of the system that are largely private:physicians,physicians’services,
    pharmaceuticals.Most European systems position themselves to exert more control of those cost drivers.

  16. The delivery of the services seems to me to be a sideshow; the central issue is who pays and how. Private delivery of services funded by the tax-payer seems to me to be an open invitation to abuse and gouging.

    One of the main difficulties with the American system of HMO’s is that these bureaucracy’s are the least efficient way of paying for and controlling the costs of the services. When they layer the public health system on top of that, it doubles down the problem.

    Only when consumers have control over the services they chose and pay for will we get a more efficient system, but this is a problem that has eluded resolution to date.

    I don’t see the events in Quebec making any real contribution in this area.

  17. The problem isn’t that private healthcare delivery is happening without debate, the problem is that it’s happening without any regulation, and without any accountability even though so-called “private” delivery organizations quickly become very efficient at billing the public healthcare system.

    Eventually we’ll be providing operating grants to private hospitals the same way that we provide education funding to private schools, because their users “pay taxes too.”

  18. Doesn’t this inevitably lead down the slippery slope of the disasterous US health insurance system, which has over a million jobs in pushing paper on claims, mainly with the goal of denying often valid service?

    Or is it feasible for Medicare to retain a monopoly on insurance for covered treatments?

  19. One of the interesting things about our health-care systems is that it works about as well as it could be expected to, given the paucity of resources we apply to it.

    When it comes to health care results for health care expenditures, we’re actually punching way above our weight. So when people suggest that France or some other country is better, I suggest they look at the portion of GDP that said country spends on health care. Until we reach similar levels of expenditure, we can’t in honesty suggest that we know of any other better system.

    That said, I too think that publically funding private delivery of health care can make a lot of sense, and I don’t buy the slippery slope argument so long as Canadians are very clear on what’s not acceptable.

  20. We paid about $750/month for mandatory health insurance in Switzerland. The service was amazing. No queues, well-equipped doctors offices and friendly and helpful staff available at a moments notice.

    That works out to about $9000 a year, which is less than what a family of four pays for taxes in Canada on an income of $40,000.

    I’m not saying that model would work here, but everything about health care reform in Canada doesn’t have to be about Tommy Douglas versus the Americans.

  21. I don’t see what’s so “inevitable” about private not-for-profit delivery metamorphosing into private for-profit. You just pass laws saying no-no. Then you’d have a 100-0 public-private split from the financing point of view, which beats even Scandinavia! As things are now, the publicly managed system can’t keep up.

    Case in point: in Ontario at least, the each OR has a monthly quota of how many operations it will perform, and it doesn’t voluntarily exceed that quota. What is the logic in that? With private delivery, they could simply perform more operations, charge the government insurance agency more, and deliver better service.

    Plus, if they had to compete with other OR’s, there wouldn’t be the endless balls-up’s one hears about. Case in point: a friend of mine recently went in for breast cancer surgery, consulted the anaesthesiologist beforehand, only to have her operation delayed half an hour – and the anaesthesiologist went home because it was after 5pm, Hippocratic oath be damned! The replacement anaesthesiologist then bungled the local anaesthesia and she had to personally beg the surgeon not to operate before proper anaesthesia could be applied! I could cite several other examples – thankfully I’ve never been in the hospital myself – such as a dear friend who was given morphine while her appendix was exploding (overcrowded emergency room, overworked staff), but surely to God someone who cares about ordinary people receiving basic medical care can hardly tolerate the fiasco that is our current system. Enough with this BS about “elites” being the only ones to complain. Financially I’m no elite and I say enough’s enough.

  22. some private delivery and universal access to not have to be mutually exclusive

  23. Very clever reference to Garou’s role in Notre Dame de Paris. Except that technically, that bit was sung by Bruno Pelletier ;)

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