Health No shortage of bureaucrats There is, however, one grading in which the Canadian single-payer system excels: the proliferation of public service administrators (bureaucrats), involved in the micromanagement of provincial health services, all absorbing their fair share of sparse health-care dollars. Matthew Lister, a Canadian health-care analyst, surveyed health systems in several developed countries and discovered that Canada in 2015 had 32,000 health-care bureaucrats (government-appointed managers, directors of local and regional boards, evaluators, etc.) organizing, adjusting and fine-tuning health care as it was being delivered. That number, wrote Lister, represented 0.9 health-care bureaucrats per 1,000 Canadians and compared to only 0.06 per 1,000 people in Germany and 0.23 per 1,000 Japanese. From a different perspective, Japan had 30,000 health-care bureaucrats for 130 million people; Canada had 32,000 for 35 million people. Another interesting comparative study was prepared for Jeff Yurek, former environmental minister for Ontario who wrote that in 2017, the Ontario College of family physicians listed some 10,500 family physicians available to serve the entire province, and 13,000 health ministry and affiliated agencies, consultancies and partnerships to “administer” the system. From 50-50 to not so much In 1966, when the original Medical Care Act (medicare) was enacted, the funding deal offered to provinces was a 50-50 federal/provincial split. But in 1984, the Canada Health Act supplanted the original funding deal and replaced it with federal grants “at sustainable levels.” All vestige of private funding gave way to the current single-payer system and monopoly government control. Along with it, a chronic concern regarding underfunding has only grown. In 1984, Dr. Everett Coffin, president of the Canadian Medical Association wrote a lead article in the association’s journal in which he predicted that the newly imposed Canada Health Act would “radically change Canada’s 10 diversified provincial health insurance programs into state medicine − into a medical service that is completely controlled by government.” He also asserted that “What health care services are available, their quality, who will get them and where, will be determined entirely by government through complete control of health-care financing and the medical profession.” Added Dr. Coffin, “Health care of the future is too important to be sacrificed to political expediency, a provincial-federal power struggle or the dogmatic thrashings of any government seeking a way to get re-elected.” Thirty-seven years later, this message resounds even more forcefully. Milan Korcok is a national award-winning medical writer who has been reporting on Canada’s Medicare for Canadian and international professional journals since it was passed by Parliament in 1966. Milan is a dual Canadian/American citizen. He lives in Fort Lauderdale, Florida. 38 | www.snowbirds.org
RkJQdWJsaXNoZXIy MzMzNzMx