Health Care and Aging: Where's the Fundamental Problem?

In some respects it’s not news at all: the Canadian Medical Association came out on Monday in favour of more privatization of health care while only days before Statistics Canada reported that Canada’s population is older than ever. Newspapers and electronic media followed with much hand wringing: whatever are we going to do about our health system?

Last summer the CMA elected Brian Daly as its president, someone who has been encouraging talk of a two tier health system for years. Therefore it should be no surprise that the CMA is proclaiming that doctors should be allowed to get paid for working in both public and private systems. (The practice has been forbidden in Canada since universal Medicare arrived in the 1970s—doctors here have to make the choice, and most choose the public. ) How allowing docs to work both sides of fence would change things is rarely addressed in these discussions, which seem to forget all about the great savings inherent in our single payer system. (See Michael Moore’s Sicko if you have any question about what a private insurance-driven mess our neighbor to the south has.)

But, you ask, how is Canadian Medicare going to face the challenge of an aging population (defined as people over 65)? Certainly, we’re probably going to have to spend more on end-of-life care, and less on infant immunizations, but this is a trend that has been going on for some time, a trend that we’ve actually been able to cope with very well, thank you very much. In fact the projected rate of increase in aging over the next 30 years will be no higher than the rate of increase has been for the last 30 years.

What’s needed, as a health economist close to my heart says, is the sort of modest economic growth that we’ve had historically and the will to recognize that great advantages of a publicly-funding, universal, single-payer system. As for the idea that a growing dependent population will be a burden unprecedented in our history, during the 1950s the ratio of dependents to tax-paying members of population was much higher than is projected for the future. Far fewer women worked then and a large proportion of the population was too young to work, while many people over 65 continue to work, and all must fill out income tax reports. (For more details see background papers of the Réseau de recherche en santé des populations du Québec, particularly the article "Le vieillissement de la population québécoise : les implications pour le financement des services de santé.")

What is disappointing is that these two reports have received so much media coverage, with little reference to the great body of research which puts things in perspective.

But then it's summer, and most people think the living should be easy...