The Sixth Estate

This weekend, the Vancouver Sun printed an inexcusable op-ed by Dr. Brian Day, making the case for mandatory private health insurance in B.C. I say inexcusable because the gloss on Day (a Vancouver orthopedic surgeon and a former CMA president) somehow overlooks the fact that Mr. Day is the president of Cambie Surgery Centre, Canada’s (and B.C’s) only private hospital. Day would presumably stand to gain a great deal from an influx of new private money into the healthcare system. Incidentally, he doesn’t bother to point out his obvious interest in the issue in the body of the article, either.

Before discussing Day himself, let me point out that his argument is unadulterated bullshit. Day says that we should pass a law saying everyone has to have private health insurance — basically, the sort of thing the Obama administration was promoting in the U.S. — instead of the current patchwork of basic Medicare (public) and extended health (private or Pharmacare). For a half-million people who can’t afford to pay, he says the government will kick in $125 per month per family. Somehow he thinks this will be cheaper than keeping things in the public sector, but there’s no reason to believe that. The bottom line is that someone is going to have to pay for healthcare, or it’s not going to be delivered. Either that someone is a private individual, or it is the government. Either we pay for healthcare, or we go without. The contrived notion that who pays will somehow affect that fundamental reality is one which people only raise because they have an interest in the matter. If we can afford to do this, we should do it collectively, so that everyone benefits equally. Day’s system is just a way for people with more money to purchase better health. The one thing added private money will lead to is an influx of new clients for private-sector surgery centres like Brian Day’s own Cambie clinic in Vancouver.

Don’t get me wrong, I’m absolutely in favour of a universal system that would provide access to medicine and dentistry in addition to basic healthcare. But my point is that Day skirts around the obvious point here: we can do that in the public sector. We can probably do it cheaper in the public sector than in the private sector, if the bloated American medical system is any indication (they spend almost twice as much per person as we do, and still don’t have universal healthcare). The only way the private system will reduce overall costs is by forcing some people to go without healthcare entirely. And the “benefits” aren’t even that significant in some cases. Currently the public sector takes 20 weeks to remove a gall bladder. Day says his system would do it in 13 weeks, at a low-balled cost of $600 million.

Some people may question my repeated suggestion that if this is going to be done it should be done publicly. My main reason for this, I (unlike Day) will admit, is purely ideological. I believe all Canadians have a right to access quality healthcare when needed. The public sector can deliver on that. The private sector, quite simply, can’t. Day tries to solve the “problem” by getting government to subsidize poorer people’s access to markets, but that doesn’t solve the problem, it only legitimizes queue-jumping by rich people. It will do to healthcare what school vouchers have done for American education — which is to say, at best, nothing.

But it’s not at all clear how much the private sector will save, either. Leave aside for the moment the fact that insurance company profits are probably going to equal, if not exceed, the cost of excess bureaucracy in the public system. In 2008, BC residents waited 84 days for an MRI. In Ontario, the wait was only 32 days, and Ontario’s MRIs are just as publicly funded as BC’s are. Now, the going rate for MRIs at private clinics seems to be about $750-1000. In the public system there are about 102,000 MRIs per year — at least $80 million from private providers. Last fall the government announced that it would spend $3 million providing 14,000 extra MRIs this year, or $215 per scan. Saskatchewan thinks it costs close to $300, so while the B.C. estimate might come in a little low, it’s not outlandishly low.

This is where the math gets funny. Let’s assume the above stat seems so low (less than one-third of private-sector costs) because the government is just adding extra service hours at B.C.’s existing 24 MRIs. 116,000 scans divided by 24 machines suggests to me they’re going to try and run about 15 people per day through each MRI (or 4800 per year per machine). An MRI machine costs $2 million, and then each scan costs $215.

Let’s say we need to provide an additional 48,000 scans per year to burn through the waiting list and then reduce waiting times to pretty much zero (which is what private clinics now provide). The private sector can sell that for $36 million per year or more. For the public sector, that’s an additional 10 MRI machines, at a cost of $20 million, plus $10.32 million per year in public sector operating costs, for a total of $30 million in the first “year” of operation and $10 million in each subsequent year.

Wait a minute…

It’s almost like the private sector really isn’t worth it, after all. Mr. Day, if you wish to peddle your private-sector snake oil, there are millions of Tea Partiers to the south who would be happy to accommodate you. Please go there now.