Private Health Care: The Editorial Opinion

DURING THE 1997 FEDERAL election campaign, Gallup Canada asked Canadians which issues influenced their voting decision. Not surprisingly, health care was the top policy issue; 75 percent of respondents indicated that health care was "`very important'. . . in determining which party to vote for." [The Gallup Poll, "Liberals Dominate on Issues, Leadership Qualities," May 20, 1997.]

Then Health Minister David Dingwall certainly knew the value that Canadians attached to health care when he roundly denounced plans for a private hospital during last year's election campaign. Portraying himself and the Liberal Party as guardians of Canada's medicare system, Dingwall attacked the Calgary-based Health Resource Group (HRG) for their private hospital plans and called for Alberta Premier Ralph Klein to "close it down."

This story made headlines in newspapers across Canada and was reported on the nationally-syndicated "CTV News." The Globe and Mail reported: "Federal Health Minister David Dingwall threatened yesterday to amend the Canada Health Act to stop a new private health centre planned for Calgary, saying it could lead to two-tiered medicare services." [Brian Laghi, "Dingwall wants hospital halted," Globe and Mail, May 16, 1997, p. A1.]

This story, perhaps more than any other in 1997, sparked debate on the future of private health care in Canada. This edition of On Balance examines the editorial positions taken by 7 major Canadian dailies, focusing on the HRG Inc./Dingwall scuffle, the proposal by the National Forum on Health to provide a publicly funded pharmacare plan, and the general issues associated with private health care delivery.

Alberta newspapers split on private hospital

According to a recent Health Canada report, hospital funding in 1996 was 87.7 percent public and 12.3 percent private. [Health Canada, National Health Expenditures in Canada, 1975-1996, June 1997, p. 12.] Private payments include uninsured services, such as cosmetic surgery, and care to non-residents of Canada. The Health Resource Group planned to offer these services and also transact third-party insurance contracts, such as orthopaedic care to clients of Alberta's Workers' Compensation Board.

Mr. Dingwall's opposition to the private hospital was clearly based on the ideological rationale that profits should not be accrued through the delivery of health services. He stated: "I want to make it perfectly clear that I don't like the idea of hospitals for profit." [Brian Laghi, "Dingwall wants hospital halted," p. A1.]

Despite Mr. Dingwall's sentiments, the renamed Health Resource Centre (HRC) received accreditation as a day-surgery facility on August 1, 1997. However, when HRC requested authorization to provide overnight surgery, the College of Physicians and Surgeons denied the application because of the political implications and a lack of public consultation.

As such, the future of HRC and other for-profit health care facilities once again moved to the political arena where public opinion rules. And while public opinion is elusive and unpredictable, it is known to be fuelled by news reports and commentary, including the long-standing tradition of the newspaper editorial.

Between March 1 and August 31, 1997, Alberta's two major dailies, the Calgary Herald and the Edmonton Journal, published 4 editorials that discussed the political implications of the Health Resource Centre. The Herald's editorial position was supportive of the HRC, while the Journal's position was initially impartial, but became increasingly suspicious, even hostile.

The Calgary Herald's May 19, 1997 editorial stated: "[Health Minister Dingwall], who appears to have worked himself into near apoplexy over HRG's plans to fund and operate a private hospital in Calgary, will win few friends by misrepresenting the intentions of a group of enterprising westerners. In a recent meeting with the Herald editorial board, HRG . . . made it clear they wish to operate within the spirit and the guidelines of the Canada Health Act."

In contrast, the Edmonton Journal wrote: "What Canada's private medicine proponents really want to create is subsidized line-jumping for the wealthy or desperate. They want to enable patients to pay supplemental fees for a premium level of service from doctors or facilities that would still draw the bulk of their revenue from governments." ["Health privateers not welcome," Edmonton Journal, August 14, 1997, p. A16.]

The Journal went on to argue: "It's disingenuous for [proponents of private health care] to argue that the country should engage in a broad national debate. . . . That debate has been had. The verdict is clear—Canadians by a huge margin oppose any proposal to provide publicly funded health services at a faster or better level of care to those who will pay extra."

The Journal's claim is undoubtedly backed by a particular poll; however, it is a gross misrepresentation of widely publicized survey results spanning several years. According to Gallup Canada, more Canadians do oppose "two-tiered" health care (53%), but a significant proportion are supportive (40%). [The Gallup Poll, "Majority Opposed to Two-Tiered Health Care," November 26, 1997.] Further, when asked "Would you be willing to pay for your own health care services?" in order to receive faster or better care, the majority of respondents said "yes." Clearly, the debate is not over.

The Journal's editorial proceeded to state that the debate should be re-focused on whether current private services—pharmaceuticals, dental, therapy, home care, etc.—should be included in the public health care system. The Journal stated: "Canadians should ask whether those expenditures should revert to the public system, with its proven ability to manage costs and deliver care equitably."

Newspapers on public pharmacare

The National Forum on Health also recommended expanding components of health care that are currently funded privately, most notably, a publicly-funded pharmacare system. On February 4, 1997, the National Forum on Health presented its final report. Two recommendations—publicly funded home care and pharmaceuticals—captured the headlines and sparked editorial comment.

Seven newspaper editorials commented on the idea of a publicly funded pharmacare system. Four newspapers—the Montreal Gazette, the Hamilton Spectator, the Vancouver Sun, and the Vancouver Province—opposed the idea, primarily because of the associated costs. Surprisingly, neither the Ottawa Citizen nor the Calgary Herald offered an editorial opinion on publicly funded pharmacare.

The Montreal Gazette commented: "The biggest potential problem with pharmacare is the pricetag. . . . Until the federal government can demonstrate that a universal drug-insurance plan could be affordable for both consumers and governments, the pharmacare idea deserves a healthy dose of scepticism."

The Hamilton Spectator's April 29, 1997 editorial on the federal election campaign took the same position: "The Liberals are endorsing the results of their National Forum on Health which recommends adding universal access to prescription drugs and home care to the country's beleaguered medicare system. Show us we can really afford such a system when the current system is disintegrating under its own weight and adding prescription drugs would add about another $6 billion a year in costs."

The Vancouver Province's February 3, 1997 editorial also commented, "The home care and drug part of the equation is a laudable goal, but probably not feasible at the moment: People are in no mood for a tax increase." The Province's April 25, 1997 editorial was equally ambivalent, but more supportive of the idea. It stated: "If a national plan can improve public access to drugs and corral the price monster, let's have it."

Edmonton Journal out of sync

In contrast to the other dailies, the Edmonton Journal wholeheartedly endorsed the idea of publicly funded pharmacare. On February 6, 1997, the Journal's editorial stated: "Canadians continue to show a deep commitment to the central principle of our medicare system—that money should not govern our ability to get health care. As long as some people are left struggling to pay for prescription drugs, or unable to afford home care, that great national commitment has not been fulfilled."

Once again, the Journal's strong ideological position on this issue resulted in the exclusion of some relevant facts. The National Forum on Health examined Canadian's values on health care and found that while equality of access ranked highly, the system's ability to deliver health care efficiently was an even greater concern. [National Forum on Health, "Canada Health Action: Building on the Legacy—Synthesis Reports and Issues Papers," 1997, p. 7.]

Editorials oppose parallel private system

While the idea of expanding the services funded by Canada's public health care program was generally denounced by most newspapers, the proposed parallel private system was even more vigorously critiqued in the editorial comment.

On the topic of so-called "two-tiered" health care, the Vancouver Sun, the Vancouver Province, the Hamilton Spectator, and the Edmonton Journal opposed any move towards a system in which money meant privilege, or health care was provided by a business motivated by the bottom line. The Province's June 26, 1997 editorial concluded: "As BCNA president Ivory Warner says, `health care is not a commodity to be bought and sold on private markets, but an essential service to be funded and administered publicly and . . . accessible to all regardless of ability to pay. Amen.'"

These two concepts, access for all versus the profit motive, were often presented as if they were mutually exclusive, and applied equally to the myriad services considered to be part of the health care system, from heart surgery to herbal medicines. Such alternatives as private hospitals providing care to patients insured by a public system were not seriously examined. In fact, the only newspaper arguing that a parallel private system would make the health care system as a whole more responsive to the needs of Canadians was the Ottawa Citizen.

Ottawa Citizen calls for MSAs

On January 10, 1997, the Citizen recommended medical savings accounts in which each Canadian is allocated a certain number of dollars to spend on health care, with catastrophic insurance to cover expenditure beyond that amount. If there are funds in the account at year-end, the money is retained by the individual to be used for pharmaceuticals, dentistry, or tucked away into an RRSP.

The Citizen concluded: "MSAs allow the government to cap financial outlays for health without keeping citizens on a short leash. Each of us would remain generously funded and our health care dollars would go much further, because the system would become far more efficient under the watchful eye of careful consumers. We health-care consumers, instead of the government, would be directing the health care economy, creating an immense market for new products and services that the private sector would rush to meet."

Similarly, the Citizen's March 15, 1997 editorial on the closing of "the only truly francophone hospital in the region" stated: "if our system were more private . . . [this] hospital . . . probably wouldn't be closing its doors on paying customers . . . this is the nature of political as opposed to market solutions: one size fits all, and there is no complaints department."

Cost containment seen as solution

The Vancouver Sun took the conventional editorial position on health care: namely, that the solution to Canada's health care crunch was to manage the system more efficiently. On August 20, 1997, the Sun's editorial argued against increased funding for medicare and concluded: "doctors [should] search for ways to make the delivery of health care more cost-effective. BC nurses, for example, talk up community health centres where multidisciplinary teams provide coordinated care, unlike the current system `dominated by doctors paid by fee-for-service, working largely in isolation.'"

Similarly, the Montreal Gazette argued that: "The question the Canadian Medical Association should be asking is why we don't get full value for our health care dollars . . . [rather than requesting more funds] physicians can look at . . . performance and productivity in hospitals, better information systems that can lower patient costs and better monitoring of soaring drug prescriptions."

In papers other than the Citizen, health care cost containment was widely seen as the solution to Canada's ailing medicare system. Minimal attention was paid to either the demographic profile in Canada and the soon-to-be-retiring baby boomers, or the economic benefits of allowing the health care sector to expand. Two-tiered health care, according to the Vancouver Sun, the Montreal Gazette, the Edmonton Journal and other daily newspapers, is simply un-Canadian, and must be avoided at all costs.

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Last Modified: Wednesday, October 20, 1999.