Part 1 of 3
On December 19, 2011, I gave an invited talk in Manila on Canada’s Medicare: Sharing Insights with the Motherlandto this year’s Graduating Class of Residents and Fellows of the Philippine General Hospital-University of the Philippines College of Medicine where I did my internship half a century ago. It was a delightful opportunity – coming as it was on the occasion of the 50th Anniversary of my graduation – to have shared with the recent alumni-specialists the lessons I have learned from our valued Canadian health care system.
Preceding me to the podium was Dr. Eduardo P. Banzon, the President and Chief Executive Officer of the Philippine Health Insurance Corporation (Phil-Health), which was established in 1995 by Republic Act No. 7875 for the purpose of “instituting a national health insurance program for all Filipinos.” He passionately spoke about how the country wants to ensure its health insurance program is there for Filipinos in their time of need. I further learned from him and others that the motherland has been in a continuing search for an even better model of health delivery and coverage for all her citizens.
Back home on the Canadian scene, I have observed that both levels of government (federal versus provincial and territorial) have already fired their political salvos in anticipation of the forthcoming negotiation to replace the current federal-provincial-territorial Health Accord due to expire on March 31, 2014.
Preparing the public grounds
This three-part series focuses on Canada’s Medicare for two timely reasons: first, in the hope that readers of Pilipino Expressfrom the Filipino-Canadian community may be better informed and thereby better able to share their insights of our Canadian health system with their families and friends in the motherland in her continued search for a system that can offer sustainable universal coverage; and second, in the additional hope that non-Filipino Canadian readers are similarly updated so that all Canadians can effectively help weigh the arguments being put forward by the two levels of government in support of their respective and evolving positions in the forthcoming federal-provincial-territorial negotiation.
Viewed from his vantage point of years of experience in both medicine and politics, this columnist will (1) identify the broad parameters of health care needs, (2) differentiate delivery of health services inside and outside the acute-care system model, (3) utilize published health information data from authoritative sources, (4) objectively present the points already being made by knowledgeable persons in the field, and (5) in conclusion offer his considered opinion after also reviewing the existing Accord.
Guiding principles and prohibitions
The Canada Health Act – the Medicare law of today for the whole of the country – was passed in 1984 by the House of Commons and the Senate and given Royal Proclamation in 1985. Enshrined in the law are five national standards to be complied with by the 10 provincial and 3 territorial governments, which have exclusive jurisdiction under the Canadian Constitution on the delivery of health care: comprehensiveness, accessibility, portability, universality and not-for-profit public administration (single-payer system). In addition, the law stipulates two specific prohibitions: (1) health care facilities may not impose additional charges (no user fees), and (2) physicians may not include additional fees (no extra-billing). Compliance with these five principles and two prohibitions is monitored by the federal government, which transfers to the provinces an agreed upon amount to add on to their provincial budgets for health.
Barely a quarter of a century old, Medicare has stood the test of time. It has become a measure of our collective political will and ingenuity for a common public good and a signature of Canada’s set of societal values. Thanks, indeed, to our visionary and creative political leaders. This columnist once seized the opportunity and tabled in the House of Commons a resolution to re-affirm its support for Medicare.
Canada’s crown jewel
Medicare is the crown jewel of Canada’s social programs, which include, among others, Old Age Security and Guaranteed Income Supplement, Canada Pension Plan retirement, disability and spousal death benefits, and Unemployment and Parental Leave payments. What makes Medicare particularly unique is its free universal coverage for medically necessary health services for residents (citizens and immigrants), regardless of their age or situation – retired, disabled, unemployed or expecting a baby – and regardless of their income. The latter cannot be overemphasized since poor and rich alike have a natural collective fear of sickness, which can eliminate all the family savings for the other basic necessities of life.
Challenges to sustainability and options
Advances in diagnostic and therapeutic technology, discoveries of newer prescription drugs, the increasing age of the population, the cost of hospitalization and physician fees for increasingly complex nature of the medical decision process all contribute to the escalation of health care costs that apparently exceed and threaten present and predicted government revenues. Hence the challenges they pose to fiscal sustainability, that is, our ability as a nation to continue to pay for the program today and in the future. So much so that health policy experts, government health officials and leaders of both levels of government have begun to publicly issue statements on different policy considerations to help address possible eventual scenarios: (1) cut medical services (2) cut other government programs, (3) raise taxes, (4) cut the costs of illness, (5) change or modernize the model of health delivery, (6) include some form of co-payment, or (7) risk national bankruptcy.
Parts two and three of this series will examine these considerations and other scenarios.
Listed in the Canadian Who’s Who, the Honourable Dr Rey D. Pagtakhan is a retired lung specialist and University of Manitoba professor of Pediatrics and Child Health and a former Member of Canada’s Parliament, Parliamentary Secretary to the Prime Minister, and senior federal cabinet minister in the Government of Canada. Widely published and lectured in the twin fields of Medicine and Politics, he has been the recipient of several honours and awards, including the honorary Doctor of Science and Doctor of Laws.