Reforming Canadian Primary Care – Don't Stop Half-Way :: Longwoods.com

 Blogger's Note: references Commonwealth Fund data and other countries as comparisons; some excerpts:

open access

 ......"Unfinished Business
The medicare we have today is not the entire program envisioned by Tommy Douglas and Emmett Hall. In 1961, Douglas said: "This [the proposed Saskatchewan Medical Care Insurance plan] … will prove to be the forerunner of a national medical care insurance plan. It will become the nucleus around which Canada will ultimately build a comprehensive health insurance program which will cover all health services – not just hospitalization and medical care – but eventually … all other services which people receive." Featured prominently in the Hall Commission Report (Royal Commission 1964) was a "Health Charter for Canadians" calling for a comprehensive, universal health service program "including] all health services, preventive, diagnostic, curative and rehabilitative, that modern medical and other sciences can provide." The Commission made specific recommendations for coverage of vision care, dental care and pharmaceuticals. This vision has yet to be realized.
Nevertheless, Professor Ted Marmor at Yale University has referred to Canadian medicare as a public policy miracle. Perhaps what is truly miraculous is that in an inherently unequal capitalist society, where access to almost all other goods and services depends on ability to pay, the majority of Canadians supported, and continue to support, a program that rests on the fundamental principle that access to care should be determined solely by medical need....But if the principle of care based on need deserves our support in relation to hospital and physicians' services, why should it stop there? What about other beneficial health services such as pharmaceuticals, vision care, dental care, home care, chiropractic services and rehabilitation therapies? We have few principled answers."

"We Can't Afford" Medicare – New Singers, Same Old Song

The plea for continuing investment in primary care – or, indeed, any other health sector – is frequently countered by concerns about the rising share of health spending in provincial government budgets, and more generally about rising total public and private health expenditures as a proportion of gross domestic product (GDP). Often the two are lumped together as a concern about medicare's alleged "unsustainability," though the linkage is faulty and confused (or deliberately deceptive). Those who allege unsustainability are in fact arguing for an expanded role for private financing, user payment with or without private insurance....

"The relationship between values and income means that the struggle to maintain, improve and expand medicare as a program that embodies the core value articulated by Douglas and Hall – healthcare access and quality based solely on need – will continue to face opposition from individuals and organizations whose economic and political influence is disproportionate to their numbers. However, the line-up today is essentially the same as it was when medicare was being debated in the 1960s. We won then, and we can win again."