Health Care – Who Pays?
Martha and Henry have been reading through a paper called “Political Wolves and Economic Sheep – The Sustainability of Public Health Insurance in Canada” It is a companion document to the recently released “Public Remedies, Not Private Payments – Quality Health Care in Alberta”. Both of these are available on line by clicking on the links.
Both these papers point out the need to answer the fundamental question in Health Care; Who Pays? Parties of all political stripes agree that the system should be the most effective and cost efficient it can be. Sure there are important debates over Private vs. Public delivery but regardless of how health care is delivered it has to be paid for. The issues around this question are summed up in this quote from “Political Wolves and Economic Sheep”.
The Canadian universal tax-financed system requires higher-income people to contribute more to supporting the health care system, without offering them preferred access or a higher standard of care. Any shift toward proportionately more private financing, through user charges with or without private insurance, would reduce the relative burden on people with higher incomes. Insofar as private payments also limit access by people with lower incomes, they also open better access for those willing/able to pay. Relative to universal, fully tax financed public insurance, an expansion of private payment would thus enable the wealthy to pay less (in charges, private premiums and taxes) and get more (in volume, quality, and/or timeliness). And conversely for those with lower incomes. This conflict of economic interest is real, unavoidable, and permanent in all systems, which is why the “public/private” debate is never resolved (and why it is typically so occluded with “econofog”)
After Martha looked up “occluded” in the dictionary (it means obscured), we felt this pretty much covered the issue. Today in all provinces except Alberta and BC, public health care is funded by the tax system. In Alberta and BC, individual health care premiums are also charged. Alberta increased their user fees back in 2001 to help finance the Alberta “flat tax” tax cut.
Who pays is basically a question of political philosophy. Right wing philosophy says we should all pay our own way either through user fees or through the ability to purchase private health insurance. This would allow government to reduce their public health care costs and pass these savings on to the citizens in the form of tax cuts. The winners are the higher-income people whose tax savings are large enough to finances their private health insurance and user fees and the losers the lower-income people who cannot afford to do the same. The same process is at work as we described in our article “Some Questions About Money “.
Supporters of the right wing, user pay approach would say this breeds a responsible, independent and maverick Albertan. Those more to the left favour a system where those with a greater ability to pay take on a greater share of the costs. They feel that Albertans are basically compassionate people and willing to help others even at some cost to themselves. That’s the $64 question fellow Albertans. Which are we?
Premier Klein is reluctant to discuss his solution for health care in Alberta before the election. He says it’s too complex for ordinary Albertans to grasp. However, as leader of the right wing cause in Alberta, we feel he should be able to defend his right wing philosophy.
So. Here is our simple question for the Premier.
Mr. Klein. As leader of the right in Alberta, do you believe individual users should pay a larger proportion of the health care services they receive so that the amount the government pays for health care can be reduced? Please feel free to elaborate.
Both these papers point out the need to answer the fundamental question in Health Care; Who Pays? Parties of all political stripes agree that the system should be the most effective and cost efficient it can be. Sure there are important debates over Private vs. Public delivery but regardless of how health care is delivered it has to be paid for. The issues around this question are summed up in this quote from “Political Wolves and Economic Sheep”.
The Canadian universal tax-financed system requires higher-income people to contribute more to supporting the health care system, without offering them preferred access or a higher standard of care. Any shift toward proportionately more private financing, through user charges with or without private insurance, would reduce the relative burden on people with higher incomes. Insofar as private payments also limit access by people with lower incomes, they also open better access for those willing/able to pay. Relative to universal, fully tax financed public insurance, an expansion of private payment would thus enable the wealthy to pay less (in charges, private premiums and taxes) and get more (in volume, quality, and/or timeliness). And conversely for those with lower incomes. This conflict of economic interest is real, unavoidable, and permanent in all systems, which is why the “public/private” debate is never resolved (and why it is typically so occluded with “econofog”)
After Martha looked up “occluded” in the dictionary (it means obscured), we felt this pretty much covered the issue. Today in all provinces except Alberta and BC, public health care is funded by the tax system. In Alberta and BC, individual health care premiums are also charged. Alberta increased their user fees back in 2001 to help finance the Alberta “flat tax” tax cut.
Who pays is basically a question of political philosophy. Right wing philosophy says we should all pay our own way either through user fees or through the ability to purchase private health insurance. This would allow government to reduce their public health care costs and pass these savings on to the citizens in the form of tax cuts. The winners are the higher-income people whose tax savings are large enough to finances their private health insurance and user fees and the losers the lower-income people who cannot afford to do the same. The same process is at work as we described in our article “Some Questions About Money “.
Supporters of the right wing, user pay approach would say this breeds a responsible, independent and maverick Albertan. Those more to the left favour a system where those with a greater ability to pay take on a greater share of the costs. They feel that Albertans are basically compassionate people and willing to help others even at some cost to themselves. That’s the $64 question fellow Albertans. Which are we?
Premier Klein is reluctant to discuss his solution for health care in Alberta before the election. He says it’s too complex for ordinary Albertans to grasp. However, as leader of the right wing cause in Alberta, we feel he should be able to defend his right wing philosophy.
So. Here is our simple question for the Premier.
Mr. Klein. As leader of the right in Alberta, do you believe individual users should pay a larger proportion of the health care services they receive so that the amount the government pays for health care can be reduced? Please feel free to elaborate.
posted by Martha & Henry at 11:15 AM
3 Comments:
Health Care has to be paid for by the government funded from our taxes. We don't choose to get sick. We don't pick our genes. We don't pick our accidents. Third world countries have user pay systems. Aren't we beyond that?
We already know which way Ralph is going. He's starting to talk about health care deductibles of $400 to $1500. See details. This is just another form of user fees. He’ll pick our pocket one way or the other.
Great blog I hope we can work to build a better health care system. Health insurance is a major aspect to many.
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