Health Care.

K.V. Nagarajan is a professor in the Department of Economics at
Laurentian University.

This first book in a series about Canada released by Fernwood Publishing is a resounding success in explaining Canada’s health care framework and making the case for keeping the system in the public realm.

The book begins with a tightly written background to the divergent paths followed by the U.S. and Canada. While the U.S. went the way of mostly private care, Canada chose the path of publicly funded health care. They attribute this development to Canada’s parliamentary system, the recommendations of the Hall Commission, and overwhelming public support.

While singing the praise of Canada’s public health care system, they do not shy away from discussing its inadequacies, imperfections, and gaps in coverage. They show how the system with its fee-for-service payment system provides perverse incentives, leading to lack of preventive care and inefficient use of medical personnel. What seems more distressing to the authors are the gaps in Medicare coverage. Home care, pharmacare, dental care, and alternative/complementary care are missing from the Canada Health Act. They make a strong case for developing a national approach to these issues.

In recent years, there has been rising perception that Canada’s health care system is in crisis and that private solutions ought to be considered. The authors dismiss both the perception and the solution. While admitting that there are problems, they do not see how they amount to a crisis. They argue that most of the talk about crisis leads directly into making a case for private solutions. They marshal evidence from studies done in the U.S. and U.K. to show that private care is more costly, less effective, and less safe. They also show how many of the problems are best addressed within the public system.

The book’s main point is health care is best provided through public channels. While its expectation of national coverage for the missing parts of health care is unlikely to be realized in these troubled economic times, the book makes a convincing case that Canada got onto the right path with its publicly funded system and any deviation from it will be at grave peril to the nation’s health.