Health Care: Conflicting Opinions, Tough Decisions

Paul G. Thomas is a political science professor at University of
Manitoba and co-author of Canadian Public Administration: Problematical
Perspectives.

Studies and initiatives to reform health care are under way in all
provinces, and the reform agenda in each case is remarkably the same:
more emphasis on disease prevention than on cure, less reliance on
expensive hospitals and greater use of ambulatory and community-based
care, limits on the number of doctors, alternatives to fee-for-service,
greater use of allied health personnel, and better measurement and
management of scarce health resources. For William Weiss, who is both a
practising physician and president of a medical computing company, these
ideas represent an old and fading paradigm of health care that was based
on a limited range of medical interventions to deal with catastrophic
illnesses.

Today, our notions about what qualifies as ill health have expanded
enormously, and continuing advances in medical technology and molecular
biology allow for a seemingly infinite number of medical interventions.
Tinkering with the medicare system, Weiss warns, will not contain the
paradigm shift taking place. We need to consider a more entrepreneurial
and competitive approach to the provision of health care. Although Weiss
insists that we can avoid the excesses and inefficiencies of the
market-based system found in the United States, many Canadians will see
his book as an attack on the sacred principles of medicare.

Weiss argues that the designers of medicare failed to provide patients
and providers with incentives to exercise moderation in the use of
health-care resources. He suggests, without any hard documentation, that
many consumers are guilty of frivolous use of physician and hospital
services. On the other hand, Weiss portrays physicians as the
unfortunate victims of doctor-bashing by politicians and bureaucrats who
seek to control the practice of medicine and to cap physicians’
incomes; not surprisingly, he rejects salaries for doctors.

As an alternative to the implicit rationing of health services that is
already taking place, Weiss recommends that Canada consider the Oregon
plan for public participation in the explicit determination of which
medical services will be paid out of public funds and which will be
covered privately. Popular proposals like community health centres and
health-service organizations are described as not being all that
reformers promise. Even prevention, everyone’s favorite means of
saving scarce health dollars, comes in for sceptical analysis.

This wide-ranging book examines numerous other topics: the impacts of
aging on health costs, the reliability of clinical trials as a way of
testing medical procedures, the emerging use of smart-card technology to
track patient utilization, and the economic opportunities represented by
the expanding field of biotechnology. Weiss’s tendency to overstate
his case weakens his overall argument.