It is well known that our publicly funded health-care system is expensive. But can it honestly be said we get fair value for all the money we plow into it? Consider some of the problems we face. It takes seven months to see an allergist in Victoria. The wait times for some elective surgeries are even longer.
Several tens of thousands of British Columbians can’t find a family physician. Residents in rural parts of the province must travel long distances for essential procedures such as cancer radiation treatment.
Looked at from this angle, if often seems we get less out of the system than we invest in it. But a new study by the Canadian Institute for Health Information puts a different face on things.
Viewed from purely a monetary perspective, it turns out many of us do get back what we put in, and a good deal more.
Average wage-earners in Victoria, making around $44,000 a year, pay about $2,210 in various health-related taxes each year. Those include the annual Medical Services Plan premium, and the portion of income tax and sales taxes that go toward health care. In return, they receive medical services worth $2,880 on average — about 30 per cent more than they paid.
The gap is even more pronounced at lower income levels. British Columbians in the poorest group pay just $740 into the public health-care system and receive a benefit each year worth $3,860 on average — about five times what they contributed.
At the other end of the scale, the opposite applies. The wealthiest members of the community pay $7,210 annually, and receive, on average, services worth only a third that amount.
Part of this spread is due to the progressive nature of our income-tax system: People with higher incomes pay progressively more than those who make less.
And part is due to the fact that poverty is strongly associated with poor health. Those at the bottom of the income ladder make more use of the health system than those at the top.
Some critics make an issue of the fact that the affluent pay more than their share.
In Vancouver, a private surgery clinic is suing for the right to establish a parallel health-care system for those who can afford it.
The argument is simple enough. Why shouldn’t the well-off be allowed a private tier of their own? If someone has money, why shouldn’t they be able to visit a specialist more quickly, or get elective surgery sooner?
We’ll see what the lawyers make of this. Yet there is a public interest at stake here.
Illness is not only a personal burden — it is a weight we bear collectively through higher unemployment, homelessness and, particularly in B.C., child poverty. And none of us are immune to communicable diseases, once they gain a hold in the community.
By the same token, good health is not merely an individual blessing, it is something the whole population benefits from. Systems that rely on ability to pay fail to capture those benefits.
In the U.S., where hospitals and physicians charge what the market will bear, life expectancy is 2.5 years below the Canadian average.
And a recent study south of the border showed that 18,000 Americans die each year because they can’t afford treatment.
What the results from the CIHI study highlight are a set of policy choices made over the years. We’ve chosen a health-care system that places medical need ahead of other considerations.
And we’ve consciously accepted that the financial burden will fall more heavily on those with higher incomes. Those may be debatable choices, but they reflect long-standing Canadian values.
