More arithmetic of health care
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* Robert Y. McMurtry

*   © 2005 CMA Media Inc. or its licensors

Janice MacKinnon's commentary1 is a classic: her arguments are resilient, used time and again regardless of their flaws.

It is all about the denominator, which in this case is revenue. Health care expenditures are indeed rising faster than revenues — that is apt to happen when revenues are foregone because of tax cuts.

According to the economist Armine Yalnizyan2 the rise in health care expenditures of all provinces and of the federal government since 1996 has been $108 billion, an arresting figure. However, this increase pales in comparison with the revenue foregone by the same jurisdictions over the same time frame, which amounts to $250 billion.

In other words, governments in Canada have given priority to tax cuts over social programs. Ontario's Premier Dalton McGuinty, whom MacKinnon quotes, won an election by giving priority to social programs over tax cuts. It is those priorities that need to be debated, not the question of dismantling the single-payer health care model in favour of more expensive and less safe alternatives.

Other facts, no doubt well known to MacKinnon, do not make an appearance in her commentary, such as the fact that health care expenditures as a percentage of GDP are at the same level as 10 years ago.3 This is not the picture of out-of-control growth she is trying to portray.

Yes, change is needed, and the sooner the better. That view is unanimous across Canada. But privatization, taxing the sick and other related “remedies” are not the answer.

## References

1.  1. MacKinnon JC. The arithmetic of health care [editorial]. CMAJ 2004;171(6):603-4.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzEvNi82MDMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTcyLzYvNzMwLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Yalnizyan A. Can we afford to sustain medicare? A strong role for federal government [position paper]. Ottawa: Canadian Federation of Nurses Unions; 2004 Aug.
    
    

3.  3. *Health care in Canada, 2004*. Ottawa: Canadian Institute for Health Information; 2004.