Arithmetic failure and the myth of the unsustainability of universal health insurance

In response to apprehension about health system sustainability, Béland, and Dhalla earlier in the same issue, take the view that such concerns are not supported by the facts. Although I am in agreement with their general conclusions, I would like to supplement their views by raising two points that they have not addressed.

First, Béland has noted that studies on this matter may involve analyses of costs, proportion of GDP, or percentage of provincial government spending. Another analysis, the estimation of expenditures over time (27 years in Alberta) after adjustment for population growth, inflation, and aging, found that an often touted increase of 900% was misleading. It is about 65% after correction. Further correction for increases in average personal wealth dropped the figure to 17.5% (two- thirds of one percent per year).1 This small and manageable figure does not evoke thoughts of unsustainability.

Secondly, when budgets are overspent, governments cannot pretend that some other body was managing the process. It is the job of government to respond to the wishes of citizens about the proportion of our wealth that we wish to spend on health care. The fact that many governments seem unwilling or unable to do this is worrisome. Is it too difficult or is “unsustainability” a smokescreen for another agenda? In any case, Canadians have not expressed outrage over health spending. In fact, the majority state that they would pay higher taxes for more high-quality medical care2 and mental health treatment.3 It does seem reasonable to say that the health system can be “as sustainable as we want it to be.”

Angus Thompson, Dept of Public Health, Flinders University, Australia

References

1. Thompson AH. Healthcare costs in Alberta in context after corrections for inflation, population growth, and the aging of the population: 1975-2001. Longwoods Review 2004;Oct:1-7.

2. Maxwell J, Jackson K, Legowski B, et al. Citizens’ dialogue on the future of health care in Canada. Discussion paper prepared for the Commission of Future Health Care in Canada. Ottawa Commission on the Future of Health care in Canada; 2002.

3. Thompson AH, Stuart H, Bland RC et al. Attitudes about schizophrenia from the pilot Site of the WPA Worldwide Campaign Against the Stigma of schizophrenia. Social Psychiatry and Psychiatric Epidemiology 2002;37:475-482.

Conflict of Interest:

None declared