Canadian Medicare is, once again, under attack. Despite being wildly popular among Canadians, and internationally admired, our system of universal insurance for “medically necessary” hospital and physician services is being dismissed by critics as old-fashioned, unsustainable, economically unfeasible, and otherwise out of step with our new global times. The newspapers are full of announcements of “privatization” of hospital care in Alberta, accusations that “we already have two tier medicine” and might as well finish the job, and seemingly erudite pronouncements that we must choose between “maintaining equity” and economic good sense. Too often, however, these criticisms result from some fundamental confusions about both concepts and evidence. In consequence, they often misinterpret the actual problems with Medicare. Just as physicians cannot treat without an accurate diagnosis, healing Medicare requires that we be clear in defining our terms.
This paper provides some background information about public and private places within our health care system. It begins with some concepts and definitions, including:
• the distinction between how we finance a health care system and how we choose to deliver care;
• the various levels within “public” and “private,” and, more specifically, the difference between for-profit and not-for-profit delivery;
• the ways by which funding can flow between those who finance care, and those who deliver it;
• the nature of insurance, and the concept of “risk selection.”