November 21, 2000
Empowerment seen as the best medicine in proposed system
Doctors, lawyers and other professionals aren’t as healthy, and don’t live as long, as those who occupy even higher rungs on the socio-economic ladder. Neither do the children of doctors, lawyers and other professionals.
White and blue collar workers aren’t as healthy, and don’t live as long, as doctors, lawyers and other professionals. Neither do their children.
The poor fare even worse, and the very poor worst of all, even after adjusting for lifestyle factors such as eating and smoking.
While Canada’s political parties have been indignantly accusing each other of permitting an inequitable two-tier health system, and while the public has awakened to how many Canadians have been tapping into a second tier, all have ignored the actual relationship between social rank and well- being, which exists among rich and super rich, neither of whom want for special treatment, and among poor and very poor, neither of whom use the second tier. A study of Winnipeg’s population found the most affluent 20% of men outlived the poorest 20% by 11.3 years; the most affluent women outlived the poorest by 7.7 years.
Those fixated on the inequities of a two-tier system also ignore the first tier’s own extraordinary inequities. As various studies show, socialized medicine treats the poor as second class citizens. In Manitoba, medicare spends more on better educated patients for primary care. In the U.K., the subject of the most extensive analysis, physicians spend 50% more time, and 40% more money, on the ailments of rich people than on those of the poor.
Yet at its root, the gap among health outcomes may have more to do with empowerment, which the well off tend to have more of, than they do with money, access to the medical system or education. A landmark study of 31,000 London bus drivers and bus conductors –the ones who collect tickets and assist passengers — found drivers had much poorer health than conductors, including twice the conductors’ death rate from cardiac disease, although they worked on the same buses, breathed the same air, earned the same pay and occupied the same social status.
Yet in one fundamental respect, the bus drivers and the bus conductors did differ. Bus drivers must keep to strict schedules, with their performance judged on their ability to arrive at the next stop on time, yet they are captive to traffic. In contrast, bus conductors much more tend to be their own masters, having some control over stressful relations with passengers and being less subject to the soul-destroying feeling of helplessness that undermines human happiness, human resourcefulness, human empowerment, and, in all likelihood, the human immune system.
Medical care influences our well being in two ways: Quality care saves lives and the knowledge that it’s available is empowering. Through waiting lines and other impediments to prompt care, the current medicare system thus doubly damages the public’s health — it not only denies us service when we’re most vulnerable, it dispirits and debilitates us in the process. Ironically, expanding the public one-tier system to provide everyone with most of the medical services that only the affluent can now afford, if done through a system becoming widespread in the private sector, would save money.
Under this expanded one-tier system — known as health care allowances or medical savings accounts — each year the government would give all Canadians individual allowances greater than the amount they’re likely to need, based on their age, sex and medical history. Put another way, the old would receive more than the young, the sick more than the healthy and the poor, because they are likelier to need medical care, more than the rich. Each of us, using doctors and other health care experts for advice, would then manage our own health care budget. If we had a bad year, and exceeded our allowance, medicare would provide free additional support, just as it currently does. But most years would produce small savings, if our lifestyles stayed the same, and larger savings if we changed our diets or otherwise looked after ourselves better. We would then split the savings — $12-billion, according to one of the world’s leading health actuarial firms — with the government.
With a meaningful budget with which to take charge of our own health, health care allowances would be empowering. The savings might then be higher still as one important factor driving the appalling gap in lifespans between the empowered rich and the disempowered poor diminishes.
Health allowances recently helped cause a furor on news that a Canadian Alliance discussion paper had contemplated them among other reforms. Although the other parties jumped on the Alliance with bitter accusations of betraying medicare, in fact governments of all political stripes — the NDP and the Liberals among them — have expressed interest in health care allowances. But one factor and one factor alone discouraged governments coast to coast from attempting a pilot project or otherwise experimenting with them — the certainty that any concrete steps they took toward possibly implementing them would unleash unremitting demagoguery against them of the kind we’ve just seen in our federal election campaign, demagoguery that prevents any reasoned discussion or exploration, and any constructive reform to our deteriorating medicare system.
Lawrence Solomon is executive director of Urban Renaissance Institute. The actuarial study he describes (http://www.c-p-i.org/cpi/report/report.html) was undertaken for Consumer Policy Institute, a sister organization.