Public Insurance vs. Private Delivery

The magazine Lab  Business did an interview on False Positive and the value of public labs.  A transcript of the interview can be found  at:

A theme in the interview  was the relationship between public delivery and universal health insurance  system. The interview drew out the fact that with a single payer system public delivery is the most cost-effective. If cost is a concern, and it should be,  than universal insurance requires public delivery.

The corollary of the incompatibility  between public insurance and private delivery is that private delivery will  undermine universal insurance and likely lead to its demise. For-profit delivery of publicly paid health care services increases cost which either increases  taxes but not service or decreases service: neither are desirable.  As the public system becomes less accessible and costs increase there is pressure from those that can pay to buy more dependable private health care.  Private companies welcome this business. They can charge more and increase their profits while using public payments as the mainstay of their income.  As more people buy privately, the clamor for broader private insurance coverage and limiting universal insurance increases.  These dynamics have all been active in provinces where for-profit corporations deliver public laboratory services.

A cynic might say that supporters of private delivery, even though they argue that it will improve public health care, are pushing these alternative delivery options as a way of eventually opening up the market to more private insurance.  On the other hand this cynic might simply be an accurate observer of Canadian health care politics. The overwhelming public support for medicare, and its acknowledged benefits in terms of cost, access and justice, makes it a hard political target.  But advocating private delivery is less risky and, if they succeed, private delivery can make public insurance unstable and eventually unpalatable as a universal system.

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