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E-mail interview

'An egregious situation' Add to ...

Adam Radwanski, globeandmail.com: Dr. Martin, thanks for taking the time to elaborate a bit on your call for medicare reform. You wrote this week that the absence of "competition" is holding back our health care system. Are we talking about competition in the form of different providers within the public (single-payer) system, or in the form of private fee-for-service care outside the system for those who can afford it?

Liberal MP Keith Martin: Thanks, Adam, for this opportunity.

I am referring to both. In many European countries, if a patient cannot receive care within a certain period of time, then the private sector is allowed to care for that patient. The money follows the patient, who is seen as an asset as opposed to a burden. The monies come from a mix of public and private funds, but everyone is covered and no one is hurt financially when they fall ill.

Adam Radwanski: The common argument that's made, of course, is that in that situation, relatively affluent patients would be able to get relatively timely care, whereas others would be forced to wait until the public system could serve them. Would that inequality not exist?

Keith Martin: It would not exist because everybody is treated based on their medical need, not on the amount of money they have in their pocket. The government will step into the breach to ensure that a person will receive the care when they need it, either in the public or private system. This will maximize the capabilities of both systems. The incentive to care for the patient is based on the fact that the funding - which will either come entirely from the government or be a combination of public and private monies - follows the patient.

Adam Radwanski: When we're talking about a combination of public and private monies, I assume that means private insurance plans...

Keith Martin: In the best European systems, there are a number of funding options:

1.) Publicly funded - but the providers can be public or private.

2.) A combination of public and private funds that, again, use public or private providers.

The important issue is that everyone is covered, patients are treated equally based on need, and payment is borne entirely by the state for those of modest means or is a combination of state and individual payment for those that can afford it up to a point, so that those who have chronic diseases or sustain a catastrophic medical event are not hurt financially because the state will pay for everything after a certain point.

Adam Radwanski: Which European countries, in particular, do you think we should be striving to emulate?

Keith Martin: We must have a "made in Canada" solution that takes the best ideas from Europe (and around the world). The countries we should look at are France, Denmark, Austria, Germany, Belgium, the Netherlands, and the UK. However, of the top 20 health care systems in the world, 17 are European. So we have many to choose from.

There is no one system that will enable us to provide the best care for our citizens. We should identify and adopt the best solutions we can find.

Adam Radwanski: As you wrote this week, we tend to get bogged down in fears that any reforms constitute a shift toward "U.S.-style health care." Why do we keep falling into that trap, as opposed to looking at the various European models you've mentioned?

Keith Martin: Health care has been used for too long as a political stick to club those who would like to modernize our system. Some have found it too seductive to wrap themselves up in the status quo, suggesting that this is the route to prevent Canada from adopting an American-style system, which has poorer health outcomes at a higher cost.

These same people make a profoundly flawed statement that our health care system defines ourselves as Canadians. They have trotted out the pervasive myth that Canada has "the best health care system in the world." This, however, has been a big lie, often rooted in political expediency at the expense of patient care.

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