In poll after poll, Canadians reaffirm their commitment to a health-care system in which access is based on need rather than wealth. So it stands to reason that opening up medicare to a private second tier would be bad for people who have no choice but to rely on the public system. With a relatively fixed number of health-care providers, wait times in the public system would increase as staff were recruited to the private sector. From Australia to Zimbabwe, this scenario has unfolded repeatedly around the world.
But, deep down, some of us wonder: If I had the money to buy my way to the front of the line, wouldn't I be better off in a two-tier system?
The answer, perhaps surprisingly, is probably not. Private health care would be almost as bad for the wealthy as for the poor, as long as the public system provides high-quality care (and most Canadians who use the system rate it highly).
The reason is, there's such a thing as too much health care - too many tests, too many interventions and too many pills. The emergence of for-profit health care in Canada would produce just this situation - not enough health care for some, and too much health care for others.
This is exactly what happens in the United States, where people with private health insurance find themselves subjected to the risks of unwarranted procedures. The U.S., for example, has the highest rate of invasive cardiac procedures in the world - 45 per cent more than the next highest country. Yet, all these additional procedures have not bought Americans better heart health. Worse still, each invasive cardiac procedure carries a small but real risk of a serious complication - stroke, a torn coronary artery or even death.
Similarly, in a two-tier system, the wealthy would be bombarded with advice to get "checked out," and many would end up receiving unwarranted screening tests such as CT scans, which produce enough radiation to increase the risk of cancer.
Even if there were a well-developed private health-care system in Canada, the wealthy would still need to use the public system for many forms of health care - trauma care, for example - because the private system would focus on elective and outpatient care. The erosion of political support for medicare probably would result in worse public care for everyone.
A two-tier system also would be bad for business. In a world where wealth buys faster access to more health care, corporations would be expected to pay for their employees to jump to the front of the line. Some Canadian businesses do this already, purchasing too much health care - executive physicals, for example - for their most-favoured employees. The cost of providing too much health care for a large proportion of the work force would be enormous.
Bank CEOs understand this already. Charles Baillie, the former CEO of TD Bank, said a few years ago: "I choose to talk about health care as a banker - as a corporate leader - because I believe it's high time that we in the private sector went on record to make the case that Canada's health-care system is an economic asset, not a burden, one that today, more than ever, our country dare not lose."
Danielle Martin is a family physician at Women's College Hospital in Toronto; Irfan Dhalla is a general internist at St. Michael's Hospital. Both serve on the board of Canadian Doctors for Medicare.