Waiting for Klein.

Ralph Klein has his solution to waiting list problems in the health care system--allow and encourage doctors and health care facilities to function in both public and private sectors. His solution will enable those willing to pay to buy their way to the head of the line. To justify his position Klein points to European and other countries with national health care systems, all of which have some type of private care function beside the public one. However, he does not offer a European alternative to the one that exists in Alberta.

It is true that the Australian, British and European health care systems allow fees and private services that are banned in Canada. Depending on the country, one finds privately paid physicians and facilities operating alongside the public sphere. Some countries require modest co-payments, extra billing, insurance premiums, facility fees and other ways of charging fees for part of the cost of the public system.

However, Klein and his advisors left one important item out of their analysis: almost all other countries with national health care insurance provide a greater breadth of services through their public programs than does Canada. These include: dental care, prescription and non-prescription drugs, long-term care, prosthetics (including toupees and wigs), spa services and more. Some even include fertility treatments. Canada's national system is limited to "essential" medical services provided by physicians and hospitals. These are supplemented by provincial programs such as long-term care.

While these countries do allow private medical facilities, these arrangements are so tightly regulated that even the presidents of the Canadian and the Alberta Medical Associations, who agree in principle with Klein, would be kicking and screaming if they themselves were subjected to such controls.

What is the financial outcome for people in these other countries? Despite the fees and the private system, people still spend less out of pocket (or through private insurance) for health care than Canadians do now if Premier Klein wants to introduce a European style health care model to include a private component, we could have a very different kind of debate. But he won't go there and he should stop conning us with his "European" nonsense.

During the nearly 50 years of Canada's national health care system, the province's have tried to cut costs and waiting lists by deterring users from the public system or shifting more of the costs to the consumers. These efforts have included: co-payments and extra billing. None of them worked satisfactorily because they tend to make lower income people hesitate before visiting a physician. They also tend to encourage physicians to locate their offices in more affluent neighborhoods. The Canada Health Act and provincial legislation no longer permit such practices for "essential" medical services and doctors cannot work both within and outside the public system.

Klein's proposal will enable the establishment of private clinics which will take affluent and low-risk patients for procedures, such as hip, knee and cataract surgery. When cases get too complicated, the patients, regardless of income, will be shipped back into the public system. This suggests that the public system will provide an indirect subsidy to the private ventures. Will it shorten waiting lists? Most experts agree that it will remove any number of doctors and nurses from the public system but have no impact on waiting lists.

Waiting lists are the headache of most national public health care systems because access is easy. Right-wing critics propose measures to limit access and to punish people for taking care of their health. They suggest that the system is bogged down by people taking up an unnecessary share of medical services. They ignore the fact that people in countries with strong national health care systems are healthier (as measured by life expectancy, infant mortality, and other indicators) than countries such as the United States, without such programs.

The current waiting lists are the result of many factors. Not the least of them are the "reforms" of the 1990's which prevented the existing system from developing to meet growing needs. Nevertheless, health care professionals in all parts of Canada. including Alberta, have shown initiative and creativity in finding ways to manage and shorten these waiting lists. The final results are still not in but they look promising.

Waiting lists have a few mysteries yet to be unravelled. For instance, the Canadian Institute for Health Information tells us that the average wait time for hip and knee surgery is six months but CIHI is still trying to figure out why some people wait 21 months and some are treated in less than average time.

More is still to come from Premier Klein. Will he act on his statements and challenge the Canada Health Act? Will the federal government withhold its contributions if the Act is violated? Or will it give in and throw Canada's medicare into chaos? Meanwhile, Ralph Klein has all of Canada on his waiting list.--L.K.