Health Care and the “Robin Hood Principle”

On November 15th I attended AIMS’ most recent conference: Creating Wealth through Better Health.  The premise of the conference was that although today health care is an expensive drain on our economy, tomorrow it could become an economic driver- with a few little changes in policy.  By showcasing proven strategies and solutions, AIMS was able to bing together a collection of voices advocating for policies that could change health care for the better both in Nova Scotia, and in Canada.

As Canadians, we are often afraid to tackle difficult issues such as a health care and education.  Our elected officials would often much rather stick with the status quo, even when the status quo is unsustainable.  Universal health care is considered sacred in Canadian culture, a pillar of what it means to be Canadian.  I love what this says about our country: that we are a nation of people who care for one an other, that we believe that every human should have the right to life, and that each and every citizen deserves dignity.  However, I worry about what this can mean for our future: generations in debt, mounting taxes, and no return on investment.  Health care is an investment in our present, and our future.  The solution is not to spend more money on health care (The government of Nova Scotia already spends 45% of all tax revenue on health care) but rather to spend the money that we are spending more effectively.  Quite simply there must be some areas where efficiencies can be found that do not negatively affect the patient outcomes, and other areas where some costs can be recuperated.

The suggestion to fix our ailing health care system that I was most intrigued by was Dr. Lloyd Maybaum’s suggestion, the “Robin Hood Principal”.  After further reflection, I also realized that it was the policy with the most room for success.  Across the country, Canadians sit on waitlists for procedures.  Lets assume that in most cases the limiting factor in preforming these procedures is money, not staff, and not the space to preform them.  So what if we allowed people to pay to jump the line?  Now, before you jump to conclusions, let’s think this through.  Let’s charge people 2, 3, 4, times the actual price of the procedure and then use the extra funds to pay for the next few people in the line.  Don’t forget that the “jumper” is also paying into the tax base, and so is paying more than their fair share.  Transparency is important if this idea was to become a reality, as it would be necessary for payers to see that their fees were staying in the health care system.

The two most important suggestions I would like to add to this idea are that the doctors must not know who is paying into the system to jump the line, and to answer who will cover the extra fees.  It is imperative to the standard of care that doctors in Canada must not know who is paying additional fees to cut the lines because if they did, they may unintentionally preform better on those who pay, or worse on those who do not.  Those who pay may get extra attention that would not be afforded to those who did not.  By withholding this information from doctors, patients retain their autonomous status and everybody walks away with dignity, a high quality standard of care, and with trust in the system.  The second question is regarding the insurance agencies.  Will they cover this under a premium, or is this a direct charge to the client?

To say that health reform in Canada is an easy task is an understatement.  One needs to only look south of the boarder to see how “Obamacare” is opening engaging debates and creating lines of division in America.  As I have said, health care in Canada is a pillar of our society and out identity.  Once we were a leader on the world stage, but this is no longer the case.  Despite our huge investment in this policy area we are not getting the return that Canadians deserve.  I understand that this is a huge task to improve, which includes, but is not limited to, preventative care, education policy, fiscal responsibility, and our demographics.  Nova Scotia has the oldest population in Canada, this simple fact only shows how quickly change is needed.  Canadians deserve a fair, effective, and sustainable health care system that is affordable today, and for generations to come.  As somebody who will continue to pay into the tax base and health care system for the rest of my working life, I believe that Canada owes it to its younger generations to seek new, innovative, solutions to create a sustainable health care system.  These solutions may be controversial, but it is imperative that we start the conversation so that our health care system emerges stronger.   I think that the “Robin Hood Principal” is a perfect place to start that search.

-Alanna Newman

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