June 13, 2002

Death is Cheaper

Rising health care costs are not unique to BC. What is unique to BC is a hospital that sells unnecessary procedures to fund necessary ones, and health authorities that cut necessary services in order to comply with provincial budget targets.

St Paul's hospital was in the news this week claiming that wait lists for CT scans were reduced because money to hire another technologist was raised through the sale of scans to people who wanted them for medically unnecessary reasons. In other words, the wait list could have been reduced long ago if the hospital had simply hired the necessary technologist but it waited and claimed that it could only get the funds by selling unnecessary services. There is no inherent relationship between selling unnecessary services and hiring the necessary technologist. Any other funding or fund raising scheme could have been used. Other approachs, other than selling unnecessary services, would not help to create an artifical demand for unnecessary CT scans. What is next; copying third world promotions of miracle cures that are now considered unethical in BC? Why would a hospital sell medically unnecessary services to raise money? How does that help educate the public about evidenced based medicine? Can the public trust that their necessary service won't soon be labeled unnecessary so the hospital can collect a private fee?

The Provincial Health Authority needs to cut $70 million over three years in order to balance its budget. If more people have cancer and need treatment, that is too bad. The length the Provincial Health Authority will go to meet its budget target was revealed when the Hospital Employees Union obtained documents showing such options as not paying for new cancer drugs and for limiting mammography screening to women over 50. While the CEO for the Authority denied that those options will be implemented immediately, no assurance was given that the options won't reemerge at any time.

One of the largest purchasers of health care in the United States is the California Public Employees' Retirement System (CalPERS). It provides health benefits to 1.3 million people. CalPERS has just announced premium increases for coverage in 2003. Its website says "At their April 17, 2002 meeting, the CalPERS Board approved an average rate increase of 25.1 percent for its Basic HMOs and a 40.1 percent increase for its Medicare plans." The premium rate table for the most comprehensive plan shows the 2003 monthly cost for a family will be $1,425 per month (US dollars). Their least expensive plan will be $523 per month for family coverage. Neither of those plans provides coverage comparable to Canadian Medicare. They include a $500 per member ($1000 per family) deductible and various user fees such as $20 per physician visit. The annual cost to a family for the most comprehensive plan will be $17,100 (US) plus user fees and deductibles!

Notwithstanding the recent 50% increase in BC's Medical Service Plan premiums, most of the money for our health care system is still raised through taxes. The full family MSP premium is now $1,296 per year. BC's health budget, including everything from public health inspectors through hospital operations, works out to about $2,500 per person or about $6,750 per family.

We have a very long way to go before we are looking at the kind of costs facing California public employees. Even with their high costs, the CalPERS Board increased premiums rather than resorting to the types of coverage cutbacks seen in British Columbia. The Campbell government has put tax cuts ahead of health care. Death is cheaper.