Bliss’s “Critical Condition” lacks Critical thinking

And, that’s a big problem with user fees. The average person doesn’t know whether their symptom warrants medical attention. Do we really want patients to make the decision about whether to seek health care on the basis of whether that will leave enough money to pay the rent?

The scientific evidence against user charges is long and strong. So why do these discredited ideas keep coming back? UBC economic Professor Bob Evans refers to user fees and related ideas as zombies. That’s because they have been killed off repeatedly by the scientific evidence, but, just like zombies, they keep bouncing back to wreak havoc.

Evans notes that’s because the zombie masters are truly immortal. Private finance strategies (from user fees through private insurance to medical savings accounts) all tend to benefit the wealthy, the healthy, and those who want to sell services. At the same time, private finance tends to disadvantage the poor and the sick. With the political support of the rich and of aspiring business people, it is not surprising that these zombies are so resilient.

It is disappointing that Canadians of Professor Bliss’s stature display such ignorance about the true state of Canadian health care costs. It is even sadder that they are promoting zombie policies like user fees. But its truly depressing that the Canadian Medicare debate is avoiding the real issues. There are hundreds of examples of innovations within our universal system that demonstrate we can enhance the care experience, control overall costs, and improve the health of Canadians. We should be pushing our politicians to maintain universality and finally implement the Second Stage of Medicare.

High performing organizations have demonstrated it is possible to achieve the triple aim of improved population health, enhanced services and cost control. Where is the Canadian political leadership to lead us in this direction?

To read CARP’s take on Michael Bliss lecture, please see “Means Tested Healthcare”

Michael Rachlis is an author and health policy analyst. For more discussion of health policy issues, please visit

Keywords: healthcare, costs