What’s the Issue?
Sustainability is a loaded word. It often turns up when people are discussing what might be wrong with the Canadian healthcare system. In general terms, “sustainability” describes the ability to maintain something at a certain level through conservation or defence. In Canada’s healthcare debate, “sustainability” can trigger a heated argument about whether we can afford the level of healthcare people expect at a cost which is acceptable to Canadians and their government(s). But is Canada’s healthcare really at risk of becoming unsustainable?
These discussions are complicated because we usually aren’t told what is causing the concern: which costs are rising (e.g. public or private), what is being compared (e.g. absolute cost increases or cost increases as a percent of gross national product) and how health costs relate to other financial developments (e.g. is the economy growing or shrinking).
There is also confusion about what proportion of government spending is taken up by healthcare. This is affected not only by how much the government spends on healthcare, but also by how much it spends (or doesn’t) in other areas. For instance, if the government decides to cut back spending on education or police services, then healthcare spending—even if it remains unchanged—will account for a larger percentage of the provincial budget.
So instead of worrying about the unsustainability of healthcare, Canadians should be asking how the numbers are moving relative to other factors such as: private health spending, gross domestic product, government spending in other areas, and tax revenues. That’s the way to sustain an informed discussion on sustainability.