Earlier, I wrote about Peter Singer’s highly defensible view that how rationing medical care is both inevitable and desirable, when done properly. The demand for medical services will always exceed the share of society’s wealth we are willing to devote to keeping people healthy and alive. As such, the important thing is to make sure we get good value for our spending, and that the way in which health services are assigned to individuals is fair and ethical.
Because of economic and demographic trends, Canadian provinces are going to have to make some tough choices when it comes to health spending. A recent article in The Economist described the scope of the challenge:
Health spending, which is administered by the provinces, has increased from nearly 35% of their budgets in 1999 to 46% today. In Ontario, the most populous province, it is set to reach 80% by 2030, leaving pennies for everything else the government does, not counting tax increases or new federal transfers. The biggest culprit is prescription drugs, which have seen their share of public-health spending triple since 1980.
Clearly, provinces need to spend money on things aside from prescription drugs. Admitting that, however, leaves the problem of determining how health spending should be allocated.
Certainly, part of that needs to involve cost-benefit analyses that compare different courses of treatment. In situations where a superior treatment exists, but which is far more costly, it may be necessary to make only the cheaper treatment generally available, so as to more effectively serve overall health outcomes. Of course, such choices are unlikely to be popular. Other likely measures will include restricting which treatments are covered, increasing the co-payments that patients make, and continuing to employ measures like bulk purchasing to reduce costs. More controversial measures could include things like taxes on unhealthy foods and further efforts to discourage smoking and drinking, while encouraging exercise.
Medical technology will almost certainly continue to advance in the decades ahead (though issues like emerging antibiotic resistant pathogens could actually set us back in some areas). At the same time, an aging population will almost certainly increase the quantity of medical services demanded, while decreasing provincial tax revenues. Hopefully, the combination of technical improvements and necessary budget constraints will produce outcomes that at least remain consistent with those that exist today, and which hopefully improve over time.
The least ethical choice is probably to fund the medical expenses associated with the demographic transition by heaping yet-more debt on future generations. Between climate change, nuclear proliferation, and all the other frightening legacies we are passing on to them, I think they have been given quite enough to deal with already.
What else can be done to constrain the total cost of medical services, while ensuring that those that are purchased are deployed both fairly and effectively?