Tuesday, January 17, 2012

Sustainable Health Care

Living in Canada where state medicine has been provided since 1967, I have become completely accustomed to free medical care. Well, almost free. At one point, while living in Ontario, my husband and I had to contribute $66 per month to OHIP (Ontario Health Insurance Plan) to have medical care, but for that price you could get free doctors' visits, free surgery, almost everything free except for medications. Those have to be covered by a private insurance plan, unless you are a senior where they are substantially covered by a government plan if you cannot afford your drugs.

But the system is showing lots of cracks. It has become a standard joke that the wait times in Canada are looo...nnnn..gggg. In fact, I myself have been waiting for a hip replacement for 15 months now. The average wait in my province of Nova Scotia for hip replacement is 85 weeks, I heard. So it shouldn't be too much longer now.

But how is a national health care system provided? It should come as no surprise: it is paid for by our taxes.

So, it stands to reason that the health care is dependent upon a good taxation system, but it also depends upon a good base of tax-payers. And that is what is beginning to crumble.

As I wrote in a blog post yesterday, a caller on Talk Radio was alarmed because our health care system is being threatened by cut-backs, which means that our children and grandchildren will not enjoy the same quality of care that we now enjoy. That just did not sound right to me. How can we expect things to carry on as usual if other factors have changed? And one change is simply not being talked about: the changing population demographic and that affects the reality of taxation and tax-payers.

A couple of searches today on Nova Scotia statistics revealed some rather alarming facts.

- Between 1971 and 1991, NS population grew 14.9% compared to 27.5% for the country as a whole

- Nova Scotia birth rate in 1995 was 11.8 per 1000 persons, compared to 12.9 births per 1000 persons in Canada

- Nova Scotia's birth rate is the second lowest in the country (after Quebec)

- However, Nova Scotia's death rate in 1995 was 8.7 per 1000 compared to the national rate of 7.2. Nova Scotia has the highest death rate in the country.

- The rate of natural increase in population in NS is 3.1 per 1000 compared to 5.7 in the country as a whole (lowest in the country)

- Foreign migration to Canada was 3.8%, but in NS migration was only 1.6%

- Average age in NS is higher than the national average; the number of people over 75 is 5.8% compared to 5% nationally, making this an "old" province

- Nova Scotia has the highest reported disability rate in the country: 21.3% compared to 15.5% nationally (actually both these figures were shocking to me)

- In 1996, 2.5% of NS population were receiving CPP disability benefits compared to 1.0% for the country as a whole

- Labour force participation in NS weighs in at 59.8% compared to 64.8% for the nation

- Death rate exceeds birth rate in NS: in 2011, there were 9000 births (average of 9.3 per 1000) and deaths were 9,800 (average of 10.1 per 1000) - this is a negative difference of 800

These are not happy statistics. A healthy society is one that is growing, not one that is declining. The healthy profile of a nation resembles a pyramid with the base being wide and full of youngsters; the pyramid gets narrower at the top, where the elderly form the minority of the population. Our pyramid is getting heavier in the middle and it is swelling at the top, while the base is shrinking. That simply does not bode well for the future.

Other interesting statistics that I read were that the decline in births were traced to birth control. In 1981, births were 60% of the births twenty years earlier. And abortions increased from 643 in 1961 to 1700 in 1981. They remain at around that number to the present date. The result of both use of birth control and abortion is that the actual numbers of births are down, but also the number of women who come into age-bearing years has decreased, thereby further decreasing the number of births.

The fertility rate of females in the age category of 15 to 49 (child-bearing years) has dropped from 4.2 per woman in 1961 to 1.6 per woman in 1981. To keep a population from declining, a minimum fertility rate of 2.1 children per woman is required. We are far below that and have been for a number of years. Once we reach a rate of 1.2, the trend is irreversible.

All of these factors have dramatic effects on education, on the work force, on health programs, on care of the elderly. Is it any wonder that we are seeing trouble in our health care system?

Without a solid base of tax-payers (which comes from children maturing into working adults), we simply don't have the people to pay the taxes that are required to pay these bills. What is the solution? higher taxes? Can we even begin to realise how high taxes would have to be to cover the kind of health care we are demanding? Apparently, Norway has a good government health care system, which requires a tax rate of 60%. Are we Canadians willing to have 60% of our income diverted into taxes?

So why do we think we are entitled to the same quality of health care that we have come to expect? Not only is Nova Scotia going to be known as a "have-not" province, but it will become known as a "gimme, gimme" province too. The entitlement mentality has got to change. We simply cannot keep getting all the benefits we think we deserve, given the fact that we don't want to produce the people necessary to provide them.

So, when people say that having children is a private affair, are they right? It seems to me that these private decisions are having a very public impact on everyone.

In discussions on health care, I wish that someone would bring up the issue of birth rate and the declining demographic. Someone needs to start connecting the dots.

Stats taken from Population Growth - Nova Scotia and Canada
Nova Scotia Demographic Trends into the 21st Century

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