Much has been written about President Obama risking his presidency on health care reform. Health care reform has been at or near the top of his policy agenda since he became president. In the meantime, politicians in Canada avoid discussing the need to reform our health care system, preferring to whistle past the graveyard, pretending there is no problem.

Jeffrey Simpson, writing in the Globe and Mail on March 13, highlighted that health care expenditures are eating away ever increasing proportions of all provincial government budgets. Health care expenditures are approaching 45% of total expenditures for most provincial governments in Canada.

To cope with this fiscal burden, provincial leaders have quietly reduced the number of services covered, and have creatively found new sources of revenues to fund health care costs. Many years ago, a health tax surcharge was introduced in Ontario. That surcharge morphed into a simple income tax surcharge. A few years later, with a new Premier, a new health tax levy was introduced. And on and on the charade continues.

Jeffrey Simpson pointed out several options to deal with our growing health care crisis: cutting spending on all other government programs, raising taxes, and promising future changes which might produce some cost savings for our health care system. There is also the option that has been used to date of reducing further the services which are covered by the government. This latter option diminishes the universality of services, and since the provinces do not coordinate their delisting programs, significant provincial differences in coverage might begin to affect mobility.

Tyler Cowen, an economics professor at George Mason University, wrote an article entitled “Managed Care: Get Used to It” in the March 14 edition of the New York Times. Managed care systems are able to control costs because their operators are able to limit services for their members. They are able to say “No!”

Cowen concluded with the following perceptive comments, which are just as relevant for Canada: “The real challenge is to change our fundamental attitude toward health care…The question is not managed care versus the status quo, but which opportunities – and the restrictions that go with them – we are prepared to accept. When will we acknowledge that our government can’t pay every bill? We’re in denial, and the longer we wait, the more painful the solution will be.”

In Canada, the provincial and federal governments will have to sit down and decide the minimal level of services which should be provided. At a minimum, there should be uniformity across the country. And the minimal level of services should vary with age and individual life style choices. It makes no sense whatsoever for our public health care system to fund hip replacements for people in their 80s and upwards. There are also many other procedures which should be restricted based on age and life style. Keeping people artificially alive at the expense of taxpayers makes no sense.

The governments will have to learn to say NO. Canadians will be free to pay for whatever additional services they want, but out of their own pockets.

It is easy to demonstrate that money can be spent more effectively in areas other than hospitals and physicians, indeed in areas outside of health care, to achieve superior health outcomes. But politicians fear for their careers if they were to make such suggestions. Perhaps if health care were funded by an earmarked tax at both the provincial and federal levels, Canadians would be prepared to engage in a serious discussion of reform of our health care system.

Making Canadians aware of the true costs of the existing system and the inevitable cost escalation we face with an aging population, medical technology breakthroughs, and the absence of reforms, might destroy the myths that our system is free and superior to all others.

The opinions expressed in this blog are personal and do not reflect the views of either Global Brief or the Glendon School of Public and International Affairs.