Autonomy and Equity Values and Preferences in Practical Terms
Author(s): Scott Douglas Jacobsen
Publication (Outlet/Website): The Good Men Project
Publication Date (yyyy/mm/dd): 2018/06/05
Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.
Here we talk about the practical terms of equity and autonomy for Canadians in healthcare with a note on national pharmacare.
On the concrete side of the funding, Guyatt reflected on the situation in Canada. I wanted a more practical look at the costs associated with different value sets. Where in terms of values and preferences, Canadians prefer equity more than autonomy.
Although, some Canadians value autonomy too. However, the costs associated with each differ. They differ for different populations. They do not come out the same. Autonomy as the main value preference. It is associated with private healthcare.
It costs less for the rich and more for the poor. Equity as the main value and preference. It is associated with public healthcare. It may cost some more for the rich. However, it costs less for the poor.
America exemplifies the value and preference of autonomy or choice. Canada and Western Europe characterize the value and preference of equity. Canadian citizens value equity more than autonomy.
“People continue to put a high value on healthcare. I would anticipate that if, in fact, the curve starts swinging up again. We could quite reasonably tolerate, for instance, a 1% increase in our GDP devoted to healthcare. People will tolerate that pretty easily,” Guyatt explained.
With the 1% increase, I wanted to probe deeper. What would this mean in practical terms?
“Everyone [Laughing] would have to pay 5% more in tax burden. Of course, it is how you distribute that. If it were in a Trumpian way, the rich would pay less and everybody else would pay more,” Guyatt stated, “Or you could distribute it in various ways. It means a relatively marginal increase in taxes across the population.”
When I queried about the American administration in office now, Guyatt described the current delivery method of healthcare in the US highly inefficient.
“It is clear that the US way of delivering healthcare is extremely inefficient, extremely inequitable. It turns out on average that there are not better outcomes achieved and probably not as good outcomes in many areas,” Guyatt stated, “They are wasteful and poor outcomes. It is not a very good deal.”
American citizens, unfortunately, pay more for worse outcomes. Guyatt explained a systematic review of health outcomes done by colleagues and himself. In the systematic review, in an analysis on similar conditions, they compared the United States and Canada.
30 conditions were looked at in the research. “There were about 30 conditions that we looked at in the research,” Guyatt said, “There were 15 of them for which there was no difference, essentially, between Canadian and US outcomes. There was about 10 of them with Canadian outcomes as better and 5 with American as better.”
They submitted the paper the first time. They said that the US pays more and do not gain anything. The journal reviewer who examined the academic paper stated that Canadian outcomes are on mean better.
“We became less conservative after our peer reviews. On average, the Canadian outcomes are better. The very conservative statement is that the Americans are paying more on average for worse outcomes if you look across the spectrum,” Guyatt said, “We are constantly decrying the support for evidence in political decision making (academics). The continued support for universal healthcare. The governments, Kathleen Wynne extended healthcare to the under 25.”
People would pay less for equal or better drug coverage with a pharmacare program done across the country. A national pharmacare program akin to the national healthcare program. This is independent of the concern of whether the politicians could communicate this to people.
Canadian citizens would pay less. If you look at the American case, “the US may be paying somewhat fewer taxes – even though that is somewhat questionable, but their payments are gigantically more,” Guyatt said.
If Canada had a national pharmacare program, then Canadians would gain in the lowered drug costs. This would “more than make up for any increased taxes. However, Guyatt concluded, “There is no groundswell for universal pharma care.”
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The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.
He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.
For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.
He talks here with Scott Douglas Jacobsen who founded In-Sight Publishing and In-Sight: Independent Interview-Based Journal. We conducted an extensive interview before: here, here, here, here, here, and here. We have other interviews in Canadian Atheist (here and here), Canadian Students for Sensible Drug Policy, Humanist Voices, and The Good Men Project (here, here, here, here, here, here, here, here, here, and here).
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