We all know that health care is expensive. But until Premier Gordon Campbell launched his "Conversation on Health" last September, health-care costs generally weren’t counted down to the second. Now, though, you can go to the government’s Web site (www.bcconversationonhealth.ca/) and see a clock counting the amount of public provincial money spent on health per second: $406.93.

This weekend in Kamloops, the B.C. government will hold its first of 16 regional forums as part of its yearlong Conversation on Health. On Tuesday (February 6), the premier will bring his message to the Vancouver Board of Trade.

Campbell launched the “conversation” a couple of months after the sudden resignation of B.C.’s former deputy health minister, Dr. Penny Ballem. In a June 22 letter to the premier, Ballem claimed that Campbell’s plans for the ministry’s organization were “unsound and reflected a lack of confidence in my leadership on your part”.

Former NDP MLA David Schreck told the Georgia Straight that he fears Campbell will cite this public-consultation process to justify more for-profit care and more health care funded by private insurance companies. This, he suggested, would lead to higher health-care costs and less access for low-income people.

“The Web site seems to be designed to drive a message rather than to engage in a conversation,” Schreck claimed. “The first thing that hits you is this clock about how much money has been spent since you logged on to the Web site.”

Marisa Adair, communications director for the Ministry of Health, said she would not make Health Minister George Abbott available for an interview with the Straight.

In a news release issued last September 28, Campbell noted that this year’s $12.8-billion health budget amounts to more than 40 percent of provincial expenditures. In the same release, he emphasized that the government now spends $35 million each day on health care.

There are five principles in the Canada Health Act that provinces must follow to qualify for federal health funding: accessibility, universality, portability, comprehensiveness, and public administration. In launching the Conversation on Health, Campbell promised to add a sixth principle—sustainability—“to guarantee that our public health care system does not implode for lack of innovation and action”.

“If we don’t act, health spending could consume 71 percent of the provincial budget by 2017,” Campbell claimed.

Schreck, a health economist, said that if the premier is truly concerned about costs, he should look into the prescribing habits of physicians. “I have a friend who just last week went into a walk-in clinic because she had a sore throat and was prescribed antibiotics right away,” he said. “Anybody on the street knows you shouldn’t prescribe antibiotics unless they at least do a swab, because in all likelihood it’s viral [and won’t respond to antibiotics, which only act against bacterial infections]. It’s bad health because it builds up resistance to antibiotics, and it’s a complete and total waste of money. That kind of stuff happens all the time all over the place.”

There are several measures that Campbell could have taken in his first six years in power to contain costs. His government decided against making significant changes to the fee-for-service payment system for doctors. Nor did Campbell put medical-laboratory tests out to tender, even though Ballem advocated this. Instead, lab tests are still charged for on a fee-for-service basis.

Campbell’s government also wholeheartedly embraced public-private partnerships on hospital-construction projects, despite extensive evidence in the British Medical Journal demonstrating that this approach results in higher health-care costs over the long term.

There is no shortage of research in peer-reviewed medical journals highlighting the drawbacks of for-profit health care. In 2004, the Canadian Medical Association Journal published a study noting that for-profit U.S. hospitals have 19-percent higher charges than nonprofit facilities.

The study’s research team, headed by McMaster University health-policy expert P. J. Devereaux, had previously concluded that investor-owned hospitals had death rates two-percent higher than nonprofit hospitals. In an accompanying editorial, Harvard Medical School researchers Steffie Woolhandler and David Himmelstein cited several reasons for-profit hospitals are so much more expensive, including “princely” compensation packages for executives; higher administrative costs; and employing strategies to bolster profitability, among them overbilling Medicare.

The same year, McMaster health-policy researcher Stephen Birch ridiculed those who claim that publicly funded health care is not sustainable. Writing in the Canadian Medical Association Journal, Birch claimed that “in an age of evidence-based health policy, these claims stand out as a beacon of political hypocrisy and intellectual dishonesty, disregarding both the theoretical reasons and empirical evidence” supporting a single-payer (i.e., Medicare) system as the most efficient use of health-care resources.

Curiously, Campbell didn’t cite any of this research when he launched his Conversation on Health. Instead, he focused attention on the impact of an aging population—even though research in peer-reviewed medical journals suggests that this concern is overblown.

“Per-capita health costs skyrocket as we age,” Campbell said, according to the September 28 news release. “Those of us currently in our 50s use an average of about $2,100 in health care each year. When we get to our 70s, that more than doubles to $5,700. And if we’re lucky enough to get into our 90s, we’ll use about $22,000 in health services—ten times what we used in our 50s.”

He also said that if we want great health-care service for our children and grandchildren, it requires “an open, honest conversation with British Columbians”.

One of B.C.’s best-known health economists, Bob Evans, told the Straight that the premier is being less than honest by focusing so much attention on health-care costs as a percentage of provincial government spending. Evans, associate director of the UBC Centre for Health Services and Policy Research, said the standard measure around the world is health-care costs as a percentage of the gross domestic product (i.e., the entire economy). By this measure, B.C. health costs are fairly stable.

“I would be more optimistic if Penny Ballem hadn’t jumped ship,” Evans said. “Her leaving sounds much more like he is trying to soften us up for a significant privatization—not just of delivery, but of costs.”