Our association has an evidence-based approach to issues of private delivery. We are pretty well on record as saying that the single-payer system works. There ought to be a social analysis here and there if you want to bring on home care social programs, and there is room for copayment in long-term care facilities, providing, of course, people aren't impoverished by those copayments. But let us put that aside and talk about whether or not we can save money by contracting out to private surgical clinics. Can we be assured that there is accountability, that there are cost savings, that there is quality, and that there is no cream-skimming? Because you realize that the publicly funded health system can do easy procedures just as cheaply as any private clinic. The real issue is how to do complex things in private clinics.
I'd just like to cite my friends in the American Hospital Association, because I go to their board meetings. By the way, 80% of American hospitals are not-for-profit. The worst problem they say they have is private surgical clinics that take the easy things, the cream-skimming things, the routine things, including healthy people who need knee replacements and routine cataract procedures for people who have no comorbidities like high blood pressure or heart problems. They take all the easy things, and as soon as there's a complex case that lands on their doorstep in their emergency, boom, they have all the costs. So I don't think cream-skimming to private surgical clinics is an answer.
We would say we should look at the evidence. Show us where it's cheaper. The evidence is that it isn't cheaper. If it's cheaper, we'll go for it, because it's good to have values. I oppose private this and private that, but I don't think values are enough. Values need to be supported by evidence. So we would say that you should show us that you get quality, accountability, cost savings, and what not. Maybe you do for urine testing, blood testing, and maybe some housekeeping services; let's see. Let's look at the evidence. I'm not convinced.