Medicare is as sustainable as we want it to be

Michael M Rachlis MD MSc FRCPC LLDNovember 5, 2010 www.michaelrachlis.com

“Certainly those who knew the most were the least scared.”

Winston Churchill. The Second World War. 1949.Volume II. Book One. Chapter 14. The Invasion Problem

Michael M. Rachlis MD November 5, 20102

The sustainability of Medicare

• Canada’s current health care costs are increasing• Health increased its share of GDP from 2000 to 2009– It fell this year

• But recent increases in health care’s share of the GDP are almost totally due to the recession

• Health care has slightly increased its share of provincial budgets due mainly to cuts in other areas rather than increases in health spending

• Canada’s health costs are similar to other wealthy countries and substantially less than those in the US

Michael M. Rachlis MD November 5, 20103

0%

2%

4%

6%

8%

10%

12%

14%19

8119

8319

8519

8719

8919

9119

9319

9519

9719

9920

0120

0320

0520

0720

09 f/

p

PublicPrivateTotal

Canadian Health Care Costs as % of GDP (Dashed lines with 1998-2008 rates of GDP growth)

Data from: Canadian Institute of Health Information. National Health Expenditures Trends 2010

Michael M. Rachlis MD November 5, 2010

4

0%2%4%6%8%

10%12%14%

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

f/p

PubPvtTotal

ON HC Exp as % of GDP (Dashed lines with 1998-2008 rates of GDP growth)

Data from: Canadian Institute of Health Information. National Health Expenditures Trends 2010

Michael M. Rachlis MD November 5, 2010

5

0%5%

10%15%20%25%30%35%40%45%50%

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

f/p

ON

CAN

Data from: Canadian Institute of Health Information. National Health Expenditures Trends 2010

Canadian Prov HC Exp as % of Program spending

Michael M. Rachlis MD November 5, 2010

6

0%

10%

20%

30%

40%

50%

60%19

8119

8319

8519

8719

8919

9119

9319

9519

9719

9920

0120

0320

0520

0720

09

CAN Prov HC exp

Govt outlays

Canadian Gov't Outlays and Provincial HC exp as % of GDP

Data from: Canadian Institute of Health Information. National Health Expenditures Trends 2010and Federal Dept of Finance fiscal Reference Tables 2010

Michael M. Rachlis MD November 5, 2010

7

0%2%4%6%8%

10%12%14%16%18%20%

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

ON Program Exp

ON Prov HC exp

ON Non HC

ON Provincial Expenditures as % of GDP

Data from: Canadian Institute of Health Information. National Health Expenditures Trends 2010

Michael M. Rachlis MD November 5, 20108

0

10

20

30

40

50

6019

70

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

2003

2006

2009

Government Outlays as a share of GDP%

of G

DP

Can Dept Finance: http://www.fin.gc.ca/frt-trf/2010/frt-trf-10-eng.asp

Michael M. Rachlis MD November 5, 2010

9

Notes * Data for 2007. † Data for 2006. Source Organisation for Economic Co-operation and Development, OECD Health Data 2010 (June edition) (Paris, France: OECD, 2010).

Most data 2008

10