In a recent commentary, Samuel Shortt expressed the fear that Alberta's Bill 11 will lead to the destruction of Canadian medicare, increased privatization and the entry of American health care providers into the Canadian market.1 I have trouble understanding Shortt's position because it is not the law that will determine whether his fears are realized, as he argues, but economics.
Private hospitals operating under Bill 11 in Alberta must obtain payment for patient care from the Alberta government; if they are paid by the patients themselves they are in violation of the Canada Health Act. Furthermore, the government is not likely to reimburse these hospitals at higher rates than those in the payment schedule for nonprofit hospitals. These payments do not include reimbursement for one of the major expenses of hospitals, depreciation. If by some slim chance a private hospital manages to turn a profit on the payment schedule that applies to nonprofit hospitals then no harm is done: the model used by the private hospital would give nonprofit hospitals a guideline for improving their efficiency and thereby lowering health care costs.
I cannot believe that any American with his head screwed on right will enter the Canadian market to provide, for example, open heart surgery when the payment in the United States is US$75 000 and in Canada it is Can$30 000 or less. The real fear should be on the part of Americans: some bright Canadian health care entrepreneur might head south and take their business away by underselling them on health care services.