Over the last 50 years, Canada's efforts to ensure universality of access to quality health care have inadvertently robbed the health system of its ability to respond to the needs and demands of patients and providers. The consumer health co-operative does present a means for restoring flexibility - but it also could endanger universality. To find that balance between flexibility and universality we must take pains in weighing co-op options and in applying them.
"This, then, is the source of one of the most serious flaws in Medicare as it stands - lack of flexibility. It is increasingly difficult to match supply to demand at the local level, which thereby reduces the efficiency of the system as a whole.
"Normally, supply and demand are brought together in a market. In the case of Canadian health care, there are two barriers to market solutions. One is that politicians tend to object to the very idea of markets for health care, and therefore move to block them whenever they start to appear.... The other is that markets require signals: for a supplier to be willing to set up a particular operation in a particular area s/he needs some indication that the gamble is a reasonable one.
"By what means can neighbourhoods and towns signal suppliers that a serious market for a particular type of health care exists in a particular area? The consumer health co-op is one such device. It cannot fix all the problems that beset our health care system. But within a policy and regulation environment that recognizes the value of local authority and innovation, and anticipates its disadvantages, community co-ops could return to our health care system much of the flexibility that centralization has stamped out of it."