A Third Way Forward


The debate over the future of Canada's health system has bogged down into a stand-off between two options: the public or the private sector as designer, provider, manager, and insurer. Neither is capable of the task in the absence of a third actor: citizens who organize and control health care delivery in their towns and neighbourhoods. In this Special Edition, a spectrum of authors outline the case for a vast expansion of community-level capacity and authority in our health sector.

"... our political leaders, the news media, and many of the organizations currently active in the health system are convinced that we have only two possible ways forward. They say that we can either award great or greater power in health care delivery to organizations controlled by the government, or to organizations owned by individuals.

"There is also often a subtext to that stark choice. The public sector option connotes 'nonprofit (read 'benevolent') delivery'; the private sector option means 'for-profit (read 'greedy') delivery.' Common to both is the additional suggestion that the complexity of health care necessarily makes it the domain of people with specialized knowledge, whether medical, administrative, managerial, or financial. They deliver; the rest of us consume.

All this is not entirely unjustified.... Nevertheless the choice we are expected to make is false and the subliminal messages only make it more difficult to think the problem through. There are not two choices. There is a Third Way forward. It involves engaging in health care the power and insight and devotion to people of a third stakeholder, largely relegated to the margins of our current health system: Canada's communities."

Zitner, David
Kelderman, Dianne
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