Telecom Trends

I want to return to my earlier metaphorical connection between the debate on Net Neutrality (aka "Save the Internet") and Canada's angst over private medical care. In part this is driven by the arrival of this week's issue of Maclean's magazine and its "Complete User's Guide to Private Medical Care in Canada."

Metaphors aren't always appropriate; they often don't fit. Still, there is no reason why we can't look at other experiences in order to try to learn, develop best practices and improve the end result.

I think that looking at healthcare, as a cloud, can have a number of similarities with 'the internet'. Like the internet, healthcare is a concept rather than a tangible entity. People are concerned about fair, high quality access to healthcare, and it is sometimes publicly funded, privately provided together with every permutation of these.

Similar to the internet, there is a populist view that a public healthcare system should deliver a uniform quality of care to all. In the view of some, for both healthcare and the internet, such a model just doesn't work. Loads of experts can examine why this is so, but one can point to the failure of public funding to be able or willing to cope with appropriate levels of capacity planning, technological change and ongoing investment.

As a result, the delivery of healthcare is failing on many measures of satisfaction: it is hardly uniform quality (some regions of the country or province have longer or shorter waiting lists for similar procedures); it is not offering flexibility in solutions; and, public healthcare is not making sufficient use of advances in technology, due to lack of capital and ongoing operating funds.

As seen in the Maclean's feature, private health clinics are a reality across Canada. To those who predict that this means the end of Canada's democratized health care, I would argue that this may actually be the beginning of democratized premium health care.

The upper crust has always had access to preferred, private health care. They are happy to jet to US or other foreign clinics to access the best care money can buy. The arrival of private clinics in Canada means that more of us can get the same level of service, at a cost premium but within the reach of far more.

At the same time, there is no harm being done to the public system. If anything, there is a reduction in demand for public health care, so there is a net benefit to everyone.

How does this relate to Net Neutrality? Having premiums paid by content providers in order to gain preferred access to their customers is similar in many ways. Maclean's talks about the way that health insurance companies have negotiated arrangements with hospitals and certain clinics. The concern is that there be degraded service to the rest of the public internet. If content providers are satisfied with the current level of service, then they can continue as today on a permissive basis, with no quality of service guarantees.

Don't confuse tiered service with discrimination. As Dave Greenfield wrote last month, "Is it fair that Business Class customers get better treatment than Economy class? You bet." That means you (or your content provider) may have to pay a premium, if you both want delivery with a premium grade of service.

That isn't discrimination.