The Writing Is On The Wall

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Appeared in the National Post, 10 June 2005
On Thursday, the Supreme Court of Canada decided that Quebec’s prohibition against private insurance for health services violates section 1 of the Quebec Charter which states that “[e]very human being has a right to life, and to personal security, inviolability and freedom.” The Court also ruled that the ban could not be justified by other sections of the Quebec Charter. In effect, this means that Quebecers now have access to private health insurance for care in their province. It also means that the bans on private health insurance and private payment for medically necessary care elsewhere in Canada are standing on shaky ground. Though they still stand because the Supreme Court majority did not rule on their constitutionality or the relationship between the Quebec ban and the Canadian Charter of Rights and Freedoms.

What it clearly does not mean, in any way, is the end of universal access to health care in Canada.

Consider that Canada does not have a monopoly on the belief in providing access to a full range of health care services regardless of ability to pay for all its citizens. Of the world’s 30 most developed nations, 27 others agree with the principle of universal access. Of course, some of these nations manage to do so without waiting times for treatment; some do so with superior health outcomes; most provide better access to physicians and technology; and none spends more than we do.

The important fact that Canadians must understand is that every one of these nations allows individuals to seek care on their own terms, with their own hard earned money, when the government program is unwilling or unable to deliver care that meets their needs. To put it another way, Canada is alone in prohibiting private health insurance. Or, at least, we were alone.

While some are now falsely billing this as the end of Medicare and an abandonment of universal access to care in Canada, the ruling will in fact lead to an enormous improvement both for patients who want to continue receiving publicly funded services and for patients who are suffering needlessly in public queues. When some patients leave the public queue for private treatment, the result is a greater availability of services for those who remain in the public system. At the same time, for those who choose to receive care outside of the public health care program, it means receiving treatment that better suits their needs.

To those who are concerned that the privately funded health care sector will only treat the least serious cases and leave the most serious and most severe cases to the public sector, I offer two responses. First, the public health care program already deals with those cases, so a parallel private option changes nothing in this respect. Second, taking the simple cases out of Canada’s large public hospitals is actually beneficial because those hospitals can focus on and specialize in the treatment of more complex and more difficult cases while the simpler and easily treatable conditions can be dealt with in a more cost efficient environment.

Having a privately funded health care sector offering services in competition with Medicare also leads to a higher quality and more responsive public health care sector. Without effective choice, health care delivery becomes a common, uncontested standard, where patients are unable to protest for better quality services by choosing a different provider. Shackling patients to a government monopoly necessarily means a more expensive and lower standard of care in the public system than would be available if patients were able to choose otherwise.

Of course, Thursday’s decision does not directly impact the many prohibitions and restrictions in provinces other than Quebec. But it does bring them into question. If a rule that prohibits the purchase of private health insurance in Quebec violates the right to “life, personal security, inviolability and freedom,” how can a similar rule in another province not also violate these basic human rights that are a core component of the very fabric of a modern society? While it may take months, or even years, of public debates, government policy changes, and court challenges to hammer out precisely what will happen elsewhere in Canada, the writing is clearly on the wall. The prohibition of private insurance and payment for health care is not legitimate and should not continue anywhere in this great nation.

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