A Win for Healthcare Consumers

A supreme court decision begins the long process of breaking down Canada's public healthcare monopoly.
Published on June 10, 2005

Thursday’s historic Supreme Court decision is very good news for Canadians. But for feckless politicians immobilized by fear of attacks from demagogues, Parliament would have opened up the system years ago. It was left to the courts to drag us, kicking and screaming, towards what is regarded in other countries as standard operating practice.

Aside from Cuba and North Korea, Canada is the only country of any import to prohibit a parallel market in health services. Indeed, in its ruling the Court cited “the evolution of the systems of various OECD countries,” none of whom have found a ban on private insurance “necessary to protect the integrity of the public plan.” In fact many other jurisdictions with universal access and public funding have ventured much further to exploit the advantages of partnerships with private insurers and providers.

Frustrated because provincial health authorities had forced him to wait a year for a hip replacement, George Zeliotis and his doctor sought a legal remedy. Countless thousands of other Canadians are facing the same grisly fate, unable to work or enjoy their lives because they have been denied timely treatment. It’s impossible to calculate such costs, but the argument for structural reforms in Medicare would be a slam dunk if they were known. Our highest court also had the courage to speak the unspeakable, what healthcare ideologues regularly deny: many of our fellows die before they can obtain critically needed care.

Zeliotis could become the Canadian poster child for needed patient care guarantees for diagnostic, therapeutic and surgical treatments. In 1991, Britain’s National Health Service started to offer such pledges, and in 1992 Sweden enacted an iron-clad limit of three months for twelve surgical procedures. A Danish guarantee reduced the limit to two months in 2002. In that year, in its submission to the inflexible Romanow Commission, which treated our public monopoly as a religious principle, the Canadian Medical Association called for “other options” if the public system failed to provide timely access for core services.

Such measures form only a small part of a wave of reforms sweeping healthcare models throughout the developed world. In a remarkable demonstration of intellectual consensus, Britain’s New Labourites have not only accepted the Tory idea of contracting services out, they have expanded the program to include entire specialties. Stockholm’s County Council ended the public monopoly by splitting purchasers from providers, a move that improved efficiency while doctors and nurses took home fatter pay cheques.

Those who claim that private insurance cannot co-exist with Medicare should pay a visit to Belgium, or France, or Germany or Australia. In the first three countries, the whole medical infrastructure operates through a diverse and often competing polyglot of insurance schemes, private and non-private, for-profit and not-for-profit. Australia not only allows its people to purchase other insurance, it subsidizes the cost. Such enlightened policies do not bleed public systems, they relieve consumer pressure on them.

The backlash from this decision is predictably extreme. According to the Globe and Mail, “groups such as the Canadian Health Coalition say pressure to strike down the rules of Medicare came from healthcare companies that want new market opportunities.” But anti-corporate tirades mean little to the thousands of patients who are at this very moment languishing on waiting lists.

The principle is clear to anyone without such blinders. The role of government is to mandate that a service be provided, no matter by whom. In his re-election campaign, Britain’s Tony Blair invoked the mantra of “patient power.” People who are sick don’t care if a civil servant or a corporate lackey looks after their needs.

To quote former Ontario Premier Bob Rae: “I think the actual operation, the delivery and running of programs, should be done by agencies outside a government. Governments don’t run hospitals, hospitals run hospitals and then the question becomes how we mandate those hospitals.”

Thanks to George Zeliotis, we can all share in that common sense.

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