The success of Mario Dumont’s party in Québec’s provincial election adds new life to arguments for greater consumer choice in healthcare. Dumont clearly favours an expanded use of the private sector, a mixed system similar to those prevalent in Europe. The election’s outcome proves that the public is much more ready for real healthcare reform than most politicians think.
In sharp contrast to the blithe promises of quick improvement tossed off by all political parties, real progress in reducing healthcare wait times has proven nearly impossible to achieve. More money is not working, “better management” as elusive as ever. The process of change is so slow that even the snail’s pace of Canada’s higher courts is overtaking it. In the absence of more political courage of Dumont’s sort, establishing rights to prompt access may ultimately depend on judicial remedies.
The Chaoulli decision in 2005 said Québec’s health care system was a virtual monopoly that couldn’t provide timely and necessary care to Québecers. Under the Charter of Rights, the Supreme Court ruled, that province therefore could not prevent them from using their own money to purchase treatment or buying private insurance they could use to obtain core services. Access to a waiting list is not real access, the court said.
The same thing may be about to happen in Alberta.
Bill Murray, a Calgary accountant, began to experience debilitating pain in his left hip. His quality of life greatly hampered, he waited over a year to see a specialist. The Wait Time Alliance, a group of Canadian physicians drawn from a number of specialties, says that non-urgent cases of hip pain should be evaluated by a consultant within three months and, if a joint replacement is deemed necessary, should be remedied by surgery within six months of that.
When Murray’s turn finally arrived, his specialist recommended Birmingham hip resurfacing as the ideal solution for his pain. But his road back to health became even more convoluted when the province of Alberta refused to pay for the procedure. They considered Murray, a 57-year-old “baby boomer,” too old to benefit from surgery, an astonishingly brutal warning to others in that huge generation.
Luckily for Murray, he had the means to finance surgery himself, and it was a success. Shortly after, though, he began to experience similar pain in his right hip. Once again, he waited to see a specialist and got the same advice. This time Alberta refused to provide treatment at all, even at the patient’s own expense. Only by traveling to Montréal and paying there was Murray able to regain the full use of his joints.
Murray decided to fight back, Chaouilli-style, and his case is at the forefront of a lawsuit against the province of Alberta. The Canadian Constitution Foundation, an independent, non-partisan legal group is leading the case, described by its director. John Carpay, in an interview. “We’re hoping that his case is going to expand the Chaouilli decision into Alberta and other provinces in the future,” Carpay says.
He thinks that tearing down the barriers between patients and direct payment will have to happen province by province, with test cases taking about five years to wend their way through the courts. That seems a terrible waste of time and legal fees, but Chaouilli only applied to Québec.
All provinces have similar problems with wait times. Delays in obtaining referrals, diagnostics and therapies force far too many patients to live with pain and reduced abilities for far longer than doctors consider acceptable. That’s unconscionable, and denying therapy on the basis of age to a middle-aged patient with many productive years ahead is an outrage.
Over the past decade, health spending in Alberta more than doubled, from slightly under $4 billion dollars a year in 1995 to slightly over $10 billion today. But the problems remain. Throwing more money at a broken system will only make health authorities even less accountable, and postpone the day when real health reform begins.
The prospect of civil servants deciding the age at which we are ineligible for effective health care is chilling. A bureaucracy that declines to pay for necessary treatment, and then forbids us from buying either direct care or insurance coverage, is worse still. As our population ages, and the demand escalates for “quality of life” surgeries such as joint replacements, the problem will only grow worse.
The costs of delaying appropriate care are spread throughout our lives. People whose conditions prevent them from working must rely on employment insurance. They need more home care, more frequent medical appointments and more medication. Although the psychological cost of artificially prolonged suffering can’t be measured, it’s obviously significant.
Everyone except for health ministries and regional health authorities realizes that we need change. The Chaoulli case nudged Québec down to the road to better health care by restoring alternatives to consumers, options they are free to exercise in almost every other country in the world.
Dumont understands that, and used the point to his advantage in Québec. Perhaps other politicians will now get the message.
A version of this article originally appeared in the Edmonton Journal March 29, 2007.