It was an icy Feb. 3 when Graham Martin slipped and fell hard on his elbow, jamming his arm up into his shoulder and painfully tearing a tendon and shoulder muscles.
Martin, a police officer, was feeding the horses at his country home overlooking Sturgeon Lake near Fenelon Falls when the accident happened.
The nagging injury has pushed the 55-year-old – who might not get surgery until he’s 57 – squarely into the debate about Canada’s medicare system.
“I want a refund on the $1,100 we pay in Ontario health-care premiums every year,” says Martin, who’s been advised to look elsewhere in the province for a faster trip to the operating room.
Even medicare advocates admit more and more people, put off by treatment delays, appear increasingly intrigued by the idea of more privatized or two- tier medicine to get what they want, when they want. “I think the middle class is starting to use them more,” warns internal medicine specialist Dr. Ahmed Bayoumi of the pro-medicare Medical Reform Group.
“People, I think, in many circumstances are prepared to pay.”
But, for now, the debate over the future of medicare is raging more in the minds of frustrated patients and health activists than in the Oct. 14 election campaign, dominated by issues such as the sagging economy and leadership.
“I’m baffled, it really surprises me because this is one of the most pressing issues for Canadians,” says Rebecca Walberg, director of health policy at the non-partisan Frontier Centre for Public Policy in Winnipeg.
The centre released a study last week showing Ontario leads other provinces in pleasing health-care consumers. That is not to say the system is perfect, she quickly adds. Far from it. “People accept treatment from the health-care system they would never accept from a lawyer or an electrician or their kid’s school.”
A major concern now is “creeping privatization” in which services, such as physiotherapy, that used to be covered in hospitals are being moved out, leaving patients to pay for them on their own, says University of Toronto professor Raisa Deber, a health policy expert.
“If you don’t watch that, it can turn out to be a way to de-insure people.”
Martin would prefer to have his shoulder treated in the public system – he’s already paying for it, after all – but the delays are making him wonder.
If it were “affordable,” the York Region traffic constable says he wouldn’t hesitate to check out a private clinic where surgeons might not be so busy doing hip and knee replacements – two areas targeted as part of the strategy to reduce wait times in key areas.
That’s the kind of talk that makes medicare advocates nervous.
They view private, for-profit clinics as a threat to a Canadian health system designed to provide universal access for all eligible residents to “medically necessary” care as outlined in the Canada Health Act and provincial laws.
Provinces that allow private clinics to charge user fees or bill extra for services covered under public health insurance can be docked an equivalent share of federal health funding – and the tally is over $9 billion since the Canada Health Act was passed in 1984. “Really, we need pressure on all of the political parties,” says Natalie Mehra, director of the pro-medicare Ontario Health Coalition.
In a study to be released Tuesday, she has identified 89 private, for-profit clinics doing surgery, MRIs and CT scans and “boutique” physician clinics across the country with suspected violations of the Canada Health Act.
“If we’re going to maintain single-tier medicare in Canada, if we’re going to maintain equal access for everybody and not sell queue-jumping for the wealthy, then we’re going to have to pressure all of the parties to make a clear commitment to actually vigilantly monitor and enforce compliance with the Canada Health Act.”
She accuses Prime Minister Stephen Harper’s government of falling short on that front with private clinics becoming more prominent, particularly in Quebec.
“There’s only one pool of physicians and nurses and health-care specialists in the country and they’re scarce and if you siphon a bunch of them off to sell unnecessary services or queue-jumping services for the wealthy all you do is make the wait list longer for your local hospital,” Mehra contends.
Dr. Robert Ouellet, president of the Canadian Medical Association, disputes that, saying many surgeons, for example, could operate more if only they could get enough operating room time at hospitals facing continual budget crunches.
Allowing doctors to work in both the public and private systems – now forbidden under the law – would ease that problem and bring waiting lists down, argues Ouellet, a radiologist who is part-owner of a private clinic in Quebec.
“Who’s the winner? The patient.”
The issue for politicians on that front, he acknowledges, is “sustainability” – the ability of taxpayers to afford more money for treatment by increasing access.
Walberg says it’s time to rewrite the Canada Health Act so it is more focused on making the system work for patients, but doesn’t expect politicians to take on the thorny job – especially with another minority government possible in Ottawa.
“It would be easier to change the flag or the national anthem.”
What the law says isn’t Martin’s main concern now, although he is tired of political bickering over health care that never seems to result in the major improvements Canadians want despite a recent federal-provincial plan to inject $41 billion into the system over 10 years.
Martin got the results from his MRI this week. An operation is needed to repair the tears but he has a letter from an orthopedic surgeon in Newmarket saying the wait for a first appointment is 14 to 16 months.
“It pops in and out of the joint,” Martin says. “It’s uncomfortable. I can live with it but if they can fix it that’s what I thought I paid taxes and a health premium for.”
He’s ticked off, to say the least, that a colleague who had a similar slip- and-fall shoulder injury on the job has already had surgery and is on the mend thanks to private employer coverage through the Workplace Safety and Insurance Board.
That’s the kind of juxtaposition Canadians should be thinking about as consumers of medical services, says Walberg. Aside from the fact that workers’ compensation is a private insurance plan to keep employers from getting a free ride under medicare for workplace injuries, she asks this question: if someone is sick or injured why does the speed of treatment differ based on whether the cause was at work or home?
Canadians need to stop kidding themselves that they live in a country with one-tier medicare, where taxpayers foot the bill for each other and everyone gets looked after eventually, Walberg adds.
The reality is more “murky, very murky” and has given rise in the last five years to a number of private clinics that bill provincial insurance plans for “medically necessary” care and bill patients for extras.
“Nobody is all that clear about what’s illegal and what’s legal,” she says. “We already have three-tier medicine. The really rich just go to the States, then there’s workers’ compensation and private clinics plus a shadowy tier where people who know someone have the connections to get treated faster. It’s multi-tier, opaque, confusing and sometimes corrupt health care.”
