Canada has the embarrassing distinction of being the last holdout in the free world with health legislation that prohibits individuals from purchasing private medical and hospital services and insurance, even when public health services are inaccessible or not of the desired quality or convenience. Such prohibitions resemble those of a police state rather then a free society.
These repressive legislative provisions are mixed among respectable medicare rules in provincial health-insurance acts. The banning of individual choice and private health services preserves the government health-insurance monopolies and guarantees the bureaucratic and financial viability of the corporate, union and professional interests that have become totally dependent on public funding. This legislated politico-economic situation casts serious doubt on the future viability and quality of health care in general and Canada's specialized medical and hospital services in particular.
Unnecessary restrictions on private services are also reflected in the Canada Health Act (CHA) of 1984. By financially penalizing the provinces and, indirectly, their residents, when individuals purchase private medical and hospital services, the CHA restricts freedom of choice by coercion, rather than prohibition.
The CHA received its inspiration from Quebec's Health Insurance Act of 1970. This act was a model for government price controls on physician services, for prohibition of private contracting by physicians with balanced billing for these services and for prohibition of mixed public and private funding of health services.
These legislative infringements on personal liberty in 1970 were influenced by the strong lobbying efforts of the Marxist-driven labour movements. The unsettled political climate of violence, political kidnapping and FLQ terrorist activities in Quebec at that time added to the interventionist tendencies of government.
Claude Castonguay, Quebec's former health minister and the father of Quebec medicare, recently suggested that the old recipes are no longer working and that it's time to look at new approaches in health-care financing and delivery. Public opinion in Quebec and elsewhere supports this conclusion, with the majority preferring an option for private services, as long as the public system is preserved.
Sadly, too many Canadians are waiting for access to health facilities for diagnosis and treatment while facing life-threatening diseases or suffering with pain. These and many others want a patient-centred health system with ready access to high quality services. Many wish to restore personal freedom and choice in all health-care matters. Some even believe in miracles, so here's some advice for the Michael Kirby and Roy Romanow health commissions and to our provincial and federal politicians who can make it happen:
- Don't be intimidated by propaganda and pressure tactics of public-service and professional unions that prefer the status quo of corporatism and government monopoly rather than exploring better alternatives for their members. For instance, in Stockholm, health-service employees are encouraged by their unions to form small privateservice companies that compete for contracts with multiple hospitals and institutions that were their former employers. The results have been favourable to all, including the patients.
- Accept the century-long European experience as sufficient evidence that a public-health system would not be jeopardized by the presence of a parallel private health sector. The results of Europe's combined system are superior to Canada's in access, quality, choice, technology, physician supply and public funding.
- Repeal provisions in current health legislation that prohibit or discourage private medical and hospital insurance for services covered by medicare.
- Repeal legislation that effectively prohibits voluntary privately funded medical services in hospitals.
- Recommend an upgrade and modernization of all health legislation to meet Western European standards of quality, access, choice and flexibility, with parallel or mixed systems of public and private health care, while keeping universal medicare as a basic core insurance plan of high quality.
- Nothing less will stem the decline of Canada's specialized medical and hospital services and the outward migration of key medical and nursing personnel. And nothing less will bring Canada's health-system performance ranking up from its 30th place position, below most European countries.
J. Edwin Coffey MD is associate researcher with the MEI and co-author of Universal Private Choice: Medicare Plus.