The doctor’s chance to lead

This week in Edmonton, the Canadian Medical Association (CMA) holds its annual meeting. And today, physicians from across the country will consider a series of motions, including several that would reverse the CMA’s policy of opposing private health insurance. As delegates weigh that issue, they must ask themselves a simple question: are doctors going to lead the debate on health reform or will they abdicate their responsibility?

Of course, we’ve been here before. The CMA considered support for private insurance previously, including a heated debate at the 1996 meeting. Dr. Jack Armstrong, then president, successfully argued that “if [the CMA] is the first out of the trenches for private funding for core medical services, we are going to get shot down in flames.”

Nearly a decade has passed, and the medicare patient fades. Waiting times for tests and treatments are unacceptably long. Reforms of the public system are without meaningful result. And, perhaps most importantly, the Supreme Court of Canada has decided the case of Chaoulli v. Quebec.

The essence of the Chaoulli decision is contained in this one-sentence quotation from that court: “The evidence demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering.” A full 83% of physicians support the court’s decision, as do the majority of Canadians, according to a recent Ipsos Reid poll.

If doctors hesitated before because they didn’t want to be the first to challenge the tenets of Canada Health Act, the Supreme Court’s decision has eliminated that barrier to action.

Of course, many of the physicians at this meeting were not involved in 1996. And they may well be persuaded by critics, who argue that dire consequences will follow from private health insurance. Most commonly, such critics claim that support for the public system will erode because people using the private system, including influential political leaders, will no longer care about funding the system. They also claim there would be a reduction in human resources in the public plan because many physicians and other health care professionals would leave for lucrative careers in the private sector.

But CMA delegates ought to dismiss such arguments. After all, the Supreme Court did.

When the Chaoulli case was argued, the Court heard much doom and gloom about private insurance from government witnesses such as Yale University political scientist Theodore Marmor. Prof. Marmor has written on medicare for more than a quarter century; and has become one of the health experts most quoted in the Canadian media. Yet under oath, even this star government witness could not provide any evidence about the above-cited threats to medicare. Writing on behalf of the majority, Justice Deschamps explained: “Marmor supported [the traditional argument against private care] but conceded that he had no way to verify it. [He] confirmed that there is no direct evidence to support this view. [H]e testified that there is really no way to confirm it empirically. In his opinion, it is simply a matter of common sense.”

The Court’s finding on this issue should come as no surprise – for the opposition to private health care in this country has always relied more on emotion and slogans than any real evidence. Yet allowing a private option isn’t an exotic idea, dreamed up in radical circles. Britain allows private insurance. So does Germany, France, Australia and Sweden. In fact, no Western country – except ours – bans a private option for core medical services.

What happens in other countries when private insurance is allowed? For starters, support doesn’t drop for the public system. In Britain, where private insurance has always been legal, a recent poll suggests that citizens view the creation of the National Health Service as the greatest national achievement of the 20th century (greater than winning World War II, in fact).

And what of the brain drain argument? Let us just put it this way: Canadians agonize about doctor shortages, but the Swedes and the French don’t.

Looking to other western countries, we see that private insurance is rather benign. It means that a minority of people will choose to pay taxes to support public health care – and then pay again for their own coverage. It’s their choice, much in the same way some parents send their children to private schools and still pay into public education. Private health insurance has a modest positive effect on the public system, in that fewer people are in the queue for service. Additionally, there is improvement in the public system due to competition from a private alternative.

Let’s be clear: allowing private health insurance will not single-handedly solve Canada’s woes. But it would be a small step in the right direction. The alternative is to leave this debate up to our politicians. For a decade now, the CMA has done that. And what a disaster it’s been.

The CMA must now help lead us out of this health care quagmire. Its members can begin that process today with a meaningful discussion and then a vote.

Dr. Victor Dirnfeld, an internist, is a former president of both the British Columbia Medical Association and the Canadian Medical Association, and serves presently as a member of the CMA’s General Council. Dr. Edwin Coffey, a gynecologist, is a former president of the Quebec Medical Association and is a senior fellow at the Montreal Economic Institute. Dr. David Gratzer, a psychiatrist, has written numerous articles on health policy and is the author of Code Blue.

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