Private Options Could Only Make Canadian Health Care Better

A long-awaited trial got underway on Tuesday before the Supreme Court of British Columbia, pitting Dr. Brian Day against the province's Health Ministry. Dr. Day, former head of the Canadian Medical Association, has filed a lawsuit against the government of British Columbia on behalf of six patients who contend that their health had suffered due to long wait times.

Sadly, two of the plaintiffs have died from cancer during the delay. One of the four remaining, Walid Khalfallah, a teenager with a particularly severe form of scoliosis, is now paraplegic, having been unable to obtain the surgery he needed in a timely manner. The plaintiffs are asking for the right to obtain access to care in private clinics if the public system can't provide timely care.

It is truly sad to see that we have to go to court to make these necessary changes. It shows the lack of courage and vision of many politicians, as if we needed more proof.

This court case is reminiscent of the 2005 Supreme Court of Canada decision in Chaoulli v. Quebec. In that case, the court ruled in favour of Dr. Jacques Chaoulli, who claimed that the province's ban on private health insurance violated Quebec's Charter of Human Rights and Freedoms.

This ruling hinted at major changes in the field of health care in Quebec, raising the hopes of many patients. Yet very little has changed. The government remains incapable of offering access to care in a timely manner, all while maintaining a strict monopoly over the provision of medical treatments.

The law was indeed modified in order to allow Quebecers to purchase duplicate private insurance, at least in principle, but only for a limited number of medical and surgical treatments such as hip and knee replacements and cataract removals. As a result, no actual market for this kind of insurance has developed, since the number of admissible surgeries remained too restricted to be of interest to individuals and employers. The Chaoulli decision was clearly a missed opportunity.

This upcoming trial in British Columbia offers new hope. And it is an opportunity to reiterate that reforms are needed in order to improve access to health care in this country.

Among the solutions put forward by the MEI over the years are:

  • Develop a market for private insurance, as exists in most industrialized countries.
  • Promote a mixed system in which doctors could practice both in the public sector and in the private sector.
  • Finance hospitals based on services rendered rather than with a global budget.

In a way, Medicare has been on trial for decades because of its inability to deliver health-care services in good time. In Quebec, nearly one in five patients still waits over six months for a hip or knee operation, and wait times for elective surgery have not improved significantly since 2008. In British Columbia, the situation is even more problematic, with the longest wait times in the country.

Private options could only make the public system stronger and better. Indeed, international experience confirms that the presence of a mixed health-care system is not incompatible with health-care services that are accessible to all, not just the wealthiest but the poorest as well. Those who are covered by private insurance policies continue to contribute to the financing of the public system through their income taxes. Access to care for all patients is thus improved.

Should we be afraid that the universal health care system will collapse if the plaintiffs in B.C. should win their case before the courts? Absolutely not. On the contrary, the coexistence of public and private health-care systems allows for more flexibility and diversity of services, to the benefit of all, as a great number of European countries have shown.

Canadians have accepted the unacceptable for too long. Provincial governments remain incapable of providing access to care within a reasonable timeframe, yet continue to maintain their monopoly over the provision of medical care. There's no justification for maintaining a strict government monopoly on the delivery of medical care, and it's time for policy makers to make the changes required for Canada to have a universal and efficient health-care system.

Jasmin Guénette is Vice President of the Montreal Economic Institute. The views reflected in this op-ed are his own.

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