Textes d'opinion

Impaired Freedom

To save the health-care system from further destruction and to preserve a free society, Canada must restore an economic and legislative environment of personal freedom in the medical, hospital and health insurance sectors.

Canada has the shameful distinction of being the only country in the free world where freedom of individuals to purchase essential health services and related insurance is banned by law. But it was not always so.

Suppression of health-care freedom was unknown in Canada until the last half-century, when freedom-robbing provisions began appearing in federal and provincial medicare legislation. These provisions ban or discourage privately funded medical services in hospitals, and private health insurance for services covered by the provincial medicare insurance monopolies, even when these services are inaccessible.

Clauses in the Canada Health Act financially punish the provinces should they relax their ban on privately funded health services and insurance, and contradict Canadian Health Care Policy by indirectly obstructing, rather than «facilitating reasonable access to health services» as the policy calls for.

During the early years of the medicare debate, most interest groups lobbied for universal publicly funded medical and hospital insurance.

The radical Marxist and egalitarian factions linked this demand with an equally strong demand for the abolition of the parallel privately-funded medical, hospital and insurance sectors which they found socially unacceptable and morally wrong.

The legislators of that period failed to recognize the danger of this linkage. By trying to satisfy both the radical and more tolerant ideological groups for political expediency, they unknowingly sabotaged the public and private sectors of Canada’s health-care system and infringed the health-care freedom of Canadians. This infringement persists today.

On the other hand, European countries maintain universal public health insurance like Canada, and permit their citizens to purchase alternative private medical and hospital services and insurance in a parallel private sector. Like a growing number of Canadians, they find this arrangement socially acceptable, equitable and morally right.

Continental Europeans have thus maintained their health-care freedom without harming the public sector. Their parallel public and private health sectors have helped them avoid the inconvenient and life-threatening waiting lists for specialized diagnosis and treatment, and the shortages of physicians, nurses, and hospital resources so common in Canada. Their freer health system environment has resulted in performance rankings well above Canada’s.

Although the failed doctrine of social engineering, central economic planning and monopolistic government services has generally been discarded by the free world, it still dominates Canada’s medical and hospital systems. These politico-economic concepts continue to underlie the Romanow Health Commission proposals that federal Liberals and New Democrats are flirting with for the next election.

To save Canada’s health-care system from further destruction and to preserve the free society that our Canadian constitution proclaims, we must restore an economic and legislative environment of personal freedom in the medical, hospital and related health insurance sectors.

A proposal for restoring health-care freedom, based on a politico-economic philosophy totally different than the Romanow approach, was recently published by the Montreal Economic Institute, as Universal Private Choice: Medicare Plus.

In this proposal, personal choice in all matters of health care and health insurance is paramount. Patients and consumers, empowered by public or private funding, would have many options for alternative medical, hospital and insurance services in parallel public and private health sectors, as in continental Europe.

The Medicare Plus proposal would restore ready access, quality, competition and choice, without jeopardizing universal coverage of publicly funded health services. It would facilitate the rebuilding of the ailing health system that was critically injured by a previous generation of legislators, and would undertake fundamental reforms for which the majority of Canadians are waiting, but which the present generation of legislators seems unable to deliver.

Implementation of this proposal will require a legislative repeal of the freedom-infringing and monopolizing provisions in medicare legislation, through extraordinary political leadership and co-operation by the major parties, or the invalidation of the offending provisions by the Supreme Court of Canada.

  • The overall objective is not to destroy universal medicare entitlements but to: Restore individual freedom, personal choice, and the opportunity for consumers and providers of medical and hospital services to exercise their personal freedom and responsibility in the financing, insuring, purchasing, and provision of these services, including those covered by medicare;
  • Remove the monopolizing provisions in provincial medicare legislation, and restore the freedom of voluntary non-profit or commercial associations to provide a full range of health insurance and health care services;
  • Revise the criteria in the Canada Health Act, regarding federal cash or tax transfers to the provinces and territories, to enhance freedom, quality, access, choice and competition, in conformity with the proposed changes in provincial health legislation.

J. Edwin Coffey MD est chercheur associé à l’Institut économique de Montréal.

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