Textes d'opinion

Monopoly Medicine: Canadians are suffering under too many laws that dictate how doctors work and how patients are treated. How about a little freedom?

It seems incredible that federal and provincial health legislation designed to implement Canada’s Health Policy to protect, promote and restore the physical and mental well-being of Canadians and facilitate their access to health care services without financial or other barriers, could have the opposite effect. Yet this is what many harmful and unnecessary provisions in Canada’s health legislation do.

For instance, instead of facilitating access, these harmful provisions delay or deny it, and the unreasonable delays they create often threaten the lives and health of patients. Instead of protecting the quality of services and the personal freedom of consumers and providers of medical, hospital, and health insurance services, both quality and freedom are endangered by this type of bad health legislation.

Quebec’s Bill 114 is the latest example of health legislation whose objectives are contradicted by the coercive means prescribed for their achievement. It was designed to correct a shortage of 24-hour hospital emergency room coverage in some areas of the province, a situation largely resulting from previous contradictory legislation on physician supply and distribution.

The bill compelled self-employed physicians who normally arrange on-call and hospital coverage voluntarily, to work in hospital emergency rooms at a location and time decreed by government authorities and backed up by severe financial penalties. While their objectives seem reasonable, the legislative means are excessive and cause unnecessary infringements on the freedom of physicians, not to mention the anxiety created in patients who are treated under these resentful conditions. Less oppressive provisions generated through proper consultation with physicians, as was done in Ontario, would have satisfied the same health-care objectives.

Here are other examples of contradictory provincial health legislation that has threatened access to health services or infringed the freedom of individuals:

  • This case involved a young BC physician who was denied billing access to the government’s health insurance plan on behalf of her patients. The government claimed that she had chosen to locate her practice in a town of her choice, not one deemed appropriate by the government plan. She contested and won.

The courts ruled that the Medical Services Amendment Act of 1985 had infringed her constitutional right of mobility and the right to work in the place of her choice.

  • In Montreal a court challenge was undertaken by a family physician and a senior patient who was denied the right to buy private health insurance or pay for private medical service in a hospital, while waiting in pain nearly a year for hip surgery. They are protesting provisions in the Quebec Health Insurance and Hospital Insurance Acts that prohibit private health insurance for services insured by the government plan, and that ban private provision of medical services in hospitals by physicians who are non-participating in the government’s insurance plan. Although the Quebec courts found these provisions to be infringements on the patient’s constitutional right to life, liberty and security, they decided the infringements were justified in the interests of protecting the public health plan and the collective benefits of Quebecers.

The case is awaiting leave to be heard by the Supreme Court of Canada.

These coercive provisions that prohibit and discourage the sale or purchase of alternative private medical, hospital, and health insurance services, create government monopolies in these services. They are counterproductive, incompatible with a free society, and unnecessary for the implementation of Canadian health care policy and the maintenance of publicly funded, universal health insurance plans in the provinces (medicare).

Such legislative overkill is destructive of Canada’s voluntary medical and hospital systems. Physicians, nurses, allied personnel and volunteers flourish and perform best in a legislative environment of personal freedom and responsibility. Their performance and the material resources of the system decline in a legislative environment of coercion.

For the above reasons, political leaders across Canada should focus on revision of flawed and contradictory health legislation and recreate a legislative environment of personal and economic freedom in health care matters as follows:

  • 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 market alternatives for their members. For instance, in Stockholm, health service employees are encouraged by their unions to form small private-service companies that compete for contracts with multiple hospitals and institutions that were their former employers. The results have been favorable to all, including the patients.
  • Accept the century long European experience as sufficient evidence of the superiority of parallel and mixed systems of public and private health care and insurance. They do not jeopardize the public system, and their combined results 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.
  • Upgrade and modernize all health legislation to meet Western European standards of quality, access, choice and flexibility, allowing for parallel or mixed systems of public and private health care and health insurance, while keeping universal medicare as a basic core insurance plan of high quality.

By restoring freedom in the health system, these reforms will reverse the decline of Canada’s specialized medical and hospital services and the outward migration of key medical and nursing personnel, while raising Canada’s health system performance ranking from its 30th place position, below most European countries.

Dr. J. Edwin Coffey est chercheur associé à l’IEDM et co-auteur de Universal Private Choice: Medicare Plus.

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