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Enter Stage Gabbing

The wall comes (slowly) tumbling down

By Steven Martinovich

The Professor(February 20, 2006) It was a timid step but it would appear that Quebec will be the first province in the nation to allow a role for private health care. According to a proposal contained in a policy paper released by Premier Jean Charest and Health Minister Philippe Couillard last week, private insurance and delivery would be permitted for a limited range of services -- namely hip, knee and cataract surgery. Under the proposal, hospitals in the province will be allowed to subcontract those surgeries to private clinics in order to meet guidelines for timely care contained in legislation that has yet to be introduced.

"We're putting the private sector to work for the public. We have chosen to maintain, as a principle, a public health care system in which the private sector can play a role in support," stated Charest.

In truth Charest's hand was a bit forced after a Supreme Court ruling last June in Chaoulli v. Quebec which declared that prohibitions against private health care were ideologically based and that "an absolute prohibition on private insurance is necessary to protect the integrity of the public plan" had no basis in fact. The court declared that forcing patients to wait lengthy periods of time for both minor and major procedures was a violation of their right to security.

As timid as Quebec's step was, it opens the door yet further for the introduction of a private health care system in this country, one of only three on the planet -- the others being North Korea and Cuba -- that refuse to allow a private or parallel system. Along with the changes announced by Alberta last July, which allows patients to pay for enhanced services, and increasing support by Canadians for a private/public parallel system, it can only be a matter of time before the status quo is swept aside.

We love to tout our publicly-funded health care system as the world's best, though curiously no one in the world has followed our model, yet the results speak for themselves. Although waiting times for treatment dropped slightly in 2004, the latest year figures are available, compared to the year before, the average Canadian could expect to wait an incredible 17.7 weeks -- an average of 12 specialties and ten provinces -- from referral from a general practitioner to treatment, according to the Fraser Institute.

No figure, however, can measure the non-financial cost to Canadians. As the institute's 2005 report noted, "These unrecognized costs may include, for example, lost work time, decreased productivity associated with physical impairment and anxiety, and physical and psychological pain and suffering." Anyone who has seen a relative suffering while waiting for treatment knows the reality that those words fail to describe.

The most realistic solution is two health care systems working side by side: one public, the other private. Canadians would be free to choose the current system or pay out of their own pocket. Other countries, such as Germany, France, Sweden and Britain -- some of whom have been providing universal health care decades longer than we -- permit a significant parallel private system. Although Canada prefers to rely on the single-payer system, other nations permit user fees, private insurance and hospitals.

The results speak for themselves, particularly when it comes to waiting times, the heart of the suit launched by George Zeliotis and Dr. Jacques Chaoulli. In France waiting times are nearly non-existent. While we pour more money into the current system -- we rank in the top half of the G8 in terms of health care spending as a percentage of GDP -- we continue to see lengthy waiting lines with catastrophic results for many Canadians. Statistics Canada reported some years ago that Canadians pay a heavy price, economically and personally, just waiting for health care. This is a problem that has been either eliminated or mitigated in other nations with public/private systems.

It is tempting to describe Quebec's proposed changes are more important than they actually are. In essence, private clinics and insurance will pick up the slack in limited cases in order to meet arbitrary targets set by the province. Despite that, these changes are the latest sign of the growing recognition that the publicly-funded system is not meeting the needs of Canadians. Certain groups will denounce these changes on ideological grounds but anything which stops suffering and allows greater freedom of choice is to be welcomed.

Thanks for reading,

Steven Martinovich


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