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I think if/when this goes through, Canada will end up with the best of both worlds and probably the best healthcare...


Experts say Supreme Court ruling opens door to parallel private health system

Provided by: Canadian Press


Jun. 9, 2005

OTTAWA (CP) - The country's top court has delivered a powerful blow to Canada's single-tier public health care system, striking down a Quebec law that banned private insurance for medically necessary services.

The federal government insisted there's nothing to worry about, but two dissenting justices of the high court predicted the decision will lead to a parallel private health system.

The ruling is likely to generate more debate about judicial activism, since no political party advocates a two-tier health system.


Quebec Justice Minister Yvon Marcoux said the province will request a delay in implementation of the ruling, which would allow Quebec's law to stand temporarily. Such applications are rare but have been made in the past, sometimes successfully.

Four of seven Supreme Court justices ruled Thursday that the Quebec ban on private insurance for medically necessary services violates Quebec's charter of rights because care in the public system is so slow it endangers life and personal security.

"The prohibition on obtaining private health insurance, while it might be constitutional in circumstances where health care services are reasonable as to both quality and timeliness, is not constitutional where the public system fails to deliver reasonable services," wrote justices Beverly McLachlin and John Major.

In their dissenting opinion, justices Ian Binnie and Louis Lebel predicted that allowing private insurance "would precipitate a seismic shift" in health policy in Quebec, favouring the wealthy.

"Those who seek private health insurance are those who can afford it and can quality for it. They will be the more advantaged members of society."

The dissenting justices predicted a reduction in government funding to the public system.

"The concern, of course, is that once the health needs of the wealthier members of society are looked after in the 'upper tier,' they will have less incentive to continue to pressure the government for improvements to the public system as a whole," they said.

Prime Minister Paul Martin dismissed such concerns: "We're not going to have a two-tier health-care system in this country," he said.

Martin said the extra $41 billion over 10 years that Ottawa is investing in health care will improve the public system and protect it, especially by reducing wait times.

"Our purpose is to strengthen our universal public system and to provide timely access to medical services," he said.

Justice Minister Irwin Cotler also insisted the ruling doesn't threaten medicare. "On a first, quick reading . . . the importance, the validity and the integrity of the public health-care system has been affirmed."

Health Minister Ujjal Dosanjh said governments can prevent the rise of private health care by strengthening the public system. "We are already on the way to doing that. That is the crux and the thrust of our approach."

But Roy Romanow, who headed a royal commission on the future of health care, said the money being pumped into the system is not having the hoped-for impact. The Supreme Court decision reflects frustration at lack of progress, he said.

"I think what the ruling does is reflect . . . the frustration of the Canadian public that in fact we need to start implementing some of these reforms for health care very urgently," he said. "We've got to get on with it.

"The program for change is not specific enough, nor is it accountable enough; we can't measure it. The Health Council of Canada needs to be strengthened and now's the time for the federal and provincial governments . . . to make the change."

Romanow said the Canadian public "simply wouldn't allow for" two-tier health care. "What they can do is pressure governments or elect governments to solve the logjams within the current approach."

The Canadian Medical Association called it a historic ruling that could "fundamentally change the health-care system in Canada as we now know it."

CMA president Albert Schumacher said most other provinces have legislation similar to the Quebec law that was struck down, and there will be challenges.

"We don't need any holdout provinces saying, 'This will apply to Quebec and it doesn't apply to us and we're going to continue on our merry way. That's clearly not the direction the Supreme Court is moving in. Canadians whether in Quebec or Prince Edward Island or Saskatchewan should not be treated substantively differently when it comes to health care."

Christopher Manfredi, chairman of McGill University's political science department, called the ruling "a bombshell."

"It's provided ammunition to private health care reformers outside of Quebec to advance their agenda," he said."It's hard for me to imagine that this affirms public health care. That's just an untenable interpretation of the decision."

He said the ruling creates a difficult dilemma for the federal Liberals: "They've presented themselves as defenders of the charter and defenders of publicly funded health care. This case puts both those things in conflict and they can't defend both simultaneously after this case."

Maude Barlow, head of the Company of Canadians, said the ruling will clear the way for U.S. health-care corporations to enter the Canadian market.

"If you're opening it up legally to private, for-profit Canadian companies under the terms of national treatment in trade agreements you can't deny equitable access to American corporations."

Advocates of private health care cheered the ruling.

"This is the end of medicare as we know it," said John Williamson of the Canadian Taxpayers Federation. "This is a breach in government monopoly health care in this country.

"It's going to open up litigation across the country in the other nine provinces as taxpayers there press for the same right, which is the right to seek and buy insurance to cover private health care."

The case involved Quebec doctor Jacques Chaoulli and his patient George Zeliotis who argued that the ban on buying private insurance for health care infringed on Canada's Charter of Rights and Freedoms as well as the Quebec charter of rights.

Zeliotis said his year-long wait for hip replacement in 1997 violated his right to life, liberty and security under the Canadian charter, and a similar guarantee in the Quebec charter.

The high court split, with one justice abstaining, on whether the law violated the Canadian charter.

Chaoulli has long campaigned for the right to set up a private medical business, and once went on a hunger strike over the issue.

Public opinion polls have shown strong support for single-tier health care, with service based on need rather than ability to pay.

Pro-medicare groups such as the Canadian Health Coalition say pressure to strike down the rules of medicare came from health-care companies looking for new market opportunities.

Two Quebec courts had already ruled against Chaoulli.

Although it's often said that Canada already has a two-tier system, core medical services are now available only in the public system.

Some quotes on the SCOC decision Thursday striking down a Quebec law that banned private medical insurance:

"This is the end of medicare as we know it." John Williamson of the Canadian Taxpayers Federation.


"We're not going to have a two-tier health-care system in this country .... Our purpose is to strengthen our universal public system and to provide timely access to medical services." Prime Minister Paul Martin.


"I think what the ruling does is reflect . . . the frustration of the Canadian public that in fact we need to start implementing some of these reforms for health care very urgently. We've got to get on with it." Roy Romanow, who headed a royal commission on the future of health care.


"When I was practising medicine, I saw a lot of patients suffering or dying on waiting lists and I felt that as a doctor and also as a citizen I had a duty to do my best to help my fellow citizens and that is what I did, that's all." Dr. Jacques Chaoulli, who argued along with a patient that Quebec's ban on buying private insurance for health care infringed on Canada's Charter of Rights and Freedoms.


"Why should you buy insurance for your pet and go to a veterinarian? You can protect your pet but you can't protect yourself?" George Zeliotis, 74, who argued his year-long wait for a hip replacement in 1997 violated his charter rights.


"We're really, really distressed about this ... it's just like we're on a slippery slope." Lucille Auffrey, executive director of the Canadian Nurses Association.


"What the Supreme Court decision has said is that politicians can't get away with something they've been getting away with for years. Which is to take our money, promise us health-care service, not deliver that service and then say: 'Oh, by the way, you cannot use your own money to buy those health-care services which we are refusing to provide for you."' Halifax-based Atlantic Institute for Market Studies president Brian Lee Crowley.


"I am very disturbed about the concept of opening the door to an Americanized health-care system in Canada." Saskatchewan Premier Lorne Calvert.


"I fully support any change that will allow Canadians more choice in getting timely access to the health care services they want." Alberta Premier Ralph Klein.


"All Canadians want better and quicker access to health-care services. But the answer is not to allow a select few to buy their way to the front of the queue while boosting private health-care profits and siphoning resources from the public system." Joan Lesmond, president of the Registered Nurses' Association of Ontario.

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