How Quebec’s proposal threatens medicare

In June 2005, the Supreme Court of Canada struck down Quebec’s prohibition on the sale of private health insurance for medical services covered under the province’s health insurance plan. Known as the Chaoulli decision, the court narrowly confirmed that private health insurance should be allowed if solutions could not be found in the public system to reduce wait times.

The Quebec government responded in February 2006 with a “white paper” – a document outlining proposed changes in the province’s health care system to address the issues raised in the Chaoulli case. Under the pretext of reducing wait times, the Quebec government said it would to allow people to buy private insurance for hip replacements, knee replacements and cataract surgeries. The province also pledged to establish wait time guarantees, so that if a patient is not cared for within six months in the public system, the government would send the patient to a private, for-profit clinic, to another province, or even to the United States for treatment.

Here is why Quebec’s proposal threatens Canada’s public health care system:

1. Private clinics cost taxpayers more. Sending patients to private, for-profit clinics means that taxpayers’ money will be used to pay for higher administration costs and shareholder profits. Doctors operating in the private sector will be able to set the rates for the procedures and the government will be obliged to pay. Typically, the rate is 10 to 15 percent higher at a for-profit clinic than at a non-profit one.

2. Private insurance promotes unequal access to health care. The Quebec government has signalled that it will allow people to purchase private insurance for specific treatments. This would create a two-tier system where some people would be able to pay to obtain medical treatment, while others – those who couldn’t afford it – wouldn’t. The Canada Health Act says that Canada’s national medicare program must provide health care for all Canadians under “uniform terms and conditions.” In other words, access to health care services should be based on need, not on the ability to pay.

3. More doctors and nurses will “opt out.” One of the incentives for doctors to stay in the public system is the knowledge that their bills are going to be paid by the government. The Quebec government’s proposal to pay doctors in the private sector gives physicians an incentive to opt out, because they know the government will pay their bills at the rates they set. There’s already a shortage of doctors in Quebec and this plan will drain resources from the public system even more. The Quebec Order of Nurses has also warned that scrub nurses, who are already in high demand in the public sector, will choose to work in the private sector in exchange for better hours, leaving public operating rooms with a staffing shortage.

4. Solutions can be found in the public system. With its proposal, the Quebec government has ignored obvious solutions in the public system to reducing wait times. There are examples across the country of how using a centralized and coordinated method of creating wait lists can dramatically reduce the amount of time patients wait for surgeries. Programs like the Alberta Hip and Knee Replacement Program and the Cardiac Care Network of Ontario have shown that there are ways to reduce wait times without paying private for-profit operators.

5. Privatization opens Canadian health care to trade challenges. Contrary to what Quebec Health Minister Philippe Couillard and promoters of for-profit health care say, the Chaoulli decision did not require Quebec to allow private insurance or to use for-profit clinics. Quebec’s plan not only violates the Canada Health Act, it also puts Canada at risk of trade challenges under the North American Free Trade Agreement (NAFTA), which exempts Canada’s health care system from American corporate interests, only as long is it remains a publicly funded and delivered program. If public health care becomes privatized through private insurance or the use of for-profit clinics, Canada must give national treatment rights to U.S. based companies that compete for health services. Quebec’s actions have national implications, and could not be easily undone.

Take action!

Even though Prime Minister Stephen Harper pledged to enforce the Canada Health Act during the recent federal election, he has now spoken out in favour of Quebec’s proposal. Hold him accountable, and tell him to keep his promise. Demand that he enforce the letter and the spirit of the Canada Health Act, which ensures access to quality, timely, publicly funded health care. Public dollars should never pay for private health care.

Contact Prime Minister Harper today!

E-mail: pm@pm.gc.ca
Fax: 613-941-6900
Mail: Office of the Prime Minister
80 Wellington Street
Ottawa, ON  K1A 0A2

To find out more about the Council of Canadians, and to become a member, visit our website at www.canadians.org, or call us toll free at 1-800-387-7177.

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