Health-Care Freedom Infringed Upon: Canada’s 30-Year Monopolistic Medicare Experiment is Failing

The deliberate legislative infringement of personal health-care freedom in Canada constitutes the most tragic public policy blunder in the country’s recent history.

This infringement began about three decades ago with the insertion of disguised Marxist clauses in medicare legislation that prohibited private alternative medical and hospital services and insurance, and replaced them with provincial government monopolies.

These clauses are destroying the health-care services that medicare was supposed to improve, and account for the low performance ranking of Canada’s health system, in 30th place among nations of the world.

While most Canadians appreciate the free insurance coverage provided by medicare, they are deeply troubled to discover medicare coverage of specialized services often means a long waiting list, rather than ready access to quality health-care services.

Patients who suffer painful delays for diagnosis and treatment express disbelief when informed that medicare legislation prevents them from purchasing alternative private medical and hospital services and insurance that could otherwise relieve their pain and suffering or even save their lives.

To counteract the disastrous effects of flawed medicare legislation, physicians in several provinces have set up modern diagnostic and treatment centres, some open to public and private patients and others totally private.

These private initiatives have been well received by grateful patients and their families but have been resisted by public service unions, Marxian-oriented think tanks, and socialist sympathizers in all political parties.

The opponents of personal health-care freedom defend the same politico-economic and freedom-infringing public policies that have been well tested in Canada’s 30 year monopolistic medicare experiment, and our declining health system’s performance is evidence of their failure.

As health care in Canada limps along, isn’t it time
to consider a parallel public/private service?

Recently, a new approach has surfaced in the struggle to restore health-care freedom in Canada, using the courts and the legal process. The prime example is the Chaoulli and Zeliotis case, involving a Montreal physician and a senior citizen who experienced a prolonged and painful wait for hip surgery. These courageous individuals have challenged the clauses in the Quebec Health and Hospital Insurance Acts that prohibit the purchase or sale of private medical and hospital insurance for services covered by the public medicare plan, and prohibit private physician services for hospitalized patients by doctors who are not participating in medicare.

After failing, in Quebec’s lower courts, to obtain a declaratory judgment against the prohibitions that infringe personal health-care freedom, Chaoulli and Zeliotis were heard in appeal by the Supreme Court of Canada in June 2004. The judgment is pending at the time of writing.

When the Supreme Court decision is rendered, two possible scenarios could unfold.

If the decision is favourable to the appellants, it will effectively restore health-care freedom to all patients and physicians. For Canada’s medical and hospital systems it will be equivalent to the fall of the Berlin Wall.

This will allow Canadians, like Europeans, to enjoy the opportunities and benefits that personal freedom and responsibility bring by way of experimentation, market competition, and alternative choices in the financing, delivery and insurance of medical and hospital services.

As the European experience has shown, the restoration of health-care freedom in Canada will not harm the publicly funded health system. Unfortunately, it has already suffered four decades of Socialist decline under the centrally planned, provincial government health-care monopolies.

Should the Supreme Court dismiss the appeal for health-care freedom, it will be a dark day for Canada’s medical and hospital services and a victory for continuing Marxist influence in medical and hospital services.

A Leger survey for the Montreal Economic Institute in May 2004, indicated that 68% of Quebecers, 57% of Saskatchewan residents and Manitobans, 53% of Albertans, and 51% of Canadians would support a private parallel health system as long as the free public medicare system is maintained.

Quebec, Alberta and British Columbia have enjoyed a growing number of private diagnostic and specialized surgical clinics providing excellent services either outside or contracted with medicare. These provincial governments are aware of the polls and the satisfaction shown by clinic users, and have rightly turned a blind eye of tolerance toward their existence.

If public surveys continue to support these private initiatives, enlightened political parties could embrace this consumer-driven trend.

Provincial and federal governments could quickly remove the prohibitory or coercive flaws in their respective medicare legislation without disturbing medicare, and allow these and other private health service-oriented initiatives to evolve in parallel fashion to the public sector.

This approach would be in tune with the best performing health systems of the world and would be a practical and modernizing solution to Canada’s declining health system.

Dr. Edwin Coffey est chercheur associé à l’Institut économique de Montréal et co-auteur de Universal Private Choice: Medicare Plus et de Better Medicine: Reforming Canadian Health Care.