Ramping up the privatization debate
The Canadian Medical Association and private health care
Andrew Lodge Volunteer Staff
When Canadians indulge in self-definition, several themes are trumpeted over and over again, although none are held as sacred as hockey and health care.
A disappointing showing at Torino aside, hockey is in no danger of being attacked or eliminated. The same cannot be said of Medicare. The imminent election of private health advocate Dr. Brian Day as head of the Canadian Medical Association (CMA) is yet another in a string of events all but guaranteeing some kind of transformation in the medical world. Day’s election could even create the conditions for the riddance of publicly-funded care as a health policy mainstay.
Back in 2004, the Supreme Court of Canada settled in favour of Dr. Jacques Chaoulli and one of his patients, overturning a Quebec law preventing people from buying private health insurance to pay for services already available through the current system. Chaoulli called the decision a “new start for health care” in Canada. He was right.
The Chaoulli decision lent legitimacy to the ravings of Alberta Premier Ralph Klein and the like who believe that everything, including oxygen and water, should be privately owned. Other physicians soon joined the fray, and the CMA followed suit in a statement advocating for private care last August.
The CMA’s pro-privatization involvement is an ominous development. The CMA remains one of the most powerful lobby groups in Ottawa, and it is certainly downright monolithic when it comes to health care policy. Strangely, the physician community has taken a particularly vacillating position over the years, perhaps reflective of the political immaturity of a group that studies disease, not theories on governance and policy. Nonetheless, it is somewhat instructive to examine how the CMA arrived at its current stance.
In the ’60s, the College of Physicians in Saskatchewan waged a strike protesting the genesis of Medicare in that province, fuelling the ridiculous notion that providing universal health care was some kind of communist plot. While nowhere were voices and actions as dramatic as in Regina, physicians across the country also stood opposed to universality.
Public pressure won out, however, and Medicare became entrenched. The CMA changed its tune, attempting to position itself as the saintly gatekeeper of publicly-funded health.
This stance was not to last, demonstrated by the CMA’s endorsement of private care last August, ostensibly to better serve their patients, though many critics charge that such a rationale disguises the true desire to fatten physicians’ bank accounts. This is reinforced by the likelihood that Dr. Brian Day will be elected head of the CMA. Day is no stranger to private, for-profit care, having vaulted to the top by opening a controversial but highly profitable private surgical clinic in Vancouver.
The official CMA position is a corollary to the legal argument — buttressed by Day, Chaoulli and a host of others — that the prohibition on seeking private care contravenes an individual’s Charter rights. Support for these arguments is undoubtedly strengthened, even motivated in many cases, by Canadian doctors looking wistfully across the border to the United States, where a similar argument is made, and where many of their colleagues are becoming very wealthy.
Proponents of private care have repeatedly fallen back on the inflammatory issue of excessive wait times to stir up support. They argue that a parallel private system will take pressure off the public one, neatly solving the problem of an over-stressed care delivery.
Such a position is so fallacious it is barely worth comment. Private clinics will obviously not affect the number of patients or procedures. If there is a finite number of practitioners and half of them head for private clinics, then we are still left with the same problem of too many patients and too few physicians.
True, those who are able to pay could go to the less busy private clinics, effectively queue-jumping and reducing their own wait time. But in essence what will happen is that much-needed physician resources will be siphoned to the private pool, leaving a higher patient-to-doctor ratio in the public system.
Day, Chaoulli and others claim, no doubt truthfully, that they have their patients’ interests in mind. But health policy cannot be determined by the needs of individual patients in a particular physician’s practice. Health policy must be developed from a societal perspective. If a private system is developed at the expense of the public one, it’s true that those who have the ability to pay may receive swifter care than they do at present, but that would also mean that the wait time in the public system will lengthen. Those who can’t afford to pay would quite likely find their level of care deteriorating.
Public policy should keep the rights of the individual in mind, but the needs of the larger community must remain the primary influencing factor. The privatization debate is very much a debate over how our society addresses the needs of those people, and there are many of them, who will not have insurance or thick enough wallets to pay. The moral measure of social policy requires that society be judged by how it treats its most vulnerable citizens. Private health care will fail on this front.
Andrew Lodge is a third-year medical student.
