Today might be a very important day in the history of the Canadian single-payer health care system.
n a 4-3 decision, the panel of seven justices said banning private insurance for a list of services ranging from MRI tests to cataract surgery was unconstitutional under the Quebec Charter of Rights, given that the public system has failed to guarantee patients access to those services in a timely way.
But they split 3-3 on whether it violated the Canadian Charter of Rights and Freedoms, meaning there is no immediate impact on the Canadian health-care system as a whole.
That second decision is why I have used the word “might”. While many will be waving this around as the death knell of single-user pay in Canada I don’t believe that to be so.
What I do believe is that this validates the opinion that Canadians have a right to faster, better service. Faster, better service doesn’t, however, automatically mean a two-tier service.
Indeed, if all of a sudden hundreds of private clinics and operating rooms popped up where would the doctors and nurses come from to fill them? There are a very finite amount of health care professionals in Canada… private clinics would simply apply more strain on an already strained field.
I believe the Supreme Court understands that, and that may be one reason why they split on the decision on the Charter of Rights and Freedoms. They knew that a decision totally in favor of private clinics could backfire, and lead to an even worse situation where the public system was even more strained and only the rich could afford private insurance.
That situation would arguably be just as contrary to the Charter of Rights and the Health Act as the current situation.
So… it seems Canadians are at a crossroads. It is clear something needs to be done. Personally, I think there is a role for private clinics, but there needs to be staff to populate them, and they can’t be a detriment to the public system. That is a very difficult balance.
We need to train more doctors and nurses. We need to allow private clinics to perform common procedures, like the hip replacements this case was based on. The Public system could easily pay the fee to send patients to private clinics so that hospital operating rooms aren’t clogged with minor surgerys…. this is effectively how the relationship works between doctors and the Public purse… so why not extend that relationship to clinics that would help take the load off the hospitals which, in addition to not having enough operating rooms, also don’t use those rooms at night!
In fact, maybe the public system should attempt to focus on Emergency Care, major surgeries, and long term care. Basically, anything that requires a hospital or long term facility.
So really, I don’t see these decisions today as changing a whole lot. There will be a lot of bluster from both sides but in the end people will still be on waiting lists.
Hopefully what this decision *does* do is get people thinking about new ideas and actually follow through on those ideas.