Western Standard
email print

Identity crisis

Do critics of the right to private medicine care more about having a uniquely Canadian health system--or about saving people's lives?

Peter Jaworski - July 11, 2005

With hockey still sidelined by a labour dispute, Canadians who thought they could look to the queues at hospitals as a symbol of our national identity got a nasty surprise with a landmark Supreme Court decision on June 9.

The court was ruling on the case of George Zeliotis, a retired Montreal businessman who waited a year in 1997 to have a hip replacement. Given that he was unable, by law, to use any insurance besides government-run medicare, Zeliotis thought the length of time was in violation of his security of the person, guaranteed by both the Quebec and the Canadian charter of rights. After being stymied by two lower court rulings, the case wound its way up to the Supreme Court last year. The highest court in the land took 366 days to issue their ruling, but, in the end, the seven judges struck down with a 4-3 ruling, the long- standing prohibition on private insurance and care in the province of Quebec. The ruling was split 3-3 on the federal Section 7 charter challenge--the section that guarantees the right to life, liberty and security of the person--but sided with the appellant in seeing a violation of the Quebec charter.

Canadians outside Quebec who think they can still rest their national identity on the ailing shoulders of public medicine should think again, say legal and policy experts. They contend that it's only a matter of time before private health care contracts between consenting adults become a fact of life across Canada.

"Technically, this ruling only applies to Quebec," says Neil Seeman, a Toronto lawyer and research associate in health policy at the University of Toronto's medical faculty. "It must be read on the facts, but the analogy is to same-sex marriage, which, though contained to provincial laws, had clear translation federally." Nadeem Esmail and Brett Skinner, health policy experts with the Fraser Institute, a Vancouver-based free market think-tank that publishes an annual medical waiting-list survey, say this means that private payment for health care is now legal. Anyone prosecuted for buying private care, says Skinner, now has, in the Supreme Court's ruling, a virtually unbeatable legal weapon with which to defend themselves. Since the violation of Section 1 found in the Quebec charter ("right to life and security of the person") is found in other provincial charters as well, private insurers could conceivably set up shop across this country. Justice Marie Deschamps, one of the judges in the majority, declined to comment on the implications for the federal charter. But she did go so far as to suggest the Quebec ruling might have a similar impact federally: "With regard to certain aspects of the two charters, the law is the same," Deschamps wrote. "For example, the wording of the right to life and liberty is identical. It is thus appropriate to consider the two together."

Not surprisingly, government lawyers had argued that the court should avoid interfering with government-run health care since it is considered "one of Canada's finest achievements and a powerful symbol of the national identity." Medicare advocates offered up the same rhetoric in the wake of the ruling. Michael McBane, national co-ordinator of the pro-medicare Canadian Health Coalition, called the legalization of private care "an American-style approach to health care: health as a business, not as a public service, not as a public good, not as a right." He warned Canadians, "So if you don't have the money, too bad for you. You'll get inferior treatment." He added that such a system would be "un-Canadian."

Only, that's not what the majority of Canadians say. An April 2005 Leger Marketing poll, commissioned by the Montreal Economic Institute, found 52 per cent of Canadians who found allowing "speedier access to health [care] to those who wish to pay for this type of care in the private sector, while maintaining the current free and universal health system," acceptable.

Still, the view that Canada's identity is somehow wrapped up with a government-run, single-payer health care system has been long promoted by Canada's official institutions. In November, CBC viewers voted Tommy Douglas, the former premier of Saskatchewan and noted father of single-payer insurance, as "The Greatest Canadian." Roy Romanow, another former Saskatchewan premier and the senator who headed 2002's Committee on the Future of Health Care in Canada, noted in his report (which argued in favour of maintaining the single-payer model) that medicare "defines who we are; that it is not simply a list of services we receive, but an expression of the values we hold." Prime Minister Paul Martin told reporters last year: "The Canada Health Act is an essential foundation of the Canadian value system.

We are not going to a two-tier health care system."

More articles by Peter Jaworski