Paul Weinberg

TORONTO, Jun 20 2005 (IPS) — In a close 4-3 decision, Canada’s Supreme Court has put into question the country’s system of free doctors and hospital services, held as an alternative to the for-profit model of medical delivery elsewhere in the world.

“It has got import well beyond our borders,” economist Armine Yalnizyan told IPS regarding the decision that opened the door to the purchasing of private insurance for specific medical procedures.

Canada’s healthcare system has a way to go in terms of innovation in some areas, says Yalnizyan, who has been researching her country’s healthcare system for the Ottawa-based Canadian Centre for Policy Alternatives.

“We are more privatised than most. Like 30 percent of what we do is already private sector – home care, long-term care, drugs. There is a particular way we provide access to doctors and hospitals that is held in great regard and is exactly what is at the core of this ruling,” she explained.

Rich and poor citizens benefit equally from Canada’s single payer healthcare system, which is federally financed and provincially administered. In order to preserve its universality, Canadians are legally prevented from using private insurers.

But this ban was placed in jeopardy in Quebec when the Supreme Court of Canada ruled on Jun. 9 that the suffering endured by 73-year-old Montreal businessman George Zeliotis, who waited about a year for a hip replacement, violated the province’s Charter of Rights.

Essentially, the judges stated that Zeliotas could jump the queue and avoid the hospital wait by buying private insurance to pay for the surgery.

Although the decision is restricted to Quebec and the Supreme Court judges did not agree on whether Quebec’s legislated ban on private health insurance contravened the Canadian Charter of Rights and Freedoms and thus impacted the Canadian healthcare system as a whole, Canadians in other provinces could still legally launch similar court actions.

Canada could end up like France, Britain and Australia with a two-tier mix of public and private healthcare system, says Yalnizyan.

Those with the financial means will go to private clinics out of convenience and pay for services through private insurance. But private insurers will also stay away from care involving costly chronic diseases – like heart disease and cancer – that they may not find profitable enough to support, she warns.

The majority of Canadians would continue to rely on the public system, but it would lose some doctors and nurses, who might find it more lucrative to work in for-profit private hospitals and clinics.

Furthermore, Canadians are “complacent” about the trade implications of the ruling, says Scott Sinclair, the senior research and trade specialist with the Canadian Centre for Policy Alternatives.

“If the decision is acted upon, and we have basically opened health insurance to private insurers including foreign insurers, once they are entrenched in the country, trade treaties are going to make it very difficult to subsequently remove them,” he told IPS.

Private insurers could sue for lost profits, which could run in the many millions of dollars, under the North American Free Trade Agreement, if the federal government attempts to restore a universal and nonprofit system, he told IPS.

Canada is also a signatory to the General Agreement on Trade in Services (which includes private health insurance), meaning that once it opens up a market to competition from private for-profit business operations, the decision cannot be reversed, Sinclair noted.

Sinclair suggests that Ottawa succumbed to the political pressures of large export-oriented Canadian insurance companies when Canada’s trade officials agreed to include private health insurance in 1997 GATS negotiations

Now, if the Supreme Court’s lifting of the ban in Quebec is maintained and spreads to other provinces “foreign private insurers [under GATS] in the health sector would be entitled to all of the advantages including [government] subsidies and any other benefit that public health insurers have,” the trade specialist adds.

Canada’s political leaders and groups fighting to preserve the country’s non-profit healthcare system appear to be low-key about the top court’s nod to private insurers.

“I think perhaps shell-shocked and trying to understand the decision more fully is probably a fair characterisation,” says Sheila Block, a director of policy at the Registered Nurses Association of Ontario.

While the decision “still leaves a lot of room” to preserve a publicly-financed scheme, the shock comes from the resurrection of the notion of two-tier public and private healthcare, which had been rejected by separate major studies led by former provincial premier Roy Romanow and Canadian senator Michael Kirby, Block added in an interview.

Meanwhile, Canada’s health minister Ujjal Dosangh assured members of Parliament recently that “we are busy trying to establish benchmarks, set the comparable indicators, expand home care, bring more international medical graduates into the mainstream, so that we have a healthcare system that is thriving.”

There is reason for optimism since the hospital wait experienced by Zeliotis occurred in 1996, “the worst year in Canada” in terms of federal cuts to provincial healthcare programmes by a federal Liberal government primarily focused on fighting the country’s deficit, says Yalnizyan.

In the last few years federal monies have again started pouring into the Canadian healthcare system, including last fall’s 33-billion-dollar 10-year accord with the provinces.

Both Yalnizyan and Block suggest that these moves should lessen the need for hospital and acute care in Canada, as regional healthcare bodies across the nation place a greater emphasis on disease prevention, health promotion and team-based (i.e. doctors, nurses and other health professionals working together) care in a community setting.

Meanwhile, support among Canadians for the public healthcare system has eroded as the population ages and media stories about hospital waits – an issue in the June 2004 federal election – abound.

One recent public opinion poll by the Ipsos-Reid firm and published in the National Post and other associated newspapers demonstrated Canadians’ ambivalence. Seventy percent want the right to purchase private health services. At the same time, 64 percent agree that a two-tier system for rich and poor will invariably result from the court ruling.

A pollster not involved in the National Post survey told IPS that consumers in developed countries like Canada are constantly raising their expectations on everything sold and offered, from products to politics.

“Canadians are demanding more from their healthcare system [even as it has deteriorated] just as they are demanding more from other services,” said Marc Zwelling, president of Vector Research and Development Inc.