Why Jack Layton scrambled for cover on private clinics
By John Gray, CBC.ca Reality Check Team | Dec. 9, 2005 | More Reality Check
If Canada's political leaders agree on nothing else, at least they agree that they have to insist they totally and unreservedly support the public health-care system. Yes, indeed, each of them backs medicare 110 per cent.
You are not going to catch them out on the wrong side of that political trap. They are too smart for that. Medicare has become one of the totems of Canadian life, and woe betide the political leader who forgets it.
Federal NDP Leader Jack Layton speaks at a campaign stop in Vancouver. (CP Photo)
In the early days of the current election campaign, New Democrat Leader Jack Layton scrambled fast for cover when reporters thought he was softening his opposition to private health clinics.
It was the same sensitivity to public suspicion that five years ago prompted Canadian Alliance leader Stockwell Day to hold up a crudely lettered sign in the middle of an election debate to proclaim that he did not support a two-tier, public and private medicare system.
The reality is that from the day of its creation Canada's universal public health care system has had a large component that is private.
The Canadian Institute for Health Information estimates that the split between public and private is about 70-30 – less public spending than Britain, Germany and France, but more than the Netherlands and much more than the United States.
Where the Canadian system stands out is in the financing of hospital and physician services. Canada's 93 per cent funding of hospitals and 98 per cent funding of physicians is higher than any of the other countries, where patients must bear part of the cost.
Of the private component of health care funding, half is accounted for by private insurance. For the other half, Canadians are out-of-pocket to pay for dental care, drugs, nursing homes and vision care.
Outsiders wandering into the health-care debate are likely to find themselves in a minefield of distinctions that seem to make little sense.
For example, the removal of cataracts is done in hospitals and is therefore a public cost. Reshaping of a cornea is regarded as not as necessary as cataract removal because the condition can be corrected by glasses, so the cornea treatment is carried out in an eye clinic and privately financed.
The treatment of erectile dysfunction, which involved elaborate and frequently ineffective pumps, used to be covered by medical insurance policies. But in the age of Viagara, erectile dysfunction is not insured and the patient must pay.
The simple advance of medical science is responsible for much of the confusion. Many treatments can now be carried out easily in private clinics. But in clinics the patient must pay.
And of course, standards vary from province to province, so that insulin that is provided free for diabetics in most provinces is an out-of-pocket expense for patients in Saskatchewan.
As for the distinction between public and private, there are dozens of private MRI clinics across the country and countless doctors who routinely require patients to pay supplementary fees for treatment or consultation.
Not surprisingly, Michael Decter, the chair of the Health Council of Canada, fell back on a delicate understatement when he conceded that "around the edges there’s a bit of fluidity."
It was concern for that fluidity that persuaded Jack Layton to draw a firm line between private and public. There would be no public funding for private clinics, he said.
Layton's line seems clear enough. But what about Dr. Henry Morgentaler's abortion clinics across the country? The clinics are private but abortions are an insured service. Would Layton close them down? Not likely.
Medicare is so complicated.