YOUR SPACE:
Top court strikes down Quebec private health-care law
CBC News Viewpoint | June 2005
The Supreme Court of Canada ruled Thursday that the Quebec government cannot prevent people from paying for private insurance for health-care procedures covered under medicare.
The plaintiffs in the case – a Montreal patient and a doctor – wanted Canada's top court to strike down sections of the Quebec Hospital Insurance Act that prevent people from buying health insurance for medical procedures covered by the public health plan.
In its ruling Thursday, the court said the provincial policy violates the Quebec charter, but they split 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.
But Alain Joduin of the Canadian Orthopedic Association said the decision is "truly an historic one that could fundamentally change the health-care system in Canada as we know it."
Lawyers for the federal government argued the court should not interfere with the health-care system, considered "one of Canada's finest achievements and a powerful symbol of the national identity."
READ OUR COVERAGE:
Top court strikes down Quebec private health-care law
YOUR LETTERS:
After having lived in both the U.S. and Canada, I believe that the Canadian system is much simpler to use. American insurance companies have incredibly complex rules, which seem aimed more at denying treatment than providing it.
It would be a shame for the Canadian system to fall further into decline. Canadian politicians need to spend more time and money on health care, and less on wasteful and divisive boondoggles.
Douglas Lefler | Greenwood, SC, USA
I just want to point out that one of the best examples of why this hybrid system does not work is in Australia.
I have not heard any reference by CMA people to
the Australian system which has waiting lists as long as Canada's. Its public system is of substantially poorer quality than the private system.
Their private system over the years has attracted the best doctors (especially the specialists) and huge resources even to the extent that there are many private hospitals in Australia that offer much better and almost same day medical and surgical services. With out very expensive private insurance one cannot access this private sector which means the Australian public is denied the best medical care available.
I have no reason to think that eventually that is what would transpire here should we start down the road of allowing a substantive private sector.
The answer is not private health care, it is to greatly increase the number of doctors and nurses and health care equipment located in clinics so local people can have easy and rapid access to the best of care. We don't need more hospitals, especially if they are private hospitals charging exorbitant fees so that only the rich can benefit from Canada's supposed "world's best" health system.
David Inwood | Gibsons, B.C.
The president of the CMA is living in a fool's paradise if he believes that a two-tier system in Canada would work. He is using European systems as an example; but we are not in Europe. Does he really believe that we can contain private health to 5% when we have all those rapacious health insurance companies just south of us in the U.S. waiting to get a foothold in a new market?
Let us not forget this: private health insurance is in the business of making money for its shareholders, not providing health care to its clients. Opening the doors to private health care coverage in Canada would mean that a significant number of people in Canada would not have access to any health care at all.
The president of the CMA should spend his time, instead of advocating for private health care, advocating to improve the universal health care system in Canada, first within the profession itself, then with government at every level.
Health care is a right, not a privilege, but the CMA would have it otherwise, it seems.
Theresa Wojtasiewicz | Toronto
If the waiting lists for medical attention are the result of a shortage of trained doctors and nurses where are these people coming from to operate the private clinics? From the public health care system obviously so this whole situation has nothing to do with the CMA wanting to improve medical services for Canadians it's powered by sheer greed and, once again The Supremes have done Canadians a disservice!
Roger Garrity | Winnipeg
The proponents of the Supreme Court Decision need to consider a few things. What provisions are they willing to consider to keep physicians from fleeing to the more lucrative private system? Such a situation has led to a massive decline in the public system in Britain.
Will private operators be willing to provide expensive follow-up care if complications arise from their procedures? Such a situation would merely expand the gap between the public and private systems.
Correct me if I'm wrong, but I believe that the NAFTA agreement allows for corporate challenges to public provision of services if part of that service is opened up to private providers. This could lead to HMO's claiming a right to provide service alongside the public system. If anyone thinks this is a viable option for our current mess, they are dreaming in techni-colour.
Tim Bryson | Claresholm, Alberta
How can a government declare a health situation as “Essential” and then require the patient to wait for more than a year? If the wait will be more than a reasonable time, then it must not be essential and the patient therefore has the right to seek medical treatment where time will not be such a factor.
Kathryn Walker
Before we shred our "Socialist" health care system we should find out what the alternatives look like.
I doubt a private insurance company would cover an 84 year old for cataract surgery or a 70 year old for hip replacement.
If you could get coverage you could only go to 'participating doctors' and all treatments would have to be approved by the insurance company. You would have to pay a certain percentage yourself That's called co-pay. Everyone get used to that term.
If you have a chronic illness or family history your premiums will go up. The same for smokers. If your claim is denied then you can sue your insurance company. They have expensive lawyers so you should get one too.
The purpose of private insurance companies is to turn a profit. The purpose of public health insurance is to provide health care. Let's fix the current system.
Eric Hedstrom | Calgary
At last! Some common sense in a Supreme Court judgement.
I have wondered for years why our politicians could have devised a system that denies Canadians the right, the very basic right, to decide on and pay for their health care. Perhaps it is because those politicians have always been shielded from the Health Service they so badly supervise.
At the very least, this will now mean that all those dollars now going to the USA or other countries can now stay in this country.
David Cornelius | London, Ontario
So Prime Minister Paul Martin assures us that there will be no two-tier health care. Well, before the last election he assured us that his government wouldn't change the definition of marriage, either. He capitulated to the courts on marriage. Why should we believe his assurances on health care?
Michelle Martin | Hamilton, Ontario
The current state of the health care system in Canada is frayed, and stretched beyond it's capacity to serve the needs of ill, and often, aged citizens.
Access to waiting-lists for surgeries, diagnostic tests, and specialist referrals does not constitute access to medical care. Our current system is simply not able to keep up with the health care demands of our population.
Access to private care will not erode public care, any more than private education erodes public education.
We need a well-thought out approach to this issue that clearly examines a private-public health care delivery model, such as exists in New Zealand or Australia. These countries provide excellent care to their citizens, and the integrity of the public system is maintained.
Jean Swann | Duncan, B.C.
Imagine a country, probably with a Liberal/NDP style government, that decided to implement a "universal public transit system" whereby all citizens were able to ride buses for free.Not "able" but "forced" to ride buses because private cars are illegal.Not so "free" because it is paid by the citizen's taxes.
Even though the buses are crowded, require long line ups to get on, break down frequently because of overuse, or the drivers frequently strike (or leave the country) over pay issues the citizens rejoice because it is free.
Then a few look at places where you can hire a taxi to get you someplace - at an additional cost to you. How unpatriotic! The greedy taxi drivers will get rich! This will lead to - shudder - the rich buying their own cars!
The Liberal/NDP government continues to get elected by painting the dissenting citizens as "scary" with "hidden agendas" even though they know the change is inevitable. Wait; let's dither long enough until the courts change things so we don't look bad!
Would you like to live in that country? Not me.
Doug Davidson | Calgary
There is a simple way to keep access to the system universal: Pass legislation that makes it illegal for private health care providers to deny service to anyone covered by insurance, whether private or public. This turns the issue on its ear.
The wealthy being able to cue jump is only possible if healthcare businesses are able to offer services only to patients with private insurance. Just deny that right
. At the end of the day, the government (i.e. us) will simply have to fork out more money for healthcare. This ruling simply gives government a really big kick in the butt. Governments will commit political suicide if they screw around with the concept of equal access based on medical need.
Kelly Dueck | Winnipeg
I have been reading some of the response to the Supreme court's decision and I am genuinely frightened at the ignorance and total lack of understanding of what freedom is.
The responses from the radical socialists are ripe with class warfare: "this is a decision for the rich","only the rich will benefit" SO WHAT!!! Does this decision hurt the poor? Or even the middle class? NO!
The socialists have exposed themselves today, they are in support of equality (equal misery for all!). This supreme court decision (much to my surprise) is an affirmation of freedom. We have been granted the "privilege" of spending our own money on medical procedures.
Those opposing this ruling need to speak plainly and clearly to their fellow Canadians, and stop hiding behind class warfare and rhetoric. Be proud of what you believe, the left in this country wants to tell the rest of us what we are "allowed" to do with our own money. Plain and simple. Thankfully the supreme court hasn't gone that far....yet.
Matt Winder | Camlachie, Ontario
As a Canadian living in the U.S. and exposed to the American health care system, I have been following the health care debate in Canada with interest. Please be careful of what you wish for, you may just get it.
Private health insurance is not the panacea to solving Canada's health care problems. Sure some things will be better, but new problems will arise. I doubt any residents of Canada think twice about where they are going for diagnosis or treatment, how much it will cost them out of pocket, or even if they are allowed to have the treatment.
These are concerns I have to deal with every time I get sick or injured. If the doctor of hospital is outside of my insurance network, I have to pay more money out of pocket. Even when they are inside the insurance network of doctors and hospitals, there are still substantial out of pocket costs.
I must pay a portion of every visit to a doctor, every procedure carried out and every medication purchased. And an insured must get pre-approval from the insurance company prior to receiving treatment by a doctor.
I am a healthy 36 year old but I still pay between $500 and $1000 per year out of pocket expenses plus $240 per month for my insurance premium (which represents about 30 % of the cost as my employer pays the other 70 %). This is in addition to Medicare tax collected from my income used to pay for health care for seniors and the poor.
I prefer the public system Canada has to offer over the private system of the U.S. I prefer the peace of mind of knowing that I will get the best treatment available regardless of my ability to pay and not having the stress of wondering how much my medical treatment is going to cost me.
Brian Curwin | Cincinnati, Ohio
I fully support the view that we need a pay-for-service option in the health care system. If I require even minor surgery to improve my quality of life, why should I have to wait up to two years to get this so called "elective surgery" done? That is two years wasted when I could have been pain free.
If I can afford the surgery, or choose to carry insurance, why can't I have the procedure done in my home country? It should be my right.
Cory Belyk | Saskatoon, Saskatchewan
The development of a two tier health system is indeed a benefit to all Canadians. Those who wish to circumvent the current system may now do so; only at the expense of their own wallets.
The benefit is such that those who previously had to wait will now not have to wait as long for the public system as those who wish to assume the cost of their own care move to the private sector; thus, benefits all around, shorter waiting times for those using the public system and private service for those wishing to provide for their own care.
I do find it absolutely appalling that a Liberal government who has watched this case for seven years has still not been able to make the necessary improvements to a health care system they call, and I quote "one of Canada's finest achievements and a powerful symbol of the national identity."
Stephen Harper has always been straight about the necessity of a two tear health care system, hats off to Mr Harper for actually concerning himself with the health care needs of Canadians and their economy.
David deVries | Brantford, Ontario
I applaud the Supreme Court ruling. Having just had a double hip
replacement after waiting well over a year to have it done, I have first hand
knowledge of the pain and stress faced by people in similar situations.
Osteoarthritis is a debilitating disease and nobody should have to wait as
long as people do, to have their joints replaced. Hopefully this decision
will lead the governments of this country to finally get their priorities
straight and ensure that people who are sick and in a lot of pain, don't
have to wait to have their condition rectified.
B. Olsson | Calgary
I am glad that the Supreme Court of Canada has ruled in favour of allowing private health insurance in Quebec. I hope this would eventually but quickly apply across Canada.
Private health care and publicly funded health care are not mutually exclusive. On the contrary, working hand in hand, the two can benefit all Canadians. There would always be the rich and the not so rich or poor. Granting this private right would result in the general public (poor) faster access to Medicare and shortening the waiting time because for each case that went for private health care, that would mean one less in the waiting line for service.
Will all the “better” doctors leave the publicly funded Medicare and opt for the private arena? Those who depend on the Federal and Provincial Government to act as watchdogs in the past can continue to depend on them to enforce the standard of care in both the private as well as the public system.
Dennis Jay
Once again, the federal government has abrogated it's executive responsibilities to the supreme court rather than face the wrath of Canadians over health care in this country. Increasingly public policy is being decided by the judges of the Supreme Court.
With leadership like this its just a matter of time before we see Quebec separate, and the rest of Canada integrate into the United States, and that's how are leaders like it! So Welcome To U.S. Style Health Care.
Kurtis Law | Montreal
What a great day for the investment community! What a great day for "old school" capitalism!
This ruling means the eventual development of a new private health insurance industry in Canada that can only be fabulously profitable! Think of it - a private necessity increasingly in private hands, with inequality of information between the service provider and the insurance customer as to what services are required! This can only result in widespread premium pricing for treatments for every life-threatening illness and dangerous procedure (and high-priced health insurance premiums to cover it), and a wide range of extra and unnecessary "pay as you go" or "not covered" procedures designed to milk the customer dry!
But this is insurance, isn't it? Won't people be entitled to coverage by way of their contractual relationship with the insurance company? Well, sure they will - at least that is what the brochures will say.
But let's get real for a second. Do automobile insurance companies ever deny coverage? How about home insurance companies? What about life insurance companies? Well, sure...they deny coverage all the time! For them, paying-out a claim means less profit, and because profit is the only reason they exist, they are constantly seeking to avoid their contractual obligations wherever possible.
With this new health insurance industry then, as soon as a procedure looks too expensive for the insurer to pay for at a profit, they'll seek to deny the claim, with the result being that the patient will have to sue if they want the treatment in question to be covered. The alternative is that these companies will only provide coverage for services that are simple, and therefore profitable.
Do you see the irony in this! This Supreme Court decision arose from a complaint about lack of services related to complex and expensive procedures, and yet, it has opened the door to private insurers who will either be loath to provide that very type of coverage, or who will seek to avoid providing such coverage wherever possible, owing to the cost of doing so.
Wait a moment...people will often have to sue to be covered for complex and expensive treatments? Goodness, could it be - is this even a good day for lawyers!?
Arthur Heale | Ottawa
Health care for all, and not only for those who can afford it. This decision has polarized the province of Quebec today.
The rich who can afford the extra insurance will now receive quicker and better treatment than that of the system we have all invested in. And what of that of those who cannot iincurthe expense? Are they deemed second class citizens and are forced to deal with the current bargain basement and Americanized Health Care system?
Reverse this ruling. The politicians do not deserve a scape goat for their mishandling Health funds. This is not a solution, this is a patch job.
Jeff Russell
Aborting universally funded public health care opens the way for rampant corruption - physicians bribing for operating room time, "encouraging" patients known to have private insurance or financial resources to use the private wing of a practice instead of the public.
Citizens of this country who wish to preserve this important facet of "being Canadian" need to get active to ensure that doctors who wish to provide private surgeries do not have any access of any kind to publicly funded facilities.
A physician who provides any private health care service should be prevented from participating in any way in the public sector. Fee for service and private clinic docs are not in the profession because of dedication to humanity. Their greater loyalty is the folding kind.
Elaine Masur | Birtle, Manitoba
I was saddened by the latest Supreme Court ruling on health care. We are
now one more step down the slippery slope to a system that provides good
service to those with plenty of money, and "charity ward" service to
those without.
The wealthy are using smoke and mirrors to make us think
it will be better for all, but it is plain to see they are only working
for their own interests. Meanwhile, private clinics will skim the cream
from medical dollars; doing simple, profitable procedures while leaving
the dirty work to the public sector.
We need to look at values here. The constantly expanding gap between
rich and poor is sending us backward to the dark days before medicare.
The mean world of conservatism descends.
Those who subscribe to social
darwinism are having their way, at the expense of the less fortunate. If
you've got the money, then you must deserve the best! That's what they
think. Those who can't compete get what's left. It's a sad sad commentary
on the evolution of humanity.
Lee Carruthers | Carmacks, Yukon
This decision by the Supreme Court of Canada is probably one of the most horrific transgressions on our social system in decades. With this decision the Supreme Court have now created a two tier health system whereby those who can afford private insurance can not only pick their physician but possibly be moved ahead in their treatment at the expense of those in greater need.
I am sure the Insurance Bureau of Canada is salivating at this decision. They are now in line to "sign on" physicians to subscribe to their plan coverage. This is only one step away from the American system of HMO's.
The net result for Canadians can only be that those who can afford it will be guaranteed not only the best of health care but also decreased timing at the expense of those who cannot afford it.
The Martin government needs to address this situation immediately before hip replacements become more important than heart or cancer patients.
Harold Hotham | London, Ontario
Canadians are now well on the way to being freed from one of the most restrictive and interventionist programs ever devised in a so-called democracy.
The socialist dogma of our government has been exposed for the unworkable sham that it is.
Finally, the Supremes get one right!
Richard Kneller | Hamilton, Ontario
Isn't it ironic that we just had a national debate on the greatest Canadian and decided it was Tommy Douglas and mostly because of the health care system he founded. Now within a year we get this ruling which essentially says this same health care system breaches the Canadian Charter of Rights and Freedoms if citizens are forced to wait for care or are not allowed to seek alternative avenues of treatment.
Peter Persad | Clearwater, B.C.
This is an interesting ruling but unfortunately does not address the real issue. Why can the publicly funded system not keep up with the demand?
Is the demand inflated with unnecessary tests? Or is the system too small for the client base? Why do MRI machines sit idle over night instead of another shift? Why are beds closed when people are waiting?
These are the fundamental questions that need to be answered. To date the governmental and medical experts have failed to provide real answers that are not clouded by they own agendas.
Maybe what this ruling will do is signal to the 'experts' that they have not come close to fixing the system yet and if they don't start, real people will. The courts just opened a door so the real focus can be on the patient, not the medical system, not the government policies.
Mel Walker | Milton, Ontario
I do not share in the excitement of some on this ruling. I believe this is a Quantum leap backwards for fair health care in Quebec and ultimately for Canada.
Why should someone receive medical care immediately just because one can afford to pay while another gets shoved to the back merely because they cannot. It should be decided upon one's immediate medical need not the almighty buck.
I for one am sick and tired of those nine immoral, un elected judges on the Supreme Court making life and death decisions for me and my family. Canada, once admired for its fairness for all and high moral character, is fast becoming a nation to loath. It is said that you can judge a nation by how well it cares for its young and old and Canada has an extremely poor record on both.
Bob Beer | Iona Station, Ontario
The people that are applauding this decision have one thing in common - GREED.
Their intention is easy to see , once you get your foot in the door start stealing the good people from the public system. The public system then collapses due to lack of funds and people to do the work and you can charge whatever you feel like.
We end up with a system much like the American system - only the truely rich get any real advantage from it.
Mike D Potter
That we even have year-long waiting lists proves the fact that the current public health care system is broken.
The liberal methods of throwing money at a problem to fix it won't hold out since we have a whole generation of baby boomers whose age-related medical needs are already just beginning to burden the system.
We need to try new ideas and get past the fear-mongering talk of privatehealth caree being somescaryy beast that will be the ruination of our country, and the oppressor of the underprivileged.
Dual Public/Private systems are in place in other countries. Our public system is so overlybureaucraticc, and so controled bygovernmentt unions that any change is nearly impossible to implement. Governments that try are often subject to intense pressure to abandon such efforts.
Our "right to health care", and the way it is implemented in legislation has actually had the effect of removing it's self as a right by creating such obscene waiting lists.
Steve Smith | Ottawa
Why are people so jealous of others who can afford things they cannot? If private clinics can serve to relieve waiting times for those who have to wait in queue for public health services, why is there a problem?
However, the citizens who spend their money at these health clinics should beineligiblee to receive a tax credit for the services they received. GST should be charged as well. Do you suppose the professionals at private clinics would charge their patients the same amount as the professionals at public clinics charge the taxpayer?
Jason Blue | Olds, Alberta
The wealthy elite in Canada have just won the victory they've always wanted. A better quality of life than the rest of us can afford.
What is the point of being rich if you don't have better health care, than the poor, for you and your children? Who cares if millions of Canadians won't be able to pay for even the most basic of health care services? At least our politicians, Supreme Court Justices, senior public servants and the wealthy in Canada will have great health care albeit at the expense of the rest of us.
Here's an idea if rich people what to jump the line for surgeries they can use the "wonderful" health care services south of the border. Of course that's not the point they want access to private health but only as long as it is subsidized by the taxes of people who can no longer afford health care at all.
If ever there was an issue to use the Notwithstanding Clause this is it. But Ottawa certainly won’t.
William Jordan | Vancouver
How any Canadian could actually desire paying even more for private insurance, rather than developing an effective public system, boggles my mind, leading me to conclude that we are becoming an ever-more individualistic and self-interested society. How un-Canadian.
Matt Vidler | Peteborough, Ontario
Its about time some sanity was imposed on our health care system. My mother, 84, has been waiting over 6 months for hercataractt operation. We have just learned it will be postponed again due to a shortage ofanesthetistss
. This is rationedhealth caree resulting from the socialized, beuracratic, central planning that has characterized our hhealth caresystem over the past 15 years. I say bring on the private sector.
Alex McKinnon | Ottawa, Ontario
The concept that the right to buy private health insurance to pay for private health-care is universal is purely hypothetical.
If you don't have the financial resources, you don't have the right to buy private health-care regardless of what the law says.
Therefore, this is not a universal right;but rather, it is a privilege of the rich. There is absolutely no question that this ruling is a victory for health-care as a commodity rather than health-care as a right.
Once health-care becomes a commodity, it is available only to those who can afford it. How is that a "universal" right? Anyone who believes that this will not reduce access within the public system is dreaming in techni-colour. The Supreme Court should be ashamed of its disgraceful action.
Greg Gowing | Ontario
Congratulations to the Supreme Court, though I am disappointed they did not find the Quebec law inconsistent with the Canadian Charter as well.
The next step is to dismantle the host of official institutional blockages that prevent adequately increasing the supply of medical services, so that within the next ten years most queues will be history.
If this is the beginning of the end of the paternalism and monopolistic strangulation that increasingly chokes access to health care in Canada, it is all to the good.
Mark Segal | Toronto
The court stated not only is there no evidence that private insurance will destroy public health care, but they also pointed out that Canada is the only OECD country that doesn't allow private insurance. The courts found that in countries that do allow private insurance, the public system not only prospers, but the standards and waiting lists are much better than our own.
This is a great day for Canadians who, as the ruling points out, have been suffering due to Liberal government inaction on this issue.
Cory | Cornwall, Ontario
To allow for the privatization of medical care will only serve the rich and will further marginalize the poor and compromise health and well-being. Do we really want to "Americanize" health care and lose a health care system that was developed for all people, regardless of income?
There must be an alternative to improve delivery of service versus privatization.
Roz Mitchell | Peterborough, Ontario
I am not sure that I understand the arguments of Mr Zeliotis, his doctors or his lawyers in claiming that they have the right to purchase private health insurance here in Canada in order to guarantee faster access to treatment.
In other words the ability to be able to "jump the waiting line" for treatment. Mr Zeliotis is being extremely naive if he believes that opening the doors to private health insurance in Canada will result in those companies "beating down the doors" to sell Canadians affordable health insurance to cover expensive operations.
It is a self-evident truth that insurance companies sell policies with the premiums geared to risk vis a vis the bottom line profit picture.
One only has to look at the United States and the almost 50 million Americans that have no health insurance because they cannot afford it to understand that a person of Mr Zeliotis's advanced age would have a problem buying a policy to cover this procedure anywhere.
I understand that it is entirely permissible for Canadians to purchase health insurance from American carriers to cover treatment in the United States and with this in mind I wonder why Mr Zeliotis didn't simply travel to the United States and pay for treatment out of his pocket which he claims he should have the right to do here in Canada.
I lived in the United States for some years and was the victim of having no health insurance, a $28,000.00 bill for 3 days in hospital with kidney stone problems.
Adrian Davies | Toronto
Mr. Zeliotis said that "we are not going to be a third world country here in Canada". I have lived in so-called "third world countries" and I can attest that most have the kind of health care system which Mr. Zeliotis is proposing - one where the rich can afford private care and drain the public system so that others get little or no care.
Only the United States, among major industrialized countries, has not developed the kind of public health care system which moves toward all having equal rights to access its services. I prefer to keep our "third world" system.
Robert Faris | Toronto
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