The Sunday Los Angeles Times reports on a court case in British Columbia affecting private health clinics that have sprung up all over the state. These private providers perform simple surgeries and tests such as MRI’s within weeks, whereas patients often have to wait months to receive these services from the public providers. Opponents of the private providers argue that they ought to be illegal because they allow wealthier people to jump the queue, and that they put extra strain on the public system because they attract nurses and doctors away from the public providers by offering them higher pay. Proponents argue that patients ought to have a choice in their health care, that consumers of private care leave the queue thus relieving the public system, and that they provide incentives to those considering to become health care providers thereby increasing the pool of nurses and doctors to the benefit of both the public and the private providers.
The article provides some history on the case, which is interesting to look at given the push from the Obama administration to institute a public option in the United States.
The heart of the legal case is the 1984 Canada Health Act, which established the framework for the national insurance system known as Medicare. It outlawed most private insurance for essential healthcare and provided the vast majority of Canadians with free medical services.
Although President Obama is reassuring the American public that a single-payer system, as it exists in Canada, is not the objective of the current health care overhaul, instituting the public option would set a strong precedent that providing health-care is an acceptable activity to be carried out by the government. Two possible scenarios come to mind instantly: 1) the public option fails in delivering its promises of providing high quality health care for all at reduced costs, and proponents of the system will argue that it’s the private providers that keep the costs high for the public plan, and only a single-payer system can ultimately achieve the goals of universal health care without exploding the public deficit; 2) the low prices paid to health care providers by the public plan will mean that the public plan is subsidized by private plans, as health care providers charge private plans more to make up for the losses when treating public patients (this is already the case with Medicare and Medicaid) which will lead to an outcome that’s close to a single-payer-system because private providers will be crowded out of the market.
The opponents of private clinics in British Columbia clearly view the provision of private health care as a threat to the public system. One can very well imagine the same objections that are raised in Canada to be also raised in the U.S. once the public option passes through Congress. A 2005 Supreme Court response in Quebec, however, makes a strong case for individual rights in the choice of health care providers:
The first foot in the door for private medicine came in 2005, when the Supreme Court of Canada struck down the laws in Quebec that banned private insurance. The court found that having people die while on wait lists violated the province’s Charter of Human Rights and Freedoms.
To say it again, access to a waiting list does not equal access to treatment.
“What we have in Canada is access to a government, state-mandated wait list,” said Brian Day, a former Canadian Medical Assn. director who runs a private surgical center in Vancouver. “You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list.”
I hope that the Canadian courts reviewing this current case will recognize that outlawing private health care providers is a violation of the individual right to life. True, Canadians can and do cross the border into the United States to purchase private health care, but there is no acceptable reason why Canadians should have to leave their country to buy the treatments they want or need. And, who knows for how long private health care will be allowed to continue to exist in the United States?