Will private health insurance deliver?

by Colleen Flood

This commentary was first published in the Toronto Star on July 3, 2005.

The Supreme Court of Canada's decision in the Chaoulli case has been condemned by some and applauded by others. But many Canadians just wonder what will happen to them if private health insurance is allowed.

A close look at other countries with two-tier systems suggests most Canadians won't benefit.

New Zealanders can buy private insurance or pay out-of-pocket to avoid long waiting times in the public system, where lineups for treatment are much longer than they are in Canada. Britain also has a two-tier system and extremely long waiting lists. The Blair government now seems to be wrestling them down through a combination of better management and more public dollars.

The majority of the Supreme Court didn't consider the long wait times in these countries at all, although references to this was contained in the documents before them. They dismissed concerns that a two-tier system would result in the poaching of the best physicians from the public to the private sector.

But this explains why countries with two-tier systems, like New Zealand and Britain, still struggle with long waiting lists. It's a zero-sum game ó the health professionals who staff a second "private-pay" tier of health-care services in Canada will come from an already stressed public sector.

The justices do not mention European countries that allow a mix of public and private insurance. But the systems mentioned by the court are a far cry from the two-tier system that could emerge in Canada after Chaoulli.

Across Europe, there are complicated rules affecting public and private insurers, so their roles are blurred. For example, Sweden, Luxembourg, Greece and Italy prohibit doctors from practising in both the public and private sectors in an effort to keep most physicians in the public sector. If allowing private insurance doesn't have negative repercussions for the public system, why do these countries take these measures? Are they, too, as misguided as the Supreme Court has judged the Quebec government to be?

Often, the end result of regulation in the European system (with the notable exception of Britain) is that it doesn't matter what source the funding for your treatment comes from, you still receive the same standard of care.

But in Chaoulli, the whole point of striking down the ban on private insurance is so that people who buy such insurance can receive a better standard of care. A Euro-style system that regulates private insurers to ensure fair access could not emerge overnight in Canada and certainly will not emerge as a result of the court's decision.

That ruling struck down Quebec's law on private insurance without giving the Quebec government the opportunity to take any such measures.

The Supreme Court is not the only body that evaluated the pros and cons of two-tier medicine in recent times.

The Romanow Commission and the Senate (Kirby) committee have both done so over a number of years. The majority of the court ignores their final recommendations but latches onto Kirby's interim report, where he discussed the benefits of considering a greater role for private insurance.

But in the final report, Kirby concludes a two-tier system would have a detrimental effect on medicare. Canadians have to ask ourselves: Why was this evidence ignored?

The Chaoulli decision reflects the triumph of individual rights to purchase private insurance over the collective good. It also reflects the extent to which medicare has been left to wither across the country and then, in turn, inadequately defended by our governments before the Supreme Court.

Still, the Chaoulli judgment leaves it open to governments to protect medicare short of legislating a ban on private health insurance. If governments do not license private hospitals, or if they require physicians to give up their public-sector incomes to work in the private sector, then a private sector will not flourish.

But the best possible response is to restore confidence in the system by standardizing wait times across the country and managing wait lists fairly.

Canadians need to demand of the medical profession and of their governments that wait lists be tackled now.

Canadians pay for, through their tax dollars, enough money to ensure an excellent public health-care system. They should get it.