Medicare should be strengthened, not torn down
TheStar.com – Opinion/Editorials – ‘It would be a tragedy if the nation’s most cherished social program was gutted before it could be made to live up to its full potential.’
Sept. 9, 2016. Editorial
Let’s face it, there’s a lot that’s wrong about medicare.
Canada spends more per person on health care than many comparable countries, yet our actual health is often poorer. We wait too long for many procedures, and the system’s many parts don’t communicate well with each other. What’s more, medicare as we know it doesn’t even cover almost a third of our health care costs – pricey things like prescription drugs and dental care.
So health care experts and politicians have their work cut out for them to fix what’s wrong and make sure the system meets the high expectations of patients and health care professionals alike.
What they don’t need is what’s at the heart of the landmark legal case that began this past week in Vancouver – a bid to remove barriers to two-tier health care and let doctors work in both the public and private systems at the same time. That wouldn’t improve medicare; it would destroy its foundations.
The case pits Cambie Surgeries Corp., co-owned by a leading advocate of private medicine in Canada, Dr. Brian Day, against British Columbia’s Medical Services Commission, which oversees the province’s medicare system. But as all involved acknowledge, the case involves principles that go to the heart of the way medicine is structured in this country and therefore has national implications. It will surely end up in the Supreme Court of Canada.
Essentially, Day is going to court to accomplish two things. He wants to overturn B.C.’s ban on the sale of private insurance for “medically necessary” services (five other provinces have similar bans). And he wants to overturn a law that forbids doctors from offering privately paid care if they already work within the public medicare system. At present, they must opt completely out of medicare if they want to charge private fees.
Day argues that the current system violates patients’ Charter rights to “life, liberty and security of the person” because it prevents them from seeking medical care privately even if the public system can’t provide it in a timely fashion.
It’s far from clear what the B.C. court will decide, or what higher courts may say on appeal. The Supreme Court did rule in a 2005 case that Quebec’s ban on private insurance broke that province’s laws, but it didn’t rule on the Charter issue. So there’s no clear legal precedent.
Regardless of the legal debate, though, there’s little doubt about the real-life effects of what Day is seeking. If patients who can afford private insurance are allowed to buy themselves out of the public system, it will create the two-tier structure that Canadian medicare advocates have been fighting to head off for decades.
Instead of having patients wait for operations and other procedures according to medically determined priorities, there would be in effect two lines. One for those with private insurance and the means to pay extra for quicker service. And one for the rest of us. No prizes for guessing which one would be moving faster.
It’s fundamental to medicare that all should be treated equitably. If you’re moved ahead in the queue it should be because your condition requires it. Not because you can fatten the pocketbooks of health care providers.
Just as importantly, once those with means have taken care of themselves and their families, they will inevitably become less committed to the well-being of the public system. It will become harder and harder to mobilize support for making the improvements in medicare that all agree are needed.
Day has struck a nerve by highlighting the shortcomings of the system, like lengthy wait times for some procedures and outdated technology that makes doctors’ offices one of the last bastions of the fax machine. He has also focused attention on glaring inconsistencies – such as the fact that public bodies like workers’ compensation boards and the armed forces are the biggest clients of private clinics. That’s straight hypocrisy.
All those issues must be addressed, but tearing down a system that has served the country well for many decades is no proper solution.
If anything, medicare should be broadened. Even now, Canadians rely on private insurance and payments for some 30 per cent of their health costs, including vital things like prescription drugs, dental care, vision care, physiotherapy and home care.
It would be a tragedy if the nation’s most cherished social program was kneecapped before it could be made to live up to its full potential.
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