The dam holding back two-tier health seems to be breaking, as some provinces are considering radical new ideas.
When news broke recently that the Ontario government may be planning to shake up its health-care regime, the federal government responded with a stern defence of the Canada Health Act, the law that governs how tax dollars should be spent providing health care.
“We have acted in the past when provinces have not aligned themselves with the Canada Health Act and we will ensure that every province follows the requirements of the Canada Health Act,” said Prime Minister Justin Trudeau, when asked about the potential changes.
One of those proposed plans, according to a document leaked to the Ontario NDP, called for a “super agency” that could “order any health-care provider to contract out any part of their procurement or supply chain. It has the power to order any provider to privatize huge swaths of health care,” said Natalie Mehra, Ontario Health Coalition executive director, to PressProgress.
This could lead to two-tier health, which is prohibited by the Canada Health Act, according to Mehra.
The Act doesn’t specify what provinces can or can’t do in any detail, but “should any province decide not to comply, the federal government had the right to withhold all or part of a transfer payment, depending upon how egregious the offence. For instance, Section 20 states quite clearly that should a province violate the prohibition on extra-billing or user fees, an amount equal to that collected would be deducted, dollar for dollar, from that province’s transfer payment,” argues Ontario political consultant Stephen Skyvington in a new book This May Hurt a Bit: Reinventing Canada’s Health Care System.
But the dam holding back two-tier health seems to be breaking, as some provinces are considering radical new ideas.
The Newfoundland and Labrador Department of Health recently allowed eye surgeries to be performed in private clinics.
“The change will allow patients to schedule publicly funded eye surgeries either at a private clinic, which must be approved by government, or hospital. There is no timeline for when this would take effect,” according to CBC.ca. The move comes after months of wrangling over increasing wait times and public consternation from doctors.
In Alberta, a new Fraser Institute report calls for that province to take drastic steps to improve its health system. “The province can dramatically expand capacity and incentivize competition by using third-party private clinics to deliver health-care services within the public system, which is not prohibited by the Canada Health Act and would likely shorten wait times for Albertans.”
As well, Alberta could allow for private financing, again with the goal of opening space in the public system. “The creation of a private parallel system in which Albertan’s could pay entirely out of pocket, or obtain private insurance for the full cost of services is not explicitly prohibited by the Canada Health Act, but is severely impeded by provincial legislation. Removing such restrictions has the potential to alleviate pressure on the public system, and provide patients with an alternative within the province’s borders.”
Finally, in Nova Scotia, a prominent doctor is calling for a new private system to be implemented.
“Public and private delivery of health services can work, but require strong public leadership, a new philosophy, and corporations that accept the balance of a healthy, productive workforce, a good place to live, and are invested in the long game (rather than quick profits at any cost),” said Dr. John Ross, medical director of Praxes Medical Group and advisor to the Deputy Minister of Health.
Many Canadians obviously care little about political games and schemes, but they do care about one thing: health care is critically important. Perhaps some changes to the laws governing its delivery are an idea whose time has come.