Advocates for a two-tier health care system are walking with an extra spring in their step these days.Two recent developments in the health care debate have proponents of privatization declaring victory.

First, on June 9, 2005, in the Chaoulli vs Attorney General of Quebec case the Supreme Court of Canada found that Quebec’s ban on private insurance for insured health services violated the Quebec Charter of Human Rights and Freedoms

Then, last month, the Canadian Medical Association (CMA) passed a motion supporting private insurance “when timely access to care cannot be provided in the public health care system.”

Treating these developments as a green light for privatization, proponents of a parallel private system have already begun declaring victory.

They shouldn’t be.

In reality, neither the Supreme Court of Canada’s ruling nor the CMA’s motion should be taken as an outright endorsement of privatization. They simply emphasize the importance of timely access to care. In both cases, privatization is deemed justified if — and only if — timely access to health care cannot be provided.

Before we open the doors to private insurance — which would include the private delivery of health services — Canadians should ask themselves whether a two-tier system would actually be the best way of ensuring timely access to care for all.

Long waiting lists are not an inherent part of the public health care system. They are a fairly recent phenomenon. Prior to the mid-90s, waiting lists were not long enough to create the problems that we are witnessing today. Problems began with the 1995 federal budget, through which the Canadian government cut funding to the provinces for education, social security and — you guessed it — health care by 40 per cent.

Provincial governments tried to cope with this drastic decision, but access to timely services became increasingly difficult. The quality of public health services declined, waiting lists got longer, and provinces became more open to the idea of privatization. Those who were already ideologically biased towards the creation of a private health care market used the opportunity to justify their message.

When the federal government finally decided to reinvest in public health care around 2000, the compounded effects of five years of neglect had taken their toll. The public system had suffered a severe blow and it would take more than merely reinjecting funds to cover operational expenses.

Ten years later, we have forgotten how well Canada’s public system served us prior to the irresponsible budget cuts in 1995. Rather than demand that the government re-establish health care as a priority and clean up the mess it created, we have begun to look to the private sector for solutions.

Most Canadians agree that they do not want the American system. Instead, advocates of a two-tier system often point to European countries to demonstrate the viability of a parallel private system.

Consider the Chaoulli decision, which, in theory, affects only Quebec. The Supreme Court deemed long waiting lists to be a threat to the well-being of citizens and thus, an infringement on their rights. Drawing from examples from France, Sweden and Germany, the Court concluded that the request of appellants Jacques Chaoulli and George Zeliotis to overturn the private insurance ban in Quebec was reasonable given a provincial government’s failure to properly address the waiting list problem.

But there is a crucial distinction between Canada and these European countries: they have not signed on to the North American Free Trade Agreement (NAFTA).

When negotiating NAFTA, Canada obtained an exemption (Annex II) aimed at preventing foreign corporations from gaining access to Canada’s health care market.

But once health insurance and health delivery are offered in the private system, the exemption for health care services ceases to apply. Health Maintenance Organization (HMOs), large one-stop shopping corporations providing both health insurance and delivery, will be able to enter the Canadian market and compete with the public sector.

If this scenario becomes a reality, HMOs will drain a large number of doctors, nurses and other professionals from the public system, which will likely create a staffing shortage in public hospitals. They will also provide competing private insurance for services also insured publicly.

Let’s not forget that the goal of these large private corporations is to make money and not to serve the public. As in Great Britain and the United States, people with chronic illness and high-risk patients need not bother applying for private insurance. They will most certainly be turned down on the basis that treatments for their illnesses are not profitable. These tougher cases will remain in the already burdened public sector.

Other OECD countries do not face this threat. They do not have to open their health care market to HMOs or other foreign health giants. This is not an issue the Supreme Court has considered and it is one on which two-tier advocates are silent.

Canadians should be concerned about the political impacts of the recent decisions by the Supreme Court and the Canadian Medical Association. They indicate that Canadians are growing impatient with the sorry state of our health care system. As advocates of two-tier health care take advantage of the waiting list problem to push their privatization agenda forward, federal and provincial governments must respond quickly with increased funding and better resource management — before it’s too late.