Court decision on health care is a call to action

Reacting to last week's Supreme Court decision (striking down parts of Quebec's health care legislation), Prime Minister Paul Martin vowed that “We're not going to have a two-tier health care system in this country. Nobody wants that.”

Of course, that's not quite true. Clearly the plaintiffs in the case — a Quebec doctor and one of his patients — want a two-tiered health care system in Canada. And, those who intervened on their behalf, including several private medical clinics, the misnamed Canadian Taxpayers Federation, and a group of Senators led by Liberal Michael Kirby, clearly want to see a two-tiered system.

Retired politicians Mike Harris and Preston Manning openly advocated two-tiered health care in a report released earlier this year. As well, despite his province's vast wealth, Alberta Premier Ralph Klein has made no secret of his desire to set up a parallel private health care system.

And, until he decided that he needed to appear moderate (and that's working out really well, isn't it?), Conservative Party leader Stephen Harper was a staunch advocate of health care privatization. He once penned an op-ed piece charmingly entitled “Why fear private sector health care?” During the 2004 Leaders' Debate, Harper asked “Why do I care and why do we care as a federal government how they [health services] are managed? What we care about is that people can access them.”

Indeed, despite his lofty rhetoric about defending medicare, one could easily argue that his actions could only indicate that Paul Martin “wants” a two-tiered health care system. After all, since 1993, absolutely no action has been taken against provinces that have allowed private health care to flourish. Moreover, it was Martin's brutal budget cuts in the mid-1990s — cuts that are only now being partially restored — that paved the way for this Supreme Court decision.

Keep in mind that the ruling was based on the fact that (under Quebec's Charter, not Canada's) it was unconstitutional to prohibit people from paying to obtain health care, but only “where the public system fails to deliver reasonable services.” As Chief Justice Beverley McLachlin wrote on behalf of the majority, “The evidence in this case shows that delays in the public health-care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health careâe¦. Access to a waiting list is not access to health care.”

That's the crux of the dilemma faced by governments in the aftermath of the decision. They can either roll over and acquiesce to more private care (which, as I will argue below, would be a bad thing) or they can ensure that the public system offers the care that people need (which, obviously, would be a good thing).

The unfortunate thing about the health care debate is that those who favour publicly funded health care often end up being pigeon-holed as defenders of the status quo, even though they know that the status quo is far from ideal. There is much to be done to improve the system. That means much more money, but it also means much more than money.

So, with that in mind, where's the harm in letting people who can afford to pay for quicker health care to do so? First of all, doing so only creates further delays in care for everyone else, as health care providers and facilities are lured into the parallel private system.

As well, the unfortunate reality is that divorcing the concept of paying taxes from the reality of receiving services from government is a guarantee of two things: people will be less and less willing to pay the kind of taxes needed to sustain medicare; and those who are using the private health care system instead of the public health care system won't care whether the latter system is properly maintained.

That will mean that those Canadians with money will get health care, while those without will not (a potentially more serious constitutional issue).

But, perhaps most importantly, the best way to provide care to all Canadians is to have the government organizing and funding it on behalf of all Canadians. Sharon Sholzber-Gray, president of the pro-medicare Canadian Healthcare Association, explains the need for a public system as follows: “Canadians have to understand — and I've said it over and over again — it's not a $50 or $500 or even a $50,000 issue. It's who is going to pay for the very expensive and costly treatments today, and there's only one way to do it and that's by sharing in it.”

The federal government argues that it already is paying its share but, if that were the case, people wouldn't be waiting for care for as long as they are, and the Supreme Court wouldn't have ruled in the way that it did. If its only answer is last year's Health Care Accord, then our health care system will continue to be challenged in both the clinics and in the courts — possibly successfully.

Faced with a choice of allowing more private health care or funding health care adequately so that everyone receives timely access to care, the Martin government appears to have decided that it will do the former while pretending to do the latter. That may be worse than doing nothing at all.

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