Wil­liams should muster courage to cham­pion pri­vate health-care op­tion

Cape Breton Post - - COMMENT - BY BRETT J. SKIN­NER Brett J. Skin­ner is di­rec­tor of health and in­sur­ance pol­icy re­search at the Fraser In­sti­tute and is the au­thor of the book Cana­dian Health Pol­icy Fail­ures.

What does it say about the state of Cana­dian health in­sur­ance when New­found­land Premier Danny Wil­liams chooses to have his heart surgery in the United States?

Some pun­dits say it means noth­ing while oth­ers have in­sisted the premier could have ob­tained his med­i­cal care some­where in Canada.

But the de­tails of Wil­liams’s case are ir­rel­e­vant to the main ques­tion, which is: If it is OK for a Cana­dian politi­cian to get pri­vate med­i­cal treat­ment in Amer­ica, why is it il­le­gal for reg­u­lar Cana­di­ans to get pri­vate med­i­cal treat­ment in Canada?

In other words, why do pro­vin­cial gov­ern­ments make it il­le­gal for Cana­di­ans to spend their own money to pre­serve and im­prove their own health?

Why are or­di­nary Cana­di­ans forced to wait in a gov­ern­ment-im­posed queue for ac­cess to nec­es­sary med­i­cal care?

Wil­liams’s de­ci­sion is not unique. Ac­cord­ing to the most re­cent Fraser In­sti­tute es­ti­mate in 2009, the premier would be only one of about 41,000 Cana­di­ans who an­nu­ally seek non-emer­gency med­i­cal care out­side of Canada. Con­sider how ab­surd it is that the only way for Cana­di­ans to pay pri­vately for bet­ter or quicker med­i­cal care is to leave their own coun­try.

Our an­nual in­ter­na­tional re­port com­par­ing Canada to other coun­tries with uni­ver­sal health in­sur­ance sys­tems shows that Canada is vir­tu­ally alone in pro­hibit­ing peo­ple from spending their own money to get quicker or bet­ter health care.

Who is to blame for this? De­spite com­monly held be­liefs, the Canada Health Act does not pro­hibit pri­vate in­sur­ance for med­i­cal ser­vices; the act pro­hibits only user charges un­der pub­lic in­sur­ance.

It is ac­tu­ally the prov­inces that pre­vent Cana­di­ans from do­ing at home what Wil­liams chose to do in the United States.

In fact, six prov­inces (ac­count­ing for about 84 per cent of the na­tional pop­u­la­tion) legally ban di­rect pri­vate pay­ment for nec­es­sary med­i­cal ser­vices, and six prov­inces (ac­count­ing for 90 per cent of the na­tional pop­u­la­tion) legally ban the pur­chase of pri­vate health in­sur­ance for nec­es­sary med­i­cal ser­vices.

Most prov­inces also pro­hibit par­al­lel billing by health-care providers.

In th­ese prov­inces, hos­pi­tals and physi­cians are not al­lowed to ac­cept pri­vate pay­ment or pri­vate in­sur­ance re­im­burse­ment while ac­cept­ing pub­lic pay­ment from the pro­vin­cial health in­sur­ance sys­tem.

Health-care providers must choose to work for ei­ther pri­vate pay­ment or pub­lic pay­ment, but can­not elect both. Most doc­tors are not will­ing to sur­ren­der their billing rights in the pub­lic sys­tem and there­fore do not even make their ser­vices avail­able for pri­vate pay­ment.

This is how gov­ern­ments ef­fec­tively ban pri­vate health in­sur­ance and med­i­cal care in Canada.

Few Cana­di­ans can af­ford to travel to Amer­ica in search of faster or bet­ter care. When pro­vin­cial in­sur­ance doesn’t sup­ply timely ac­cess to nec­es­sary med­i­cal care, or­di­nary Cana­di­ans are forced to wait.

An­nual Fraser In­sti­tute re­search shows that wait times for many med­i­cally nec­es­sary pro­ce­dures are ex­ces­sive in Canada. Av­er­aged across the 10 prov­inces, the me­dian wait from see­ing a gen­eral prac­ti­tioner to the time of treat­ment by a spe­cial­ist was 16.1 weeks, up from 9.3 weeks in 1993.

Our re­search, us­ing gov­ern­ment data, has also shown that Canada’s health in­sur­ance sys­tem sup­plies far fewer physi­cians (as well as med­i­cal tech­nolo­gies like MRI ma­chines, CT scan­ners, and lithotripters) per pop­u­la­tion than are avail­able in the United States.

Rel­a­tive to Amer­i­can health care, Canada’s sys­tem is slow to in­vest in new med­i­cal tech­nol­ogy, while many ex­ist­ing pieces of med­i­cal and di­ag­nos­tic equip­ment in Canada are outdated and in need of re­place­ment.

It is there­fore not sur­pris­ing that Wil­liams, and sev­eral other high-pro­file politi­cians be­fore him, have cho­sen to get med­i­cal treat­ment out­side of Canada when they fall se­ri­ously ill.

Their cases cap­ture head­lines but they are just a few of the tens of thou­sands of Cana­di­ans who seek med­i­cal treat­ment in the U.S. ev­ery year without be­ing no­ticed by the me­dia.

It is time that we all stop tol­er­at­ing ide­o­log­i­cal ex­cuses for a sys­tem that pro­hibits or­di­nary Cana­di­ans from spending their own hard-earned money to buy timely ac­cess to med­i­cal goods and ser­vices.

I wish Wil­liams a speedy re­cov­ery. I hope that when he re­turns to Canada he will muster the courage to fight for the free­dom of all Cana­di­ans to make their own choices about their own health care, without hav­ing to leave the coun­try – some­thing that is al­lowed in ev­ery other na­tion with uni­ver­sal health in­sur­ance.

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