When at long last Canadian patients are finally permitted some measure of health care choice — rather than being shackled to the government health monopoly –much of the thanks will have to go to Quebec. Sure, British Columbia has a growing number of private clinics, but Quebec has far more–nearly 60 — than the rest of the country combined. Ontario and Alberta have pending court cases challenging the constitutionality of medicare, but Quebec’s public insurance law has been hanging by a thread since the 2005 Chaoulli case, which decided that patients could not be forbidden from buying private health insurance if the public system was incapable of serving them in a timely period.
And this week, along comes Claude Castonguay the “father” of Quebec’s public health care scheme. On Tuesday, in a report on the state of health care commissioned by the Quebec government, Mr. Castonguay proposed what, to some, appears a radical overhaul of the public health system. He argues that Quebec should be the first province in Canada to permit the sale of private medical insurance, even for procedures covered under medicare, and that doctors should be allowed to practise in both the public and private systems. He even recommended doctors be permitted to rent hospital facilities after hours for their fees-paying patients.
All of this is sacrilege to Canada’s advocates of public health care. Each of the recommendations in the Castonguay report, they argue, will lead to queue-jumping. Patients with private insurance or who can afford to pay a doctor directly will be able to avoid the long waiting lists in the public system. Permitting private insurance, allowing doctors to work simultaneously in both the public and private health sectors and permitting them to use hospital equipment, according to friends of medicare, all lower the bar to two-tiered health care.
Mr. Castonguay didn’t stop at advocating parallel public and private systems with plenty of intersections between the two. He also thinks patients should pay $25 each time they go to see a doctor. One of the first effects of the passage of the Canada Health Act in 1984 was the outlawing of users fees, a practice typically known as extra billing or balance billing. This was heralded as a great equalizer in access to health services. No longer did income determine one’s ability to go for a check-up or consultation.
Unfortunately, the unintended consequence of doing away with user fees was a sharp jump in visits to doctors’ offices. Since the visits cost nothing, patients started going for every little ache or minor complaint. In Alberta, one of the last provinces to give into Ottawa’s blackmail over the CHA, doctor visits jumped nearly a third in the first two years after user fees were eliminated. Albertans hadn’t gotten sicker, it was just cheaper to go to see the doctor. So they went all the time.
Mr. Castonguay’s suggestions, including extra billing, are little more than common sense. Most Canadians know instinctively the system cannot be sustained as is. They also know that wait times continue to grow while sosts are rising and satisfaction is declining.
In the 1970s, Mr. Castonguay created a public health system in Quebec that was a model for the rest of Canada. We hope that pattern will repeat itself today, that other provinces will again take their cue from the “father” of Quebec’s public health care system and embrace the change needed to improve health care in Canada.
To read an executive summary of Getting Our Money’s Worth, click here.