Terence Corcoran: Private health care for profit — it's coming


Last Sunday on CBC radio’s long-running national phone-in program, Cross Canada Checkup — formerly hosted by the redoubtable Rex Murphy — current host Ian Hanomansing calmly and professionally handled the curve balls flying through the air on the hottest political issue in the country: “Is Canada’s health-care system in crisis?”

It’s a rhetorical question. Of course it is, and everybody knows it. The debate is about how to end the crisis and come up with reforms to a crumbling national public health regime. Hanomansing was 25 minutes into the 90-minute segment on health care when he deftly and objectively fielded a curve ball from Adele in Hamilton.

Adele is a 79-year-old whose 78-year-old partner needs a hip replacement. The earliest schedule surgery possible in Toronto was “near the end of February.” She said her partner’s condition was getting worse, forcing him to take pain meds that were troubling. “I started researching on private surgery. … What I found, after really researching, is we can have it done in Montreal and the date of the surgery in Montreal is August 23. We are biting the bullet and we are going to go and do that.” The total cost: $20,000.

The issue, said Adele, is not public vs private. “I’m talking about quality of life” for people who are suffering. She went on to emphasize an ideological point: “We’re very left wing. We are not about the rich and the poor. We are not those kinds of people.” She added that there just “comes a point where you have to look after your loved one in the best way you can.”

It’s a national problem, although Hanomansing wondered whether officials in Ontario’s health ministry were listening. If anyone in the Ontario government heard Adele’s story maybe they could call in to comment on her story. Nothing came of the invitation.

Another guest, Dr. Margaret Fraser, a family physician in Nova Scotia, complained about the “creep of private health care because it benefits the people who can pay for it.” She also said it was “horrifying” that Adele and her husband had to go out of province where they would have problems accessing post-surgery follow-ups.

Even more publicly horrified by the prospect of private health care is the union-backed Ontario Health Coalition (OHC), which claims to be “at its highest level of alert” over claims Ontario Premier Doug Ford is on the brink of privatizing health care, “including Ontario’s public hospital services.” During a marathon Zoom/facebook media monologue on Tuesday, OHC executive director Natalie Mehra said any plans to turn government monopoly services over to profit-making private services is an “asinine idea, it is reckless, it is dangerous, it does actually threaten the public health-care system.”

That’s the conventional view among defenders of Canada’s government-planned and operated national health regime, despite long-standing economic theory and mounting evidence that the central planning model is predictably doomed. As a result — and this is just an impression —  the legal, political and economic debate over privatization options have never been more prominent. From the Adeles of Canada seeking prompt and life-saving care to physicians and entrepreneurs ready to challenge the system, Canadians are ready to look at private alternatives to public care.

Members of the OHC and scores of other national and provincial medical organizations sense that the change is coming. “We’re into a big fight,” said Mehra.

In Quebec, where private-pay hip surgery and other procedures have been allowed for years, expansion seems to be underway. In Alberta, increasing use of private surgeries are part of the provincial health plan, although the moves are not really full privatization. The government still controls the system.

Privatization was dealt a blow in British Columbia last month when the province’s Court of Appeal ruled against the rights of residents to pay privately for medically necessary health care. In a decision that is almost certain go to the Supreme Court in Ottawa, the appeal court essentially said that while restrictions on health care payments are breaches of the Canadian Charter of Rights and Freedoms’ protections of individual rights to “life, liberty and security of the person,” the loss of those rights is justified to protect the health-care system. As summarized by Canadian law firm Fasken, the overriding objective “is to preserve the public universal health-care system for medically necessary services and to ensure that access to medical care is based on patient need, not the ability to pay.”

Strict adherence to the principle would force Canadians such as Adele to sit with her partner as he suffered and deteriorated so as to protect the alleged integrity of public health insurance.

The essence of Canada’s health-care system is demonstrated in the B.C. court case. Public health is achieved through the nationalization of doctors and medical services. By restricting their freedom to provide services through private, competitive and profit-making structures, the system restricts the ability of Canadians to freely pay for medical services just as they are free to pay for their food and housing.

The lost economic freedom — within the medical system and throughout the population — is at the root of Canada’s national health care crisis. This time, as the crisis grows, change seems to be coming.

Financial Post

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