Allowing private providers would boost health-care system

Catherine Mitchell

ONE of the things I love most about Canadians is their fervent belief in universal health care and its connection to a national identity. Across the country, surveys consistently show that Canadians believe that access to health care should not be determined by one's ability to pay. It is the best of Canadianism, a generosity and desire to share the abundant wealth of an affluent country.

Flip over that generosity and, in some people, what you see is a miserly side, fervently insisting that medicare not be tampered with because it means those with money will use it to buy their way up the line. Those people, goes the alter ego's argument, must be prevented by law from using their cash to protect their health, to detect an aneurysm, lance a growth or prevent a heart attack.

These situations are not always life or death, and more often than not they catch up not the affluent, but ordinary wage slaves and the self-employed. Try telling a plumber with a torn rotator cuff it is his duty to wait six or seven months for surgery to preserve the integrity of medicare.

The persona of that alter ego is rarely so well defined as it is now, in the form of a national campaign by unions to wage war on private payment for health care in Canada. The Canadian Union of Public Employees and the Canadian Federation of Nurses have teamed up to present you with " yourmedicarerights.ca ," which calls upon people to "say no" to extra billing and "profiteering" and to write their local newspapers and MPs to protest.

Private payment happens all the time across the country alongside the public system, playing out in the offices of doctors and in hospitals. But in some provinces -- Quebec, particularly, and to a lesser degree in British Columbia -- there are strictly private practices setting up. Stand-alone clinics can get you an appointment pronto, with an MRI for cash on the barrelhead; specialist practices sign up members who pay what amounts to "club fees" to gain speedy checkups.

It is a parallel system catering to those who are tired of the numbing bureaucracy and inefficiency of a system operating on institutional rules and government-sponsored budgets that set quotas on procedures.

But those are merely the most provocative examples of the dual system that operates in Canada.

People don't complain about the other groups who regularly jump the queue, getting preferred service in the public system because the insurer has an interest in saving itself the expense of paying the wages of someone off work with an injury. The RCMP, the military, workers' compensation schemes and Manitoba's own auto-insurance monopoly all pay for health care outside the government system for speedier service.

If it is unfair for a private practice to cater to those who can afford the service, why is it acceptable for clients of third-party insurers to be jumping the public queue? In Canada, governments make it legal.

There are other, lesser-known ways that governments approve private payment for insured services.

In Manitoba, long past the days when $2,000 once got you in for private cataract surgery, an ophthalmologist will excise a bump on your eyelid, in his or her office, for $60. The private "tray" fee -- a charge for the anesthetic and other equipment -- is approved by an agreement between the Manitoba Medical Association and the provincial Health department, which the physician bills for the cost of the 10-minute surgery itself. The procedure gets done quickly, or the patient can opt to join the lineup for surgery at the Misericordia.

Why wouldn't the government pay eye specialists to keep minor procedures in their offices?

In Manitoba, a hospital will give a cataract patient the choice of a soft or hard lens implant, but will charge that patient $300 if they select a soft lens, which requires an incision in the eye half the size. Manitoba is one of the few provinces that continues to cover only hard lenses, which cost one-tenth the price but carry a higher risk of complication.

Similarly, why would the government fight to run private diagnostic clinics out of town when it could welcome entrepreneurs to "invest" in machinery to perform the MRIs, ultrasounds and CT scans?

The national unions promoting the protest are not interested in protecting people's "rights" under the Canada Health Act so much as they are fighting the rise of a parallel system that will erode their power in publicly funded hospitals. Unions protect the interests of their members and their organizations, which is not so nefarious as it sounds, but they are not one and the same as the interests of those needing good, efficient health care.

Everyone is a diehard fan of the government's monopoly over health care until his or her child needs a diagnostic test to investigate a potentially serious kidney disease and ends up in a line eight months long. Imagine having to wait to learn if your child has epilepsy.

I'm all for "investing" public money in the system to improve efficiency, but billions have been poured into health budgets, which now eat more than 40 cents of every tax dollar, with minor, isolated improvements to brag about. Medicare should be universal but also timely. But if money could have fixed that weakness in the health system, the so-called profiteers would have been out of business long ago.

The better idea is to welcome private providers into the public system to speed service so no one waits months for care. For those who want their surgery within days, let them use their own cash.

Canada is the only country that bans private health care. It compares poorly with European counterparts, spending more per capita for service that is hobbled by wait times. Ask a union why that is.

catherine.mitchell@freepress.mb.ca