Taboo Musings

If you ever wanted to set a Canadian citizen off on a frantic search for some cotton to stuff in his or her ears, all you have to do is to mention two words together in the same sentence: 'private' and 'healthcare'. Canadians must have been frightened out of their wits earlier this month when the Supreme Court, in a landmark decision, struck down a Quebec law banning private healthcare. As Canadians, we have been trained to boast of our public healthcare system as our proudest accomplishment, yet, paradoxically, it is widely acknowledged that the system is broken (Thus Paul Martin's pledge to "fix healthcare for a generation".) The supreme court merely confirmed this by ruling that being forced to wait ad nauseam for public health services is a violation of a patient's rights to "life, liberty, and security" as guaranteed by Quebec's Charter of Rights.

This isn't really "news" per se. Healthcare has for a long time been a major election issue, yet the debate on how to improve the system has generally been confined to discussing how much money should be pumped into the system. Mention anything about the possibility of private healthcare and the guillotine drops. In April 2004, Health Minister Pierre Pettigrew (who has since taken over the Foreign Affairs ministry) said that "the Canada Health Act does not preclude delivery of services by private elements as long as there is a single public payer." The next day he was forced to retract the comment and clarify, "[My comment] left the impression that I favour increased private delivery within the public health system. That was in no way my intent, nor is it the intent of the government of Canada." A year later, Preston Manning and Mike Harris released a joint report calling on the federal government to get out of healthcare. The report made headlines, but there was no discussion on the issues presented, just a shrill Prime Minister in the House of Commons fending off invisible invaders with a cry to "fight tooth and nail" to defend medicare.

And that is the current state of the debate. One side is determined to fight tooth and nail against any presentation of logical arguments, and the other side is losing its voice.

But, being just an average Joe writing a blog, I might be able to present some logical arguments without being drowned out by declarations that I am out to destroy Canada's soul. (I doubt most people would even read up to this point in the article, but I shall continue regardless.)

Here goes...

The federal government should leave healthcare to the provinces. After all, the Constitutional Act of 1867 defines as one of the exclusive powers of the provincial legislatures "The Establishment, Maintenance, and Management of Hospitals..." Meanwhile, the only effect that a nationally-enforced public monopoly on healthcare has been to stymie any experimentation on delivery methods.

Consider an analogy. Shortly after the French and Dutch voted not to adopt the European Constitution, the Economist analyzed the source of Europes woes, "...opponents of the constitution have displayed contradictory views - some wanting more economic liberalism and freer markets, others a social Europe with more fettered markets." It concludes, "...the only way to accommodate such diversity of views is to give countries a choice. If Britain, say, wants to keep its labour markets free of unnecessarily burdensome rules..., it should be allowed to do so; if France prefers to do more to protect those who are in work, it should be free to do that too. Neither side should be able to impose its policy on the other." In other words, rather than having the EU impose its methods on member countries, it is often better to have countries lead by example. Let Britain and France determine their own economic policy and then see whose economy does better.

The same reasoning applies to our healthcare system. Throughout Canada there are divergent views on how healthcare should be handled. In Quebec, the provincial government instantly considered using the notwithstanding clause to overrule the Supreme Court decision. In Alberta, the provincial government has been contemplating healthcare reforms. Unfortunately, since experimentation is virtually outlawed by the Canada Health Act, our monolithic health system has prevented our country from discovering more effective ways to deliver health services. It is with good reason that our Constitution alloted hospital management as the prerogative of provincial legislatures; by providing for a diversity of delivery methods for health services across the country, provinces can lead by example, allowing healthcare systems to evolve.

The Economist, however, does not argue for a complete free-for-all in Europe. It adds that a referee is still necessary, for instance, to police the EU single market. Similarly, the federal government's role in healthcare should be restricted to the role of referee. Their role should be limited to enforcing adherance to the principle of universal access to health services. Nothing more.

In the near future, the most urgently needed action is to break the taboo on discussing alternatives to the public health monopoly. We need to have an earnest debate on how to fix the system. There is no need for biting and scratching.