COMMENT: Healthy debate. Canadians are warming to the idea of parallel, private health care, so it is time for our leaders to act

Health care is still the number one issue of concern for Canadians, and August is the favoured month in which elite groups of premiers, politicians, lawyers, judges, and physicians, gather for their annual powwows to discuss these national concerns. Recent public surveys have revealed a new twist in the health care issue that should give these leaders plenty to think about during the summer.

The twist is the unexpected and favourable change in attitude by Canadians toward acceptance of parallel private and public health services. Going back to 1998, a Harvard survey found that 79% of Canadians thought that either fundamental changes or a complete rebuilding of the health system was required. In 1999 a Pollara survey found that 73% of Canadians supported the right to pay for private health services if they don’t get timely access to services through medicare. This year a Health Insider survey found that 60% of Canadians, including 64.4% of Quebecers and 54.8% of Ontarians, supported private parallel health services as long as the public system was not jeopardized. Also this year, an Ipso-Reid survey discovered that Canadians favour a greater role for the private sector, with 60% supporting the “contracting out” of public health services to the private sector.

This emerging attitude of consumerism to health care, though unexpected, is quite similar to the tolerant liberal attitude of most Europeans. Unlike Canadians, however, Europeans enjoy universal access through parallel systems of public and private health care and health insurance, co-ordinated by the free choices of individuals, market competition and regulation. This successful combination, along with other advantages, has long been the standard in Western Europe. It has enabled their health care systems to rank higher than Canada in overall performance, according to the World Health Organization Report of 2000 and Cynthia Ramsay’s research study, Beyond the public-private debate, published by the Marigold Foundation in July 2001.

This change of attitude by Canadians is remarkable. It is light years ahead of current political and economic thinking in governments and organized medicine. It is the opportunity and signal for which private health policy reformers have been waiting for decades. It is the precondition to successful financial and structural reform of Canada’s socialized health system.

These favourable circumstances could offer the politicians and physicians their first real opportunity for successful reform since the political and legislative suppression of private medical, hospital and health insurance services decades ago. It could enable them to facilitate a popular citizen initiative and restore personal freedom and choice in health care by decriminalizing parallel private medical and hospital services and private health-insurance services. This would bring Canada’s health system up to European standards, and allow Canada to improve the 30th place ranking of its health system by the World Health Organization.

Unfortunately, the majority of Canadians, including the younger generations who most strongly support this attitude of tolerance and personal freedom, are on a collision course with current health legislation. Medicare legislation bans the sale or purchase of parallel private medical and hospital insurance and privately funded medical services in hospitals, even though publicly insured medicare services might not be available, convenient, or of the desired quality.

That is why deliberations and actions of the influential political, legal, and medical bodies who meet during August and beyond, should be aimed at:

• Recognition of the important change in the attitude of Canadians, toward private health service.

• Initiation of health system policy and legislative reform, to restore the constitutional freedom of Canadians to protect their own lives and health, if they judge necessary, through the purchase of private medical and hospital services and private health insurance, regardless of any concurrent coverage by medicare.

• Repeal of federal and provincial health legislation that now prohibits or discourages these freedom-enhancing objectives in the areas of financing, insuring and delivery of health care and health insurance services and private property.

J. Edwin Coffey MD is an Associate Researcher with the MEI and co-author of Universal Private Choice: Medicare Plus, A Concept of Health Care with Quality, Access and Choice for All Canadians.