The CMA and Health Minister throw old canards into the private healthcare debate

BY OWEN DYER

Federal Health Minister Ujjal Dosanjh is disappointed with Canada's doctors, and especially with the president of the CMA, Albert Schumacher.

The reason for his displeasure is that the CMA plans to hold discussions on the future of private healthcare in Canada at its August annual meeting. "I am extremely disappointed," he told CanWest News Service. "I am wondering where Dr Schumacher wants to take the CMA. I am disappointed that he wants to take the CMA in a direction where he sees a private healthcare in Canada. I would have expected the president of the CMA to be a little more circumspect."

Few would question that Mr Dosanjh's commitment to public funding of healthcare is sincere. Yet his comments drew little sympathy from the media. It's one thing to prevent doctors from charging patients for essential treatment. It's another thing altogether to suggest that they shouldn't be able to discuss the issue of private healthcare when it is already here.

The war of words between Health Canada and the CMA over private healthcare is growing increasingly bitter, but it remains in many ways a phoney war. Last year, according to Mr Dosanjh's ministry, Canadians spent about $100 billion on healthcare. Of that, $30 billion was spent privately. Private healthcare in Canada is now a reality whether we are allowed to discuss it or not.

Dr Schumacher argues that his organization is merely trying to steer changes that are already underway. Canada needs a "societal debate" on the future of private care, preferably "without the inflammatory, incendiary words" that certain politicians use, he adds, naming no names.

But Mr Dosanjh is clearly in no mood to pour oil on troubled waters. "There are people who still remember the dark days of private health- care, where people had to sell their farms and their homes to care for their loved ones," he grumbled, when confronted by last month's Supreme Court ruling allowing Quebec patients to buy insurance to cover medical treatments already provided by Medicare.

Dr Schumacher was hardly diplomatic himself in greeting that ruling, calling it "a stinging indictment of the failure of government to respond to the needs in the healthcare system." Excessive waiting times, he said, threaten the very viability of public medicine. The government was surely justified in riposting that while delays may have occurred in the past, it recently announced a 10-year plan to inject $41 billion towards addressing the queue problem.

Neither side is really framing the debate in honest terms. Mr Dosanjh knows full well that nothing is going to undermine the founding principle of the Canada Health Act — that quality care should be given free of charge to any citizen who needs it. Dr Schumacher claims it's all about waiting lists, when clearly it's not. Since he's effectively running a trade union, he will inevitably be drawn towards policies that increase his members' income.

Meanwhile the real process of privatization goes on under the radar, particularly in Quebec. Montreal has a dozen medical imaging clinics, a private orthopedic hospital, and nearly a hundred ophthalmologists, cosmetic surgeons, family practitioners, and even emergency specialists who have opted completely out of public medicare. Quebec will probably continue to lead the charge of privatization, because of its relative autonomy from Ottawa.

But the court challenge to Quebec's Health Act will surely be repeated in other provinces. Since all of the provincial acts are essentially clones of the Canada Health Act, it seems unlikely that the Supreme Court will answer those challenges differently. The bastion of the Canada Health Act has been definitively breached.

The arguments of Ottawa's lawyers in the case were telling. The Canada Health Act, they said, was "one of Canada's finest achievements and a powerful symbol of the national identity." But the Act wasn't passed so that the federal government could take pride in it. It was passed to provide quality, timely healthcare to all Canadians. If it's not doing that, something needs to be done, or people will start making changes themselves, as they are doing in Quebec.

Canada certainly does need a debate about the future of private healthcare. The regulation of private cosmetic surgeons, for example, is almost non-existent. There is no requirement for them to have any surgical qualifications at all.

Health Canada needs to address problems in delivery of care if it is to defend the status quo. To its credit, the government appears to be doing that, and its efforts deserve a chance to succeed.

And the CMA needs to come clean about all of its motives for wanting change, and not just the pure ones. Ultimately, Dr Schumacher is saying that the same number of doctors will treat patients faster if they are privately paid. It is worth asking how the CMA can make that assumption when its members claim to be working flat out now. Canada's citizens will surely be asking that question. The CMA would be well advised to have a good answer.