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After Chaoulli: Still In Critical Condition

The Health-Care Crisis and the<br>Crutch of the Courts

Beryl P. Wajsman

10 June 2005


“I paid a visit of condolence to the Queen of England. Her husband had been beheaded by order of the British parliament. The court did not go into general mourning on this occasion, for want of funds. I found her not so deeply affected as she should have been.”


~ Duchesse de Montpensier, French aristocrat. Referring to the French court. “Mémoires”



Yesterday’s Supreme Court decision on the constitutionality of private health insurance should not be seen as a panacea for anyone. The wealthy will continue to benefit from the existing private care facilities they now make use of. Most of the rest of us will not be able to afford the premiums private health insurance will cost. One thing is certain. Waiting times will continue to plague rich and poor alike.


The reason is that private facilities are used for relatively routine examinations, tests and minor surgeries. Even the rich use the public system for all major health procedures. No private facility can bring to bear the personnel and technology necessary. And wait lists are now so terribly long, that even if they will be relieved by a 20% shift (the maximum expected by even the most vocal advocates of two-tier health) to private facilities, they will still surpass any reasonable benchmark.


The solutions to the problems of appropriate and timely delivery of health care to all Canadians lie in political will, not in legal tampering.  And everything that is missing in our national political will was manifested at last year’s First Ministers Health-care Summit. It was a textbook example of political expediency trumping public need.


Martin and Charest needed to give each other a political win, and they made the spin happen. No amount of electoral advantage gained will ever make it right. No amount of self-righteous justification will reduce the suffering of Canadians by even one iota.


The harsh reality is that instead of a bold commitment to the re-ordering of national priorities and the courage to face the failures of the past with some straight talk to the people of Canada, all we got was a typical True North compromise based on jurisdictional gymnastics. Asymmetrical federalism, a stylish term of the spin doctors, replaced substantive policy direction.


Two problems plague our health care system. Doctors and nurses leaving Canada because they are not paid enough. And hospitals not getting the money needed to buy the diagnostic equipment patients need and the operating room times the wait lists demand.


The reality is that our doctors and medical specialists must be compensated appropriately and not be tempted to move to more lucrative jurisdictions. Their pay levels are kept artificially and unrealistically low, and in some provinces like Quebec, even their mobility is dictated by government fiat. As a society we must send a message that we value something other than just sports and entertainment.


The doctor shortage may be reaching crisis proportions. The Canadian Medical Association estimates that we need 2500 medical graduates a year to maintain current levels of care. But we are only producing 2200.  And many are leaving for the U.S. and other countries.


And this has led to another troubling statistic. Canadians are justly proud that unlike America, where some thirty per cent of the population has no health insurance, here everyone is covered. But that belies the fact that the doctor shortage has meant that 3.6 million of us have no access to a family doctor. That is 15% of the population and almost matches the 20% in the same position in the U.S.


Medical administrators estimate that some thirty per cent of emergency room visits would be eliminated if people could get to a doctor relatively quickly. By making it more attractive for doctors to stay in Canada we could increase the number of general practitioners and reduce the pressure on emergency rooms thereby radically cutting the major source of unacceptable wait times.


Though health-care is a provincial jurisdiction, it is no breach of that jurisdiction for a Prime Minister of Canada to say to the Premiers that they will get all the money necessary, but only if it goes to the proper purpose.


Instead we live with some provincial Premiers brazenly stating they will put federal health dollars wherever they please in their own budgets; other provincial governments leaving hundreds of millions in banks earning interest; and still others using parts of federal transfers to experiment with their own private systems. And lest anyone think it is hard to find the money, think again.


The money we need is already in government coffers and is being systematically misspent and wasted. Our leaders must stop promising everything to everyone and get back to protecting our vital national social security interests. If they do not, our core priorities will be hopelessly compromised.


Out of a $180 billion federal budget fully one-third is spent on corporate welfare and politically-correct pork-barrel vote grabs. Each of these two areas alone equals or exceeds the total spent on U.I., welfare and pensions combined. With a stroke of the pen, that in and of itself would be a profile in courage, a Prime Minister can change the direction and destiny of Canada’s health-care system. But we have seen no courage.


Instead we live with no accountability from the Provinces. No imposition of directed dollars from Ottawa. No use of transfer payment leverage. And in the case of Quebec, no reminder that fifty years after the institution of the Duplessis-driven tax system following the 1954 election that was supposed to have implemented a set-off scheme against have-not funding from Ottawa, no set-off credits have ever been calculated, much less deducted.


It is the responsibility of our political leadership to assure that the health care system never becomes so callous to human suffering that it is intent only on meeting bureaucratic procedures and budgets, and offering services of uncertain quality at unacceptable times and in a manner more suited to the convenience of institutions and of the state rather than to the needs of the people.


If our political leaders ever find the conviction to rid this nation of its inherent systemic cynicism - a cynicism manifested in the past few years by the willing surrender of Parliamentary responsibility to the crutch of the courts - we may yet have an answer to Prime Minister Trudeau’s haunting question posed to another group of bickering and bleating Premiers a generation ago of “Who speaks for Canada?”


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