Northern exposure

Medicine | High court decision reveals folly of Canadian health care

Issue: "Bob Geldof: Whose jubilee?," June 25, 2005

All George Zeliotis wanted was a new hip. But in convincing Canada's Supreme Court to open the door for private health care earlier this month, the Quebec man found amazing leverage in his ailing, arthritic one.

The Canadian high court struck down a provincial ban that prohibited Quebec residents from circumventing the country's dysfunctional public health-care system-three of seven judges believing the ban violated the nation's constitution and one judge finding it illegal under the Quebec Charter. The surprising decision will set precedent over similar bans-and lawsuits challenging them-in other provinces.

And the lawsuits will come.

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Under Canada's system of government-run universal health care, patients wait an average of four months for surgery and various other treatments-a number that would stretch much longer were it not that so many Canadians flock south to the United States to secure private care. Waits for specialized procedures often draw out for more than a year-a prospect Mr. Zeliotis refused to accept when he first sought hip-replacement surgery in 1997.

Rather than border-hop to a hospital in the United States, Mr. Zeliotis teamed with doctor Jacques Chaoulli to challenge Canada's failing system. After two losses in provincial courts, the duo succeeded in puncturing the paper-thin balloon of socialized medicine, an accomplishment that may ripple beyond the borders of Canada into the laps of U.S. advocates for socialized medicine.

As the United States seeks to solve its Medicaid and Medicare mess, many Democrats continue to trumpet the supposed benefits of publicly funded health care for all. Ignoring the failure of such a system in Canada is one thing as people suffer and even die on waiting lists. Ignoring that failure as the system crumbles and cries out for privatization would be quite another.

But has Mr. Zeliotis cracked such a significant support beam? Will private care become available throughout Canada?

Dr. Chaoulli believes so. "How could you imagine that Quebecers may live and the English Canadian has to die?" he told The New York Times. Other less interested parties have also predicted the decision will have a significant effect beyond Quebec.

Canada is the only industrialized country (Cuba and North Korea are the only others) to outlaw private financing for primary medical services. Several provinces, including Alberta, Ontario, and British Columbia, stretch the limits of private financing the government allows. Threats from Ottawa of withholding financial aid to provinces have prevented further privatization efforts in the past, but such threats now seem hollow. "We don't need any holdout provinces saying, 'This will apply to Quebec and it doesn't apply to us and we're going to continue on our merry way,'" said Albert Schumacher, president of the Canadian Medical Association. "That's clearly not the direction the Supreme Court is moving in."

That this bombshell dropped from the very court largely responsible for Canada's entirely government-run system renders it all the more powerful. In 1964, Supreme Court justice Emmett Hall raised the idea of national health insurance and recommended the country adopt it, which it did soon thereafter. In 1979, Mr. Hall called on the nation to eliminate all extra billing and user fees, arguing they threatened to create a two-tiered system.

The tune from this still very liberal court, which unanimously declared gay marriage constitutional last year, was decidedly different earlier this month. "Access to waiting lists is not access to health care," wrote Chief Justice Beverly McLachlin. Dissenting justices Ian Binnie and Louis Lebel offered even greater encouragement to Canadian conservatives, predicting that the ruling "would precipitate a seismic shift."

Despite such candor from the court, government officials downplayed the ruling's import. Prime Minister Paul Martin denied the decision would fuel nationwide privatization efforts: "We are not going to have a two-tier health care system in this country. Nobody wants that. What we want to do is strengthen the public health care system." All Mr. Zeliotis wanted to strengthen was his hip.


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