Top court strikes down Quebec


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Source: http://www.cbc.ca/story/canada/national/20...alth050609.html

The Supreme Court of Canada ruled Thursday that the Quebec government cannot prevent people from paying for private insurance for health-care procedures covered under medicare.

The plaintiffs in the case ? a Montreal patient and a doctor ? wanted Canada's top court to strike down sections of the Quebec Hospital Insurance Act that prevent people from buying health insurance for medical procedures covered by the public health plan.

In its ruling Thursday, the court said the provincial policy violates the Quebec charter. But they split 3 to 3 on whether it violated the Canadian Charter of Rights and Freedoms, meaning there is no immediate impact on the Canadian health-care system as a whole.

One justice gave no opinion on whether the laws violate the Charter.

But Alain Joduin of the Canadian Orthopedic Association said the decision is "truly an historic one that could fundamentally change the health-care system in Canada as we know it."

He said his group and the Canadian Medical Association would comment further on the ruling later in the day, after their experts had had a chance to pore over it.

Sharon Sholzberg-Gray, president of the Canadian Healthcare Association., said although the decision applies to the Quebec act, it's clearly "a clone of all the other provincial acts, and they're all clones of the Canada Health Act."

She said her group would have to study the lengthy ruling before being able to discuss all the implications, but added that she doesn't see the entire medical system going to a private-payment plan.

"Just because someone might be able to pay $8,000 for a joint replacement doesn't mean all Canadians can pay $300,000 for a complex cancer treatment," she said.

The two plaintiffs in the case had separate complaints, but the court decided to hear their court challenges together.

In 1996, Montreal businessman George Zeliotis waited a year for hip replacement surgery. While waiting, he asked whether he could purchase insurance that would allow him to skip the public queue and pay directly for the surgery.

When he learned it was against the law, he took his case to court.

Canadians can buy private health insurance for things outside of public medicare such as prescriptions, physiotherapy or private hospital rooms.

The 73-year-old Zeliotis argued the year-long wait for surgery was unreasonable, endangered his life and infringed on the charter's guarantee of right to life, liberty and security.

The second plaintiff, Dr. Jacques Chaoulli, wanted the court to overturn a Quebec provision preventing doctors who don't operate within the medicare plan from charging for services in public hospitals.

Chaoulli, who had tried but failed to set up a private hospital, represented himself before the court.

Senator Michael Kirby, who chaired a Senate committee studying health care, recommended the provinces pay for private treatment if the patient isn't treated within a certain timeframe.

Lawyers for the federal government argued the court should not interfere with the health-care system, considered "one of Canada's finest achievements and a powerful symbol of the national identity."

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I had no idea that you weren't allowed to get insurance if you could afford it. I see the point of providding care for all, but why deny those who can afford it?

With my admitted limited knowledge of the system, this ruling seems to me to be correct.

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I had no idea that you weren't allowed to get insurance if you could afford it.  I see the point of providding care for all, but why deny those who can afford it?

With my admitted limited knowledge of the system, this ruling seems to me to be correct.

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Canada has always resisted a two-tier system that would include both public and private services (although wealthier people in Canada would just travel to the US to get something non-life threatening done if they did not want to wait). Generally, with anything life-threatening where surgery is expected to solve the problem, waiting lists are not an issue.

I personally would like to consider some sort of user-fee system so that the patient has some idea what it is costing society to visit the hospital with a broken toenail. Even if they were to pay only a very, very small percentage, I'd like to see an invoice broken down into government pay portion and user pay portion.

Somewhat on topic:

Que. MDs object to public-private partnerships

http://www.cma.ca/index.cfm/ci_id/10015434/la_id/1.htm

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Jun. 11, 2005. 08:25 AM

Public system draws strong support

Ex-ministers tout medicare over private insurance

But government urged to improve delivery of care

ROB FERGUSON

IN TORONTO

AND ANDREW MILLS

IN OTTAWA

The best way to thwart expansion of private health care is simply to make the public system better.

That's the conclusion of a number of present and former politicians involved in the Canadian health-care system interviewed by the Toronto Star yesterday in the wake of a Supreme Court of Canada decision that quashed a Quebec law forbidding private health insurance in that province.

Elinor Caplan, who was health minister in Liberal premier David Peterson's government in the late 1980s, said the court decision is the most powerful impetus yet for the federal government and the provinces to speed up efforts to track wait times.

"We need good information and we don't have it ... my hope is we'll see a national response."

Only then will officials be able to properly manage the country's health-care system, and Canadians will be able to figure out where to get treatment the fastest ? whether it's in their hometown, home province or somewhere else across the country, said Caplan, who later became federal minister in Jean Chr?tien's government.

"If you know that another doctor ... can do an operation in a month and you're on a waiting list that's 14 months, you should have a choice," she addedThe waiting lists would have to be measured against recommended, reasonable waiting times for certain procedures, Caplan added, and travel costs paid, if necessary, for people falling beyond that threshold.

As an example, Caplan told the story of her husband's squash partner, who was told in the late 1980s he would need a bypass operation. His heart wasn't bad enough yet to make it urgent for another year, but he would have to stop vigorous exercise.

So he did research and found a Sudbury hospital with an excellent record in bypass operations and virtually no waiting list, paid his own travel costs, and had the operation done there under his Ontario Health Insurance Plan coverage./b>

"That's the kind of thing that can happen when people have information," Caplan said.

Carolyn Bennett, the federal minister of state for public health, agreed that the best way to thwart an extensive private health-care system from developing is to strengthen publicly funded medicine.

"We want Canadians to feel confident in choosing the public system and we are working on that," Bennett, a physician, said in an interview. "My job is to make sure that we are doing everything in our power to strengthen the public system."

The federal government has offered little by way of interpretation of the court ruling or fresh ideas about how to tackle the potential shift in the way health care will be delivered.

"Let's not rush to a parallel private health-care system," Health Minister Ujjal Dosanjh told reporters yesterday. "It's not going to happen in Canada."

Yet Dosanjh continued to say that the government's strategy for fixing the health-care system is the appropriate way to take on the failures in delivering appropriate health care that formed the basis of the court's ruling.

The Liberals' "fix for a generation" of health care is pegged on a $41 billion payout to the provinces over 10 years and a plan to slash the time patients have to wait to have key medical procedures done.

"We are busy trying to establish benchmarks, set the comparable indicators, expand home care, bring more international medical graduates into the mainstream so that we have a health-care system that is thriving," Dosanjh said in question period.

If you know that another doctor can do an operation in a month and you're on a waiting list that's 14 months, you should have a choice.

That answer did little to satisfy opposition politicians.

"All that he's done since he's become minister is to talk about talk," said former NDP leader Ed Broadbent (Ottawa Centre). "He hasn't sat down, for example, with the ministers or he hasn't more precisely said in light of this decision, which is quite conceivably the most serious non-constitutional-related decision of the Supreme Court in modern history, he hasn't said well, maybe I'd better get the health ministers together and develop an action plan."

In the interview, Bennett warned against accepting that private insurance and for-profit clinics would be a quick fix that takes the pressure off an overextended medicare system that doesn't have enough health-care workers or hospital beds, and where waiting times are unacceptably long"I think private insurance will have serious, deleterious effects to our economy," Bennett said, pointing to companies like General Motors that have been attracted to Canada because they don't have to provide workers the gamut of health benefits./b>

"As a family doctor who has watched some of the real questionable practices of some of the for-profit people, I also have a strong message of buyer beware," Bennett said. "We want people to know that they will get what they need, but what people need and what they think they want is different."

One of the potential pitfalls of for-profit health care is that doctors push unnecessary procedures on patients to turn a bigger profit, Bennett said"If you are focused on quality of care, in a for-profit system, the research has shown either the price goes up or the quality goes down."/b>

Dennis Timbrell, a Progressive Conservative health minister under Bill Davis in Ontario more than 20 years ago, said the Supreme Court decision "doesn't have to" mean the end of medicare as we know it"The message is `clean up your act,' turn the rhetoric into real progress. There are ways to do that," said Timbrell, now a health-care consultant.

"I am one of those who believes there are ample resources in the health-care system," he said from his Toronto home. "I do have concerns how productive and effective components of the system are."/b>

The current Liberal government in Ontario is taking the right steps to get wait times under control with plans to track waiting lists and by demanding more accountability from hospitals in terms of how they spend money, Timbrell added. Health Minister George Smitherman has said wait times should be available on a ministry website by the end of 2006.

But it remains to be seen whether the government will have the guts to use the "clout" in its new legislation to bring hospitals in line, said Timbrell.Another former Tory health minister, Tony Clement, said politicians will have a harder time defending medicare now that the Supreme Court has ruled timely access to treatment is a basic right. "If government insists on a monopoly ... and then breaks its promise and doesn't provide service in a timely manner, then people have the right to access private insurance," he said.

While wealthy Canadians have the option of seeking quick treatment abroad because of long waiting lists here, the middle class will now twig to the possibilities that private insurance holds for them in getting care closer to homeThe Canadian Medical Association, meanwhile, appears to be welcoming privately insured health care.

"The reality is that there are 20 jurisdictions in Europe that are similar to ours, except they all have a small slice of private on the edge, somewhere between 3 per cent and 8 per cent," said Dr. Albert Schumacher, president of the CMA. "In the fullness of time that's where we may be moving towards."/b>

Schumacher and others want the federal government to "face that reality" and to begin formulating a strategy about how to move toward that kind a health-care delivery system.

"We need to start that kind of dialogue and the federal government needs to be involved in that," he said.

On Monday, provincial health ministers will hold a conference call to discuss the implications of the Supreme Court decision, which suggested that Quebecers have the right to private health insurance since the wait times for publicly funded services in the province are unduly long and endanger health.

http://www.thestar.com/NASApp/cs/ContentSe...id=968332188492

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This was one of the reasons i dislike Canada's health-care system. If you're going to have a public health-care system (and i don't necessarily think that that's a good idea, but assuming you're stuck with it), this is how i think it should work:

(1) You should be able to exempt out of it. If you don't want to pay a bajillion dollars in taxes every year for health care, you shouldn't have to. Of course, if you don't, you're not eligible for public health care anymore. (And there should be like a limit or something, like you have to pay taxes for a year or two before you're eligible.)

(2) Whether you're paying for the public system or not, you should always have the right to go get private care somewhere. I don't even understand why you wouldn't be able to do that. The wealthier people will get their care faster, and they won't be put on the public waiting lists, which means the poor people will get their care faster too. It's even better if someone is already paying taxes and they decide to get private care anyway. More money for the government!

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This was one of the reasons i dislike Canada's health-care system. If you're going to have a public health-care system (and i don't necessarily think that that's a good idea, but assuming you're stuck with it), this is how i think it should work:

(1) You should be able to exempt out of it. If you don't want to pay a bajillion dollars in taxes every year for health care, you shouldn't have to. Of course, if you don't, you're not eligible for public health care anymore. (And there should be like a limit or something, like you have to pay taxes for a year or two before you're eligible.)

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That goes against everything I believe in. We pay taxes to support something we believe in. If all the rich people in Canada opted out of paying taxes for health care, the whole system would go broke. The riches portion of Canadians (10%) pay over 50% of the taxes in this nation.

In your scenario, what happens to someone who has come up with enough money to pay their own healthcare, but then goes bankrupt. Now he has to pay taxes that he can't afford, for 2 years before he can get that hup surgery he needs? Or what about immigrants that are new to the Country? They come here for a better life and we simply turn our backs on them. That is not very Canadian.

As I said, I believe strongly in the system; the idea that everyone has a right to healthcare, and that the government must provide it.

But that's what makes me Canadian I guess :happy:. And I certainly don't mind paying any taxes to support it!

-Ax

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That goes against everything I believe in. We pay taxes to support something we believe in. If all the rich people in Canada opted out of paying taxes for health care, the whole system would go broke. The riches portion of Canadians (10%) pay over 50% of the taxes in this nation.

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Yeah, that's pretty cool. They don't need public health care, so it should be their duty to support the rest of the people in the nation. Makes sense.

In your scenario, what happens to someone who has come up with enough money to pay their own healthcare, but then goes bankrupt. Now he has to pay taxes that he can't afford, for 2 years before he can get that hup surgery he needs?

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(1) It's not anyone else's fault that he went bankrupt.

(2) I am sure Canada has provisions for people who don't make enough money to pay the taxes, just like America does.

Or what about immigrants that are new to the Country? They come here for a better life and we simply turn our backs on them. That is not very Canadian.

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(1) Canada would probably have provisions for immigrants also.

(2) Excuse me if i'm a little suspicious about an immigrant jumping right into the public health-care system as soon as they move into the country.

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(2) Whether you're paying for the public system or not, you should always have the right to go get private care somewhere. I don't even understand why you wouldn't be able to do that. The wealthier people will get their care faster, and they won't be put on the public waiting lists, which means the poor people will get their care faster too. It's even better if someone is already paying taxes and they decide to get private care anyway. More money for the government!

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Actually it means the opposite. If Canadian doctors switched to working for a private system that would leave less doctors to treat the patients left on the public system.

Private healthcare goes against the primary Canadian values. Not even the Conservative Party of Canada would touch it. The only items with appreciable waiting lists are non-emergency surgeries. Often if you do enough checking you will find other doctors at other hospitals that have reduced or non-existant waiting lists. One thing the Canadian system needs is better information sharing so that your doctor can tell you that there is a 1 year waiting list at this hospital, a six month waiting list at that hospital and a 1 month waiting list in the next city.

It would be even better if the public system reimbursed travelling costs to better even out the system.

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One thing the Canadian system needs is better information sharing so that your doctor can tell you that there is a 1 year waiting list at this hospital, a six month waiting list at that hospital and a 1 month waiting list in the next city.

It would be even better if the public system reimbursed travelling costs to better even out the system.

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Excellent point Fred. I think the system can be very successful, it just needs to be restructured and, as you said, more sharing of information and data between hospitals.

-Ax

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Actually it means the opposite.  If Canadian doctors switched to working for a private system that would leave less doctors to treat the patients left on the public system.

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On the other hand, maybe if Canada had a private system, fewer Canadian doctors would leave for the United States.

I suppose in hind sight that what i said might not necessarily have worked out. :shrug: I don't like the idea in general.

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On the other hand, maybe if Canada had a private system, fewer Canadian doctors would leave for the United States.

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And then no one could afford the fees, since that's the main issue for leaving to practice in the States. Universal healthcare means that no one is left behind.

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And then no one could afford the fees, since that's the main issue for leaving to practice in the States. Universal healthcare means that no one is left behind.

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As someone from Quebec, what's your stance on the ruling Joel?

-Ax

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I don't believe private medical care can solve our waiting list woes. It may relax them, but it will not solve them. Simply put, the richer will be able to recieve immediate care from private clinics, while the poorer will have to wait longer for public health care. This needs an innovative solution other than money or private care.

The court has said that hip and knee replacements should be done in 24 hours, but they are precisely the reason why our lists are so long: With an aging population, it is a problem, but it is not a vital problem that needs to be solved as urgently as other conditions. A second problem remains in our smoking population. We cannot provide free health care to those who threaten their own health and others too.

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As someone from Quebec, what's your stance on the ruling Joel?

-Ax

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I think bitching about non-life threatening surgery waits is stupid. I also think that we should NOT remain 1 of only 3 countries in the word that forbids a private system to supplement the public system. If you want to pay, pay. All the government needs to do is require of doctors a certain number of procedures or hours worked on the public side (or even the majority of hours).

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