Friday, June 17, 2005

Chaoulli: Supremes Play Daddy -- Again

My understanding of the Supreme Court’s decision is this: the court did not say that private health care is superior to public care. The court did not open the door to private health care. The court did not signal the end of Medicare, or “Tommy Douglas’ Dream”, or whatever jacked-up phrase the health care unions are using these days.

All the court said is that if the government enforces one, single-payer system of health care, if that system covers most medically-necessary services (as the tenet of “comprehensiveness” in the Canada Health Act dictates it must) and if citizens are barred from purchasing those services elsewhere in Canada through private insurance or direct payment, then that health care system cannot be a farce. Specifically, it cannot be a farce that allows a good number of people to go undiagnosed, die on waiting lists or live for years in pain and/or disability waiting for surgery or treatment.

This decision, however, is wrong.

It is no mystery to many Canadians that the health care system became a farce long ago. Those who were somehow unaware of this fact could easily inform themselves of it through regular perusal of the major media. Yet at almost every opportunity that Canadians have had to say that the emperor has no clothes – or the patient has no gown, or bed, or MRI – they have voted to continue the farce.

When the Ontario Liberal government moved to ban so-called extra billing in 1986 (i.e. modest user fees set by individual doctors, but not universally imposed), the public cheered, and a Toronto Star editorial cartoon famously portrayed doctors as pigs. The Liberals won a massive majority the following year.

When Paul Martin cut the health and social transfer to the provinces by $25 billion in the mid-90s, he was portrayed as a good fiscal manager. Provincial governments trying to restructure their hospitals and keep up with rising costs and demands were portrayed as villains. Occasionally the Liberals would use the Canada Health Act to threaten provinces who dared even hint at expanding private delivery to improve services (unless that province went by the name “Quebec”).

In the 2000 and 2004 federal elections, the merest whiff of “two-tier” health care, or allowing more private delivery, or even allowing provinces to experiment within the public system, drew high-pitched attacks from the Liberals. Liberal re-election soon followed.

In the 2003 Ontario election, one of Dalton McGuinty’s promises – and one of the few he kept – was to use provincial dollars to buy out nine privately-operated MRI clinics that were providing tests under OHIP, as do hundreds of other private facilities and labs that somehow escaped McGuinty’s notice.

So events suggest that Canadians have quite deliberately chosen this state of affairs. They have chosen anodyne rhetoric over difficult reform. They have chosen 1960s mythology over 21st century reality. They have chosen to risk delayed diagnosis, chronic pain and even death because they accept that all the other options are worse, and one step away from bankruptcy through illness or dying in the street, which happens every day in the United States, don't ya know?

Whether this choice was made consciously or unconsciously is no matter. Voters are adults and should be treated as such. They should bear the consequences of their actions, and not be soothed with the lie that those consequences are not their fault, and it’s someone else’s responsibility to fix things. In short, we have a farcical, Soviet-style health care system that Canadians have affirmed and re-affirmed again and again. Who is the Supreme Court to override their votes? Who is the Supreme Court to save them from themselves?

Yet this is precisely what the Supreme Court, in its well-intentioned way (for they are always well-intentioned when they declare that democracy got it wrong) has done. Is it a mature populace that requires four lawyers in St. Nicholas robes to force them to look at the truths they were vaguely aware of but chose not to see?

Conservatives who have argued for honest language and mature debate on health care have nothing to celebrate in this ruling, even if they do agree with its gist. And it is no less a case of judicial activism than the same sex marriage rulings. “The end justifies the means” is a rationale typical of the other end of the political spectrum.

As for the honest, realistic debate that many hope will be spurred by this ruling, I’m not holding my breath. The Supreme Court is unlikely to wipe away the health care delusions of Canadians, when a decade of declining services and increasing waiting lists have done nothing but reinforce those delusions.

Some may argue that this decision was a blow on behalf of the people against institutions that believe they know what’s best for Canadians, whether those institutions be bureaucracies, legislatures or courts. Sadly, it is just the opposite.

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