This op-ed originally appeared in the Wednesday, April 19 edition of the Winnipeg Free Press: Protect Health Care With Laws
Manitobans want to improve health care and protect universal, public Medicare. Given the extreme stress to our public health care system, the Manitoba Health Coalition is calling for a Made-In-Manitoba Medicare Protection Act to ensure that everyone who needs medically necessary care is able to receive that care, regardless of their ability to pay.
Similar legislation - British Columbia’s Medicare Protection Act - recently did the whole country a favour. Because of its provisions, one of the most aggressive pushers of American-style, two-tier health care (Cambie Surgeries Corporation, led by Dr. Brian Day) was defeated twice in the BC courts - and the Supreme Court of Canada has dismissed leave to appeal. Cambie attempted to challenge prohibitions under the Act that prevent physicisans or medical corporations from extra billing patients and from giving preferential access to medically necessary procedures for the wealthy, allowing them to pay to jump the queue.
Clearly, those with a financial interest in expanding user-pay medical care and their ideological backers are not best pleased. The Fraser Institute breathlessly denounced the decision. Dr. Day himself said long wait times were now “forcibly embedded” in Canadian health care. “Marxism!” cried the Financial Post’s Terence Corcoran. Temperate and balanced critiques all, to be sure. But if you take the time to read all 880 pages of the original judgment you can understand why they are worried. It makes clear that private health care cannot fix what ails Canada’s health-care system and would, in fact, make the issues we face much worse.
Consider the issue of wait times for surgical care. In Manitoba, the government’s solution has been to outsource capacity to private, out-of-province providers with secret contracts and no stake in the performance of Manitoba’s health care system. Premier Stefanson has committed to increasing private delivery of health care. Upon studying the evidence presented by both sides, Judge Steeves found that ‘there is clear evidence that wait times would not improve with the introduction of duplicative private healthcare” in British Columbia; in fact: [T]there is considerable evidence and literature that, where there is duplicative private healthcare, physicians reduce their time and efforts in the public system. This in turn leads to increases in wait times for care in the public system”.
This feeds into the timely issue of health-care staffing and concerns about private health care poaching from the public system. On this, the judgement is equally damning: “[T]here is sufficient evidence to demonstrate that duplicative private healthcare would lead to competition between the private and public system ( .... )This would raise the price of healthcare in the province and make it more difficult to ensure an adequate supply of healthcare professionals in the public system.”
None of this should be surprising to anyone following the last seven years of health care cuts and re-organization in Manitoba. The push for increased private delivery of health care services - from out-of-province surgical providers, to outpatient services, to agency nurses and home care - has led to less transparency and accountability, staff being poached from the public system and higher (or hidden) costs alongside worse outcomes for patients and families.
Also of note, the recently-released Canada Health Act Annual Report has gone out of its way to highlight the growth of private “[e]xecutive and primary health clinics that charge patients enrollment and annual membership fees” in five provinces, including Manitoba. The federal government has called on these governments to “develop legislation that is clear about patients’ access to insured services and which prohibits out-of-pocket charges to patients.” This is a timely warning that those who seek to put profit ahead of patient care will always seek to test their limits and that prescriptive legislation has an important role to play in protecting patients.
Manitoba families deserve a plan to fix health care, not privatize it. They deserve a structured path forward with clear provisions that ensure fair access for all to the care they deserve, regardless of ability to pay. Coupled with a dedicated plan to fund public services appropriately in a long-term, sustainable manner, a Made-In-Manitoba Medicare Protection Act could focus efforts on the real and necessary work of expanding public health care and improving health outcomes for all, not just the wealthy few.
Thomas Linner is the Provincial Director of the Manitoba Health Coalition mbhealthcoalition.ca
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