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Chaoulli Decision Shapes Public Opinion
By Zoltan Nagy, CIMCA Executive VP
As the first anniversary of the Chaoulli - Zeliotis decision was approaching, CIMCA was frequently asked by the media, our members, and citizens interested in health care developments whether there was a noticeable increase in the number of private/independent clinics in Canada in the last 12 months. And our answer has always been that the success of this landmark decision is not measurable in the number of independent providers - at least not in the first year when the stay of execution was still in effect. While the number of new clinics has kept growing steadily, the most noticeable change occurred in the general perception and thinking of Canadians about new options in health care.
The greatest achievement of Chaoulli - Zeliotis so far has been the dramatic change in the nature, level, and orientation of health policy debates. Chaoulli - Zeliotis has brought to Canada the example of "European Health Care Experience," which proves that universal health care and private health insurance can not just co-exist, but foster a system that generates superior quality and outcome. Dedicated health care reformers, who in the past were criticized because they promoted more public/private cooperation in delivery and financing, were vindicated by the Supreme Court of Canada. The highest court of the land recognized the need for reform and acted upon it. By doing that it also enhanced the legitimacy of private health care in Canada and sparked a tectonic shift in the legal landscape of Canadian health care.
More importantly, Chaoulli - Zeliotis extended the focus of health care debates from options in delivery to the merits of different health care financing models. The sanctity of the public financing model was rarely questioned until Chaoulli - Zeliotis.
Politicians, physicians, health policy researchers, legal and insurance experts presented, discussed and debated freely the pros and cons of private health insurance last November at the CIMCA conference in Vancouver. Even the most ardent opponents of change have acknowledged that "there was a buzz in the room" for two full days.
Chaoulli - Zeliotis has also resulted in the sudden marginalization of those pressure groups and diehard ideologues that clamor for the preservation of the status quo. The Supreme Court decision discredited them, and rendered their objections against any reform initiative that contained the word "private" meaningless. The phrase "Americanization of our health system" has become a tired, boring and meaningless cliché.
We cannot discount the influence of these groups just yet, since changing the climate of opinion under any circumstances takes time. It is clear, however, that with the advent of private financing options, with the across-the-board discontent with the outcomes of our present system, and with the aging of the most powerful and demanding generation in Canadian history, the arguments of the opposition are becoming increasingly hollow.
Although, on the surface it seems that Chaoulli - Zeliotis applies strictly in Quebec, it has far reaching implications across the country. While there are some who believe that private citizens in other provinces will have to launch lawsuits similar to Chaoulli - Zeliotis, litigations of this kind are unlikely or unnecessary. The message to governments was that they cannot keep a monopoly on the financing and provision of health services, while failing to provide care in a timely manner. They must change or be changed.
Finally, Chaoulli - Zeliotis has changed the tone and attitude of the mainstream media in presenting and discussing private health care options. Even a cursory review of editorials in virtually every daily newspaper demonstrates a move from ideology-based arguments to more pragmatic and open minded approaches in health-care financing and delivery. Moreover, magazines like Macleans, or Canadian Business Magazine are publishing comprehensive reviews of private health care options, and are presenting them as new realities rather than some transitory oddities. Even CBC jumped on the bandwagon (to the chagrin of the defenders of the public monopoly) and televised in December the documentary "Medicare Schmedicare," which presented a scathing criticism of our health care system.
Private health care in Canada is marching from no man's land to mainstream and it is flexing its muscles. This is most obvious in Quebec and British Columbia, where patients have learned that private health care is good, efficient, patient-oriented and affordable. With the introduction of private financing, these services will be even more affordable, and advanced medical care that has been made unavailable to Canadians today, will be within our reach tomorrow.
After a review of Chaoulli - Zeliotis's general impact, let's take a quick look at the provinces' reaction. Three of them have demonstrated so far that they are willing to initiate structural change in their health care systems.
- British Columbia: In the Throne Speech delivered in February, the Liberal government recommended updating the Canada Health Act (and adding "sustainability" to the existing principles), and launching a province wide conversation on health care reform. British Columbians will find out soon what this means in practical terms.
- Alberta: The Conservative government released its Health Policy Framework in February, and identified fresh and innovative approaches to introduce a mixed public/private system, and to put patients first. As a result of challenges to Premier Klein's leadership, the implementation of Health Policy Framework was postponed until the election of the new provincial leadership.
- Quebec: Since Chaoulli - Zeliotis addressed the situation in Quebec primarily, it's hardly surprising that the introduction of private financing options is happening in this province. After the expiration of the stay of execution, Minister Couillard tabled Bill 33 (which outlines amendments to Quebec's Health Insurance Act) on June 8. After Bill 33 is passed this fall, Quebec will allow the purchase of private insurance for hip and knee replacements, and for cataract surgeries. To paraphrase Neil Armstrong: that's one small step for a province, a giant leap for Canadian health care.
Pioneering change with your support,
- Zoltan Nagy
Notes:
- A more in-depth analysis of Bill 33 will follow in an upcoming issue of Health Frontiers News.
- For more information on private health insurance options and on the regulatory framework, please read the Economic Notes published by the Montreal Economic Institute:
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