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Web-exclusive comment
By speaking out on medicare, doctors are leading the debate
Special to Globe & Mail Update
August 7, 2007 at 11:39PM EDT
by Robert Hollinshead and Suzanne Strasberg
Last week, Canadian Medical Association president Colin McMillan released Medicare Plus, a plan seeking to modernize medicare with a view toward ensuring timely access to high-quality health care. Produced on behalf over 65,000 physicians across the country, the document consolidates existing CMA policy on waiting-time guarantees, the public-private interface and the expansion of the continuum of care.
Medicare Plus was drafted with the input of doctors across the country, with a wide range of specialties. It was drafted as a call to action for an expanded medicare system, and a call for debate about how to build a Canadian health-care system for the next generation that is stronger, more effective and more equitable.
To suggest, as some have, that we have started this debate to raise the profile of privately funded health care is preposterous and insulting. It is preposterous because in fact, the document calls for the strengthening of medicare. It is insulting because the interest of Canadian physicians is the welfare of our patients, first and foremost.
While some have portrayed Medicare Plus as a radical departure for the CMA, we assure you that it is not. In fact, the document respects both current Canadian values and medicare's legislative framework. It also reflects the debate that is already well under way in Canada — one that was kicked off by the Supreme Court, no less.
In Chaoulli v. Quebec, the court ruled that should the public system fail to provide needed care in a timely way, patients cannot be denied the option of private-sector insurance and treatment.
Right now, if patients are denied timely access to necessary medical treatment, they have very limited options. They can sit and wait, or they can come up with the substantial cash necessary to travel elsewhere and buy care. The lucky ones will be able to recoup some of their costs by suing governments after returning. This sounds pretty close to the situation Tommy Douglas was trying to avoid when he helped create medicare in the first place.
The Quebec government has been grappling with how to respond to the Chaoulli decision, while other provinces have been hoping they don't face similar challenges of their own. Well, time is up: A similar case has been filed in Alberta and another is about to be filed in Ontario. As Dr. McMillan rightly said when he released Medicare Plus: "Now is not the time to be sticking our heads in the sand."
If we don't examine and debate the nature of public and private health-care delivery and payment now, the courts will continue to be forced to decide for us. The CMA believes these discussions should be led by policy-makers acting on the wishes of the electorate, not by judges in chambers.
Medicare Plus calls for the shoring-up of our current health system with new, strategically directed resources aimed at extending benchmarks for waiting times. It also recommends a publicly funded "safety valve" to provide Canadians with guaranteed access if those benchmarks are exceeded. The Wait Time Trusts included in the last federal budget were a good first step in that direction.
However, Medicare Plus also recognizes the reality of the Chaoulli decision. If (and only if) the public system fails to provide timely care, Canadians should have access to private insurance that can be used to cover the cost of obtaining private-sector care.
This is not an endorsement of a private care, nor is it what headline writers describe as a two-tier health system. Rather, it is the recognition of the right of all Canadians to timely access to quality care. In releasing Medicare Plus, Dr. McMillan reaffirmed the support of Canada's doctors for the principle that access to medically necessary health care be based on need, not the ability to pay. That has not changed, nor will it.
The physicians of Canada make no apologies for raising these issues on behalf of their patients. In fact, we think it is our responsibility. Dr. McMillan has called for an open and honest public debate about where we go from here.
We all know that it will be a tough debate and that some may want to vilify those who speak out against the status quo. But medicare is more than simply a box to be checked off at election time, and physicians are prepared to take the criticism necessary to improve the system. We will continue to speak out, because failing to do so would be a disservice to our patients and to the next generation of Canadians.
Dr. Robert Hollinshead and Dr. Suzanne Strasberg are co-chairs of the CMA Task Force on the Public-Private Interface.
© Copyright 2007 CTVglobemedia Publishing Inc. All Rights Reserved.
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