It is December, 2018, and at long last Canadian health care has been reformed. Long waiting lines are a thing of the past. Universal coverage has been maintained and expanded. The numbers of doctors and treatment facilities available to serve Canadians has been significantly increased. Health care for the vast majority of Canadians has dramatically improved and at lower cost per capita.
How did it happen? Let me list the major factors.
Quebec Kicks Open the Door
By 2015, health care was consuming more than 55 per cent of the province's budget while the quality of care continued to deteriorate. Weary of ineffectual government and sovereigntists obsessed with secession, Quebeckers elected a new reform-oriented government. It was this administration that pioneered a "mixed health-care system," characterized by universal coverage regardless of ability to pay, freedom of choice for health-care consumers, and balanced provisions for both public and private health-care insurance, financing and delivery.
The reformed system appeared to violate an important principle of the Canada Health Act (requiring provincial health-care plans to be publicly administered), but the federal reaction was hesitant. With Quebec voters deserting the Bloc Québécois, federal politicians had hoped to win their support and thus had no desire to pick a fight with Quebec's new administration over health care. Also, the argument - so persuasive in English Canada - that a public monopoly over health-care delivery established by a federal statute was the very essence of "national identity" struck most Quebeckers as ludicrous. Then, mercifully from the federal government's standpoint, the Supreme Court rendered its landmark decision in the Pepki case.
The Pepki Case
George Pepki was a retired Alberta farmer who suffered from a kidney ailment and was referred by his family doctor to a specialist. While waiting for over four months to see the specialist, George's condition became critical and his family rushed him to the emergency ward of an Edmonton hospital. After waiting there for more than six hours and receiving no help, the family in desperation flew George to the Mayo Clinic in Scottsdale, Ariz., where he was diagnosed, treated and released within 72 hours. The family sought to recover the entire cost of the unauthorized trip and treatment from Alberta Health Services, which refused to pay. The Pepkis then took Alberta to court, the case eventually reaching the Supreme Court of Canada about the same time as Quebec was instituting its health-care reforms.
Supreme Court Decision
In arriving at its decision, the court gave considerable weight to an intervention by the Society for the Prevention of Cruelty to Humans. The society argued that if the Pepki family was free to acquire whatever health care was needed by Fido, the family dog, they ought to have the same freedom to secure whatever health care was needed by Grandpa Pepki. To the vast relief of Canadians (who had always wondered but had been too polite to ask), the court declared that "no Canadian has a constitutional obligation to suffer or die waiting for publicly administered health care if other options are available." The court then declared the offending sections of the Canada Health Act to be unconstitutional in that they led to violations of Canadians' right to life under the Charter of Rights and Freedoms.
A decade earlier, strong public opposition to Quebec's mixed health-care system would have been mobilized by key members of the Ottawa establishment, the public service unions, and the mass media. But this time efforts to organize such opposition failed completely for one simple reason.
In November, 2016, WikiLeaks released the confidential client lists of hundreds of private and quasi-private medical treatment establishments in Canada, Europe and the United States. To the astonishment of Canadians, these lists included the names of hundreds of judges, senators, members of Parliament, senior civil servants, union officials, union spokespersons, media executives, editorialists, journalists and television personalities - many of whom had been in the forefront of publicly denouncing private health care while privately availing themselves of its services. The exposure of such hypocrisy deprived the opposition movement of both its legitimacy and its strength.
The Great Waiting-Line Experiment
Meanwhile, back in Ottawa, the Standing Committee on Health had invited Dr. Lars Aalborg, Nobel Prize-winner and a world-renowned expert on queuing theory, to propose means of reducing Canada's health-care waiting lines. Dr. Aalborg said he would do so only on the condition that members of the House of Commons agreed to participate in a scientific experiment. Being near Christmas, the members were in a charitable mood and consented to this unusual request. When Dr. Aalborg arrived he closed all the doors to the House of Commons except one and then asked all 308 members to form a line outside that door. He then asked the members to enter the chamber through that door, one by one, while he timed the process. Approximately one hour and 15 minutes later, all the members had entered the chamber. Dr. Aalborg then opened two more doors to the chamber and divided the members into three uneven lines, one outside each door. Once again the members were instructed to enter while Dr. Aalborg timed the process. This time it took less than 45 minutes for all members to enter the chamber.
Leading members of the Liberal and NDP caucuses - those who could count, tell time, or both - immediately explained the meaning of the experiment to their bewildered brethren. By establishing three open doors to its health-care system - a public care door, a private not-for-profit door, and a private for-profit door - and with government responsible to ensure that the care available through each met acceptable standards, Quebec ensured that the average waiting time for getting into the health-care system and receiving quality care would be significantly lower than if everyone was forced to wait in a long line behind a single door.
A House United
The House, now enlightened by science and buoyed with Christmas cheer, unanimously approved a motion endorsing the "mixed systems" approach to health care and commending it to all provinces and territories. The motion specifically affirmed that such a system was completely compatible with the Canadian way, since, as all members had always known in their hearts, "mixed systems are the very essence of Canada's national identity."
Preston Manning is president and CEO of the Manning Centre for Building Democracy.
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