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Doctor Javier Teijeira is performing an open heart surgery in order to replace a malfunctioning valve. The surgery took about 4 hours and the patient heart stopped for about one hour. (Charles-Antoine Auger/The Canadian Press Images/Charles-Antoine Auger)
Doctor Javier Teijeira is performing an open heart surgery in order to replace a malfunctioning valve. The surgery took about 4 hours and the patient heart stopped for about one hour. (Charles-Antoine Auger/The Canadian Press Images/Charles-Antoine Auger)

Part 2: Canada, it's time to get our Health Act together Add to ...



At the same time, Quebec is the only province with a universal pharmacare program. The law decrees that everyone must have prescription drug insurance: Employers must provide the insurance to workers, while others must buy private insurance or, if they are seniors or low-income, register for government-sponsored prescription drug insurance.



Armine Yalnizyan, an economist at the Canadian Centre for Policy Alternatives, said the real strength of medicare is the single-payer system that it provides universal coverage for medically-necessary services.



"The quintessential Canadian lesson is: Pool risk. It's not about public or private, it's economies of scale that matter," she said.



If anything, Ms. Yalnizyan said, Canada should be looking to expand large-scale insurance programs into areas like prescription drugs like many European countries have done.



But, at the other end of the spectrum, what role should private (and even private for-profit) entities play? Does allows those who can afford to pay for care actually undermine the principle of equity?



Janice Mackinnon, finance minister in a NDP government of Roy Romanow and now a professor in the school of public health at the University of Saskatchewan, says opposition to private care delivery does not come primarily from the general public. They care not a wit if services are delivered by private entrepreneurs, non-profits or public employees, as long as access to care is fair (not necessarily identical for everyone) and affordable.



She says ordinary people seem to understand better than politicians that public spending needs to be reined in and new approaches are required, while opposition to change comes from well-organized lobby groups representing physicians and nurses.



"These groups are very powerful and politically astute and they like the status quo," she says. "But the status quo isn't working. We need to try some new approaches."



First and foremost, we need to throw off the shackles of the Canada Health Act, a well-meaning law that has become an impediment to reform.



The CHA, in its current form, perpetuates a fundamental absurdity of medicare: The universal single-payer model applies only to "medically necessary" physician and hospital services. Focusing on doctors and hospitals made sense in 1960 but not does not in 2010; and leaving the term "medically necessary" undefined suggests that medicare must provide all care to all people - an unrealistic expectation that has driven costs through the roof.



Similarly, the law suggests that having patients pay for care - out-of-pocket or with private insurance - is unlawful when, in reality, it is commonplace.



While the CHA articulates some fundamental principles, there are also some important ones missing like accountability, sustainability and patient-centeredness.



Adopting those values is a good a way as any to kick-start a much-needed reform of the system. They would remind us that delivering affordable, timely care in practice is much more important than merely doing so in principle.

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