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All Canadians should have the right to buy private health insurance to complement their care in the medicare system, the country's leading doctors' group says.

The Canadian Medical Association said, in essence, that a recent Supreme Court of Canada judgment, which struck down a ban on private health insurance in Quebec because patients were not ensured timely access to care, should apply to all Canadians.

In doing so, the CMA, which represents the country's 62,000 doctors, also clearly rejected the notion yesterday that there should be a medicare monopoly. It did so just one day after doctors gave their backing to the existence of a parallel, private for-profit health system.

"We have to provide our patients with every possible solution," said Robert Ouellet, of Laval, Que., who proposed the motion to delegates at the CMA's annual meeting in Edmonton. The motion was approved by two-thirds of the delegates.

He noted candidly that while the proposal says purchasing private insurance would be contingent on the public system failing to deliver, practically speaking, patients would have to buy insurance long before they needed it, or they would likely be unable to get coverage.

Barry Erlick, a physician from Toronto, told his colleagues that buying private insurance would be a wise investment because the medicare system cannot keep pace with demand for services.

"Governments are failing my patients today," he said during the debate. "We are saying, 'Give our patients options to alleviate their suffering.' "

But Atul Kapur, an emergency-room doctor from Ottawa, said only healthy, wealthy Canadians would be able to afford private insurance and the privileged access to care it provides, and that would undermine medicare.

"This is not a solution that will help our patients," he said. "It will help private insurance companies to skim and cream healthy patients."

Steve Chambers of Edmonton argued that backing the idea of private insurance is a mistake because it lets governments off the hook and undermines the CMA's long-time support for medicare.

But John Rapin of Kingston said he resented the implication that those who support exploring various options of private and public delivery are undermining the current system.

"Discussing options such as private supplementation is not a blow to medicare," Dr. Rapin said.

After the vote, Ruth Collins-Nakai, an Edmonton cardiologist and the new president of the CMA, stressed that doctors are strong supporters of medicare. But they are looking to alternatives such as private insurance because they are "frustrated at not being able to provide timely care," she told a press conference.

In addition to backing private health insurance, the CMA delegates approved a motion saying that patients who turn to the private, for-profit system because they cannot get timely care in the public system should be fully reimbursed.

The doctors also soundly defeated a motion saying that a parallel private system should not be permitted in Canada.

And they called for governments to create uniform requirements for the accreditation and monitoring of both private and public health facilities.

All told, the proceedings at this week's gathering show that the CMA is now marching clearly down the path that leads to the creation of parallel private and public systems.

Just how far the CMA will go will become clear in six months, when it will produce a discussion paper that will "define and guide the relationship between the public and private sectors in the delivery and funding of health care in Canada."

A recent poll showed that 83 per cent of doctors supported the Supreme Court decision.

Under the Canada Health Act, only the publicly funded system can provide "medically necessary" services. These are defined loosely as care provided by physicians and in hospitals.

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