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Conservative Leader Erin O'Toole speaks to the media on Aug. 24, 2021 in Ottawa.Ryan Remiorz/The Canadian Press

Conservative Leader Erin O’Toole promised to give Canadians “choice” in health care on Tuesday, saying he would not intervene in provinces that allow people to pay for faster access to some services after the Liberals pledged to claw back cash over privatized care.

The debate over health care delivery drew a premier into the fray for the first time during the campaign for the Sept. 20 federal election. Saskatchewan’s Scott Moe released a statement on Tuesday condemning the Liberals for saying on Monday that if re-elected, they would penalize the province if it continues allowing people to pay out-of-pocket for faster access to MRIs. And Liberal Leader Justin Trudeau was pressed to explain whether he would apply the same policy to Quebec.

At the same time, Mr. O’Toole sought to clarify his position on privately financed services within a public health care system after the Liberals surfaced a 2020 video from when he was a Conservative leadership candidate in which he called Saskatchewan’s two-for-one MRI program a “brilliant move” and an example of how to “find public-private synergies and make sure that universal access remains paramount.”

The Saskatchewan program allows for-profit clinics to charge individuals for MRI scans if they provide an equal number of free scans to people on the public waiting list. One clinic lists a base fee of $950 for the first MRI.

“If Saskatchewan, Alberta, Ontario or Quebec want to innovate to provide better health care, I support that,” Mr. O’Toole said on Tuesday in Ottawa. “Why? Because it gives Canadians more choice. The more choices Canadians have in health care the better.”

When asked to explain his endorsement of the Saskatchewan program, he said: “I support universal access in our system, public and free. And I also support provinces making sure that they can offer more choice, faster service and less waits for their citizens.”

“I support the current system,” he added.

The Liberal government raised concerns about privately funded services in Saskatchewan and Quebec in 2016 and 2018. In both cases, it threatened to claw back federal health funding because the Canada Health Act is supposed to ensure Canadians do not have to pay for medically necessary care.

In 2020, the Liberals brought in a new diagnostic services policy under the act. It gives Ottawa the right to penalize provinces that offer queue-jumping for people who are willing to pay. But the new policy does not take effect until December, 2022, and is based on self-reporting. And it gives the federal health minister the discretion to reverse deductions for provinces that change their policy.

On Monday, the Liberals for the first time said they would apply the clawback to Saskatchewan if the province doesn’t change its policy. Mr. Moe accused the Liberals of singling out Saskatchewan while turning a blind eye to others.

“We need a federal government that unites the country, not divides it further,” Mr. Moe said in a statement.

However, Mr. Trudeau’s government twice deducted millions from Quebec over the same issue, according to the 2019-20 annual report on the Canada Health Act. Both times, the province was reimbursed after it eliminated the patient charges.

On Tuesday, Mr. Trudeau said his government has “made adjustments” in the past to Quebec’s health care transfers.

“We will continue to stand up for a public, universal health care system, unlike Erin O’Toole. In the depths of a pandemic, he actually shared his perspective that he believes in a for-profit, private health care system, and he will not tell people what exactly he wants to do with that,” Mr. Trudeau said.

The Conservative Leader on Tuesday avoided the word “privatization,” instead talking about “choice.” Colleen Flood, Ottawa University’s research chair in health law and policy, said that term is often used as “code for privatized options” and can refer to two-tiered health care.

Prof. Flood said there’s an important difference between private financing of health care, where individuals pay for a service and can “jump the queue,” and private delivery of health care that is publicly funded, which is used in many parts of the public system.

The core issue for Canadians is wait times, Prof. Flood said, and the evidence suggests that adding user-pay options “only solves the problem of wait times for the wealthy.” Saskatchewan data show wait times went up since the policy was introduced in 2016.

Still, she said the Liberals “rest on their laurels” and haven’t done enough to enforce the Canada Health Act, letting medicare “be undermined from within.”

On Monday, Mr. Trudeau promised to give the provinces $6-billion immediately to reduce health care waiting lists, and $3-billion over four years to hire more family doctors and nurses. But Katherine Fierlbeck, the chair of Dalhousie University’s political science department, said unless the Liberals also address the number of staff available in Canada, throwing money at the problem will only drive a salary competition.

“There is already a finite supply,” Prof. Fierlbeck said. “All you’re doing is causing a bidding war between provinces, which means that the poorer provinces are going to lose out, just like they do now.”

In a statement, NDP Leader Jagmeet Singh questioned Mr. Trudeau’s sincerity about preventing privatization within the health care system and accused the Liberals of not doing enough to address privatization in long-term care.

“If he’s really against private health care, why has he let provinces privatize health care services and why does he think it’s good enough for our seniors?” Mr. Singh said.

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