In the short term, the decision may light a fire under provincial
governments to improve chronic problems, especially long wait times for
surgeries, tests, and treatments. Some experts believe the ruling could
eventually spawn a parallel, private healthcare system here.
"For our government, it's a very strong indictment of the way they've
handled the system," says Dr. Albert Schumacher, president of the
Canadian Medical Association. "I hope it will move us forward in the
debate. 'Private' has always been used by politicians as a very evil
word, associated with America and for-profit. But it's not necessarily
so."
It all started with a disgruntled doctor, Dr. Jacques Chaoulli, and
his patient, George Zeliotis, a retired salesman from Quebec who waited
nearly a year for a hip replacement.
In a split decision, the Supreme Court in June found that waiting
lists for medical treatments were unacceptably long, causing some
patients to suffer or die. The judges struck down a Quebec law banning
private health insurance for procedures covered by Medicare. Patients
like Mr. Zeliotis should be allowed to go outside the public system and
pay for timely medical treatments through private insurance, the court
said.
"There are tens of thousands of Mr. Zeliotis out there languishing on
waiting lists," Dr. Schumacher says. His patients, for example, go to
nearby Detroit and pay out-of-pocket to get CAT scans in six days
instead of waiting six months in Canada.
By the end of this year, the federal government has promised to
establish benchmarks for "medically acceptable wait times" for treatment
of cancer, heart disease, and other ailments. The government is already
spending billions to try to reduce waiting lists.
Technically, the court ruling applies only to Quebec, and the court
on Thursday granted the government's request to delay its decision for a
year. But Chaoulli v. Quebec will eventually ripple through the entire
country.
"No minister of health can say, 'We're going to deny you a right that
exists in the province of Quebec,' " Monahan says. "As a matter of
political reality, it's applicable in all provinces."
The man who sparked this revolution was often dismissed as a gadfly
during the years he spent fighting the system. Dr.
Chaoulli once went on a hunger strike to protest fines levied on him
for charging fees. Chaoulli represented himself in court, and his rough
yet impassioned arguments struck home with the court.
"I am so happy," Chaoulli says. "Sooner or later, the medical
monopoly will be stopped."
He predicts the emergence of a private healthcare system existing
alongside the public one, as in Australia or New Zealand. Meanwhile, he
is busy lecturing conservative US groups about the dangers of socialized
medicine.
"Libertarians and conservatives do regard him as a hero," says
Michael Cannon, director of health policy studies at the Cato Institute
in Washington, a libertarian think tank. "He's going to be a very
influential figure moving forward in Canada, in the US, and abroad."
Cannon hopes Chaoulli's victory dampens the ardor for Canadian-style
healthcare in the US.
For many Canadians, private healthcare wears the scarlet A - for
America.
"There is no political support for American-style healthcare," says
Michael McBane, coordinator of the Canadian Health Coalition, a
healthcare advocacy group. He says he hopes provinces will toughen laws
to prevent private insurers from entering the market.
Allowing people to buy private health insurance violates fundamental
rights, McBane says, because not everyone will be able to afford
it.
"You can't discriminate based on the size of your wallet on something
as important as healthcare," McBane says. "I would say this is an
aberration and the democratic process will correct it."
The public appears ambivalent about the ruling. A new poll conducted
for the Canadian Medical Association finds that 52 percent of Canadians
view the decision "favorably," and even more said it will reduce wait
times. But when asked if the ruling would weaken the public system, 54
percent agreed, saying it was "a bad thing."
Allyson Lange, a federal government employee, says she would support
a parallel, private health system but doesn't expect dramatic changes.
"There would be too much opposition," Ms. Lange says. "We see a lot
of what goes on in the US - people go broke because they have a health
issue."
