Belinda Stronach and Ralph Klein have declared open season on the concept of universal health care. Their timing is impeccable. In a matter of months, the Supreme Court will entertain just such an argument, perhaps opening the door to permanent two-tier health care.
The Supreme Court case will test a bid to allow Canadians the right to private health care when they want it -- a Pizza Pizza-style guarantee of 40-minute delivery or it's free.
At issue: A Quebec doctor and his patient claim the provinces are violating the Charter of Rights and Freedoms by blocking access to speedy health care. The law doesn't allow extra billing or private insurance for medically necessary care, even for those Canadians who can and want to pay up front.
Jacques Chaoulli's arguments for more private health care have been defeated twice, in two courts of law: the Quebec Superior Court and the Quebec Court of Appeal.
The court of final appeal, the Supreme Court of Canada, has agreed to hear the case in June, and it is poised to become the health-care court case of the decade.
The case challenges the fundamental notion behind Canada's universal medicare system: that health care should be equally accessible to everyone, regardless of ability to pay.
Cloaked in the language of freedom and choice, Dr. Chaoulli's challenge asserts that patients should have the right to decide how long they are willing to wait for public health-care service and have the option to access a parallel private system to pay for faster care, yielding a model similar to the one in the United States.
What is the hallmark of health-care delivery in the United States? It gives quickest care to those who have the most money. The focus on "when" and the focus on "my choice" is a U.S. focus, regardless of whether the care is necessary, or even ultimately harmful.
That's the opposite of what Canadians said to the Romanow Commission two years ago. The focus then, as now, was on making sure everybody has access to health care, and that the care is appropriate to the person's health needs. No more and no less.
In the wake of Romanow, there has been a virtual propaganda campaign focusing on wait times. Can we do better to improve wait times? You bet, but not by creating a parallel universe of private, customized care. We need to devote more resources and more planning in the public system to lever change. But when our entire focus is on wait times alone, the tradeoffs and the costs are too great.
When Madam Justice Ginette Piché decided the Chaoulli case in Quebec, she rejected the core remedy on offer: creating a parallel, private system of care. She determined that such a development would threaten the viability of the publicly funded health-care program in Canada. It would, in essence, undermine the system's ability to provide timely, quality public health care . . . for all Canadians.
"At one time, many sick Canadians did not seek medical care because they had no money to pay for it," the judge wrote. "Eliminating the profit motive is the reason why Quebec's health insurance and hospital acts exist."
Time and money isn't all that's at stake with the Chaoulli case. Ultimately what's on trial is the principle of universality that has made Canada's public health-care system the envy of many other nations. In June, all eyes will be on the Supreme Court's deliberations. The decision will affect us all, as individuals. And it will speak volumes about the type of nation we want to be.
Armine Yalnizyan is an economist in Toronto. Dr. Robert McMurtry was Roy Romanow's chief adviser on the Royal Commission on Health and serves on the Health Council of Canada.