Thomas Walkom wrote in “Stands on medicare muddled”, (Toronto Star, Dec.6, 2005):
“No wonder that the voters are confused.
On Thursday, Conservative Leader Stephen Harper - the man many Canadians think of as the great privatizer - announced he was firmly in favour of single-tier universal, public medicare.
On Sunday, New Democrat Party Leader Jack Layton, whose party has built its reputation on public health care, said he thinks existing private clinics are all right - as long as taxpayers don't have to subsidize them.
Prime Minister Paul Martin's exact position? So far, it's hard to pin down. But, generally, Martin says he and his Liberals love medicare more than anyone - and certainly more than Harper. At first glance, it might seem that the major parties are singing the same tune on something that voters have identified as their number one issue.
But they're not. There are differences. It's just that they aren't always easy to spot.
That's because the leaders (and we journalists) too often mix up three related but different questions Who pays for medicare? Who delivers it? What's covered?
Who pays? This is the key to the Canadian system. Medicare is, in the jargon of the trade, a single-pay insurance system. This means that any Canadian resident can receive so-called medically necessary services from a doctor or hospital without paying out of pocket. Instead, they are covered by compulsory government health insurance.
This monopoly element of medicare is kept in place by not only the federal Canada Health Act but a raft of supporting provincial legislation - including bans, in six provinces, on competing private insurance. That's why the Supreme Court's decision this summer to overturn Quebec's insurance ban was so important. The court said the ban made patients wait too long for service.
So far, only the Conservatives have addressed the court decision directly. Harper wants a so-called care guarantee to ensure that patients get treatment quickly, paid for by the public system.
The NDP has attacked Harper's idea because it originated with Liberal Senator Michael Kirby. And the Liberals haven't said much at all.
In general, the single-pay aspect of medicare is politically the least contentious. All parties support it, at least in theory.
So when Harper announced Friday that he fully supported a single-tier system for "core services," he wasn't saying anything new.
Who delivers? Canadian medicare has always offered choice. Most physicians are private practitioners. Almost all Canadian hospitals are private (although non-profit).
Radiology and abortion clinics are usually private, as are testing labs. Until recently, none of this was controversial. As long as providers were operating within the ambit of medicare, few cared whether they were private or public.
But that changed in the 1990s when Alberta decided to permit a new generation of private clinics.
The problem here was that these clinics were offering both medicare and non-medicare services. In Calgary, for instance, patients who wished cataract surgery could book a medicare appointment and wait weeks. Or they could pay out of pocket and get the service faster.
Technically, this didn't break any laws because the direct-pay patents were allegedly paying for medically unnecessary extras, including a videotape and a prayer.
In the mid-'90s, Vancouver surgeon Dr. Brian Day opened a private clinic that took advantage of another technicality to let those with money jump the queue. In this case, patients didn't pay Day directly. Instead, they had friends or relatives write the cheques.
By the end of the decade, private MRI clinics in Nova Scotia, Alberta, B.C. and Quebec were offering so-called medically unnecessary scans that allowed patients with money to jump the diagnostic queue, and thereby, the surgery queue.
These developments eventually led the NDP to call for limitations on private delivery. Now Layton wants Martin to prevent private clinics from mixing medicare and medically unnecessary services.
If private clinics exploiting this loophole were denied access to medicare patients, the NDP theory goes, they would not be able to survive financially.
NDP spokesperson Jamey Heath says that's what Layton meant this Sunday when he said, in Vancouver, that he wouldn't close existing private clinics but would starve them by cutting off federal medicare funds.
Harper, by contrast, actively encourages private delivery. He always has. But the Conservative leader has not dealt with the tougher question posed by private MRI clinics How do you maintain the integrity of single-tier medicare if wealthier patients are allowed to have their problems diagnosed first?
Martin's Liberals say only that they "prefer" public delivery of medicare services.
What's covered? Technically, the Canada Health Act requires only that medicare cover "insured" services, leaving it to provinces to decide what that means. The working assumption for medicare's 37- year history has been that all so-called medically necessary services would be covered.
While all provinces have cut items from their medicare lists, none has yet had the nerve to undertake a drastic cull.
As health commissioner Roy Romanow recommended that the act be amended to include diagnostic scans, like MRIs, as medically necessary. The Liberal government ignored that.
Neither of the other big parties has addressed the issue of what should be covered. Harper talks of a universal health-care system that provides "core" services. But he doesn't say what he means by this. The NDP doesn't say much here either.
In the past, both Harper and the NDP have supported the idea of a national drug plan. But they're not talking about that these days.”
The above was written during the last (2005) federal election campaign. From the start, the candidate consistent on medicare has been Stephen Harper, who clearly supported the Canada Health Act and has clearly said that he sees nothing wrong with private health care delivery as long as the provinces pay the cost. (Similar to John Tory's platform in 2007, which was immediately twisted by the left with baseless fear-mongering condemnations of impending 'privatization', 0blivious to the 'publicly-paid, privately-delivered' distinction [which worked so well for Jack Layton]. The left's aim is complete health system control, publicly paid and publicly delivered.)
Maybe if Thomas Walkom’s story caption had more aptly read “Layton flip-flops on healthcare privatization” medicare wouldn’t be as “muddled” for Toronto Star readers. Muddling health-care reform issues with red-herrings, innuendo, and plain fear-mongering is just one way to successfully prolong a problematic medicare monopoly whose best-before date has long expired. The “many Canadians” who, as Walkom opines, think of Harper as “the great privatizer”, are most likely readers of the Toronto Star who have been “confused” by leftist Star gobbledy-gook to “think” so.
Although it may be distasteful to Walkom, the epiphany of any socialist, however incremental, is always welcome! The Star editorialized on May 16, 2004 how Layton took a “principled” stance that he’d amend the C.H.A. to ban the practice of private delivery. Now Mr. Layton says private clinics are “a fundamental aspect” of our health care system and that he would not shut down private clinics. My, how the Great Socializer has changed from “principled” to pandering.
Liberals, of course, have been healthcare hypocrites for years; their hidden agenda being to superficially denounce privatization while doing little to curb it. A blatant example of Liberal health care duplicity was when Pierre Pettigrew (in a rare moment of un-Liberal like lucidity) said “If provinces want to experiment with private delivery options, as long as they respect the single, public payer, we should be examining these efforts”. He was swiftly forced to recant, after howls of Liberal and NDP derision.
Let’s be a bit more honest as to who’s been consistently principled, who’s been consistently in denial, and who has just woken up. A civilized leaders’ debate on their nuanced visions of our healthcare future would be welcome.
[since 2005, we’ve had an Ontario provincial election (2007) where the health care system was barely discussed. There was no debate at all of any consequence on this issue. We have seen what Dalton McGuinty's Ontario Liberals did to Suzanne Aucoin, we have seen the McCreith/Holmes health-care Charter court challenge rise in Ontario; we have seen Ontario's Auditor reveal severe shortcomings in Ontario’s Liberal-run health system [most recently in Dec. 2010!]; we have we have seen many Ontarians forced to obtain their health care in the States.
We have seen Dr. Brian Day take his turn as CMA head, amidst the predictable eye-rolling and derision emanating from the status-quo left.
The opinions on Layton’s “muddled” positions were quite clear from this health-care thread in the National Post:
The National Post’s (Aug.21, 2007) editorial, “Welcome to the debate, Dr. Day” read:
“If nothing else, Vancouver surgeon Brian Day's tenure as president of the Canadian Medical Association will be fun to watch. The unapologetic proponent of more private health care choices for patients is a shrewd and articulate campaigner. If anyone has the energy and wit to explain the benefits of private options to Canadians it is Dr. Day, who assumes the CMA presidency this week. Of course, the proponents of state-monopoly care are already lining up to eviscerate him.
Indeed, medicare's defenders began making Dr. Day's tenure difficult at last summer's CMA convention where he was chosen president-elect. For only the third time in the organization's 140- year history, Dr. Day's election was opposed from the convention floor, mostly by supporters of socialized medicine fearful of seeing a man they call "Dr. Profit" capture such a bully pulpit.
One of the finest orthopaedic surgeons in North America, and an early pioneer of orthopaedic sports medicine and arthroscopy, Dr. Day is quick to point out that he has never advocated the elimination of public health care, but rather the introduction of private options for patients and incentives for hospitals to be more competitive. "I believe in a strong public system," he told an interviewer for the CMA Web site this summer. He would prefer, though, that hospitals no longer receive one big block of funding for the year, but instead are paid by governments according to the number of patients they treat. "I'd like to see hospitals competing with one another for patients."
Such a system is used in many European countries - France and Sweden for instance - and has led to the near-elimination of wait lists and the rapid modernization of medical technology. Governments determine how much a particular procedure should cost and pay hospitals for each one they perform, rather than guessing at the beginning of each budget year how many procedures a hospital is likely to do and giving it a lump sum to cover anticipated annual expenditures. Under this latter "global budget" arrangement used in Canada, patients come to be seen as drains on a hospital's resources. Administrators attempt to have as few tests and operations performed as possible to conserve their budgets. And since a hospital's income is little affected by the number of patients it serves, few administrators see any advantage to making their health centres more attractive.
Even before assuming the CMA presidency, Dr. Day had been making devastating arguments about the hypocrisy of Canadian politicians over private care. In public speeches he has pointed out that three former prime ministers - Joe Clark, Jean Chretien and Paul Martin - all sought faster private treatment, while at the same time singing the praises of public-only care for Canadians. Even NDP Leader Jack Layton bypassed the queue for hernia surgery by having an operation done at a private clinic in the mid-1990s, Dr. Day has reminded audiences.
Dr. Day also noted that while federal politicians like to boast their medicare legislation is based on principles espoused by Tommy Douglas in the 1960s, the Canada Health Act leaves out three of Mr. Douglas's eight pillars - efficiency, effectiveness and responsibility - the three most likely to be reintroduced by private care delivery.
As long-time advocates of more consumer choice in health care, we welcome Dr. Day's elevation. His one-year term is certainly going to broaden the health care debate in this country.”
Anne McGrath wrote in “Jack Layton is not a queue jumper”, (National Post, Aug.22, 2007):
“Re:Welcome To The Debate, Dr. Day, Editorial, Aug. 21.
It was extremely disappointing to read the incorrect statement that "Jack Layton bypassed the queue for hernia surgery."
Mr. Layton did have a hernia operation at the Shouldice Clinic north of Toronto in the 1990s, but it was done within the public medicare system. He was referred by his family doctor, presented his provincial health card and did not bypass any queue.
Though your editorial was careful to attribute the queue-jumping allegation to Dr. Brian Day, the new president of the Canadian Medical Association, you do owe your readers a duty to not repeat false statements.”
Anne Robinson wrote in “Layton benefitted from two-tier health-care”,(National Post, Aug.23, 2007):
“Re: Jack Layton Is Not A Queue-Jumper, letter to the editor, Aug. 22.
In defending her leader's use of the Shouldice Clinic, NDP president Anne McGrath does not seem to realize that she has just reinforced the validity of having private, for-profit clinics provide services in a more timely fashion. The Shouldice Clinic can do hernia operations in a matter of weeks. I am booked at a public hospital for a similar procedure, but it will be well into 2008 before it can be done.
It seems to me this is exactly the message that Brian Day, the new president of the Canadian Medical Association, is giving - use the private sector for providing timely services even if they are paid for by OHIP.”
Vic Stecyk wrote in the National Post, Aug.23, 2007:
“Ms. McGrath protests that Jack Layton is no queue jumper. Let's see: He left the queue in the state-run health care system to have his hernia surgery taken care of in a privately owned and operated clinic. Maybe he merely shifted, but didn't jump. Perhaps Ms. McGrath prefers the image of a shifty Jack, as opposed to a jumping Jack.”
Dan Samson wrote in the National Post, Aug.23, 2007:
“Jack Layton is not a queue-jumper for using the Shouldice Clinic under the auspices of the provincial health plan. But he sure is a hypocrite: The clinic is a privately owned and operated hernia hospital, providing timely access and high quality care to both OHIP and private patients without delay. In other words, Shouldice is the "two-tier" boogeyman that Mr. Layton has expended considerable political capital on shutting down.”
Consumers should reclaim their right to choose their own method of health care payment and delivery. I don't see any politicians willing to risk stepping on the "third-rail" of monopoly health-reform by rewriting the sacred federal CHA, or Ontario's Commitment to the Future of Medicare act. Politicians will hypocritically continue to kiss Tommy Douglas's ass while patients suffer in line ups and die. We can only hope that judicial Charter court challenges will eventually nullify the politicians' negligent legislative folly.