Canada Health Act fines

After debating with some people on twitter over recent fines for private diagnostic clinics that offer services for pay, below I will give my opinion why I support those and why I think federal government is mistaken here. I understand these were not without warning but the fact that no province who had them in 2018 was able to comply suggests to me that ending them just wasn’t realistic. BC, the province that tried hardest still got hit and of 17 private diagnostic clinics, only 3 have been purchased by government and brought into public system, 14 still private. I know many go on evidence, values, and even law but I think in real world you sometimes need to take a step back and think of consequences. Below is my thoughts on each of three.

First on the law. These type of clinics have existed since mid 90s and we have had four prime-ministers since so after not taking action for over a quarter of a century, it seems rather late to do now when horse has left the barn. So I don’t buy CHA forced them but if does then that just gives more evidence why it must either be amended or repealed entirely. Fact is all 8 provinces hit with fines have democratically elected premiers accountable to voters. In most extreme case, Saskatchewan government ran on won on 2 for 1 private diagnostics and got over 60% of the vote twice while a party that got only 10% and zero seats is saying sorry you cannot do this. Maybe this is a good case to just get feds out of health care completely. Equalization would be dramatically raised to compensate poorer provinces while federal government would cut taxes by $94 billion (CHT transfer amount) and each province would raise taxes by same amount federal government cut them by. That would put accountability under one government and then each province could decide itself whether it wants these or not. Some like Ontario may ban them, others like Quebec may allow them. And great thing about that is we can learn what works and what doesn’t. Likewise even if law, governments always have discretion in how enforced. Speed limit in theory means cannot go over by even 1 km/h over limit, but no cop realistically will pull you over for going 5-10 km/h over. So I think unless strong evidence it is causing severe harm to public system, I believe government should take minimalist approach here. If they do nothing, nothing happens unless forced to by courts, which I think is unlikely but in that case then make changes to Canada Health Act. Fact is if provinces comply I believe results will be negative. If these clinics are shut down it will just make lines even longer for everyone. If provinces forced to start paying for them, that could make new ones that pop up costly as there are huge start ups never mind will mean those who want to pay for shorter waits no longer have an option.

Next is on values and I will admit this is one where we probably are never going to agree on and different people will take different viewpoints. Key value is health care should be based on need not ability to pay. I generally agree with this approach but not at all cost. If this means long waiting times, I don’t believe it is right to make it illegal to pay for faster service. As in Chaoulli case in 2005, governments should only be able to place such ban if they can give service in a timely manner. If government wanted to say one can only pay if above maximum waiting time, I could accept that as a compromise. Likewise fine if governments placed limits on number of doctors who can go private and their hours as well as even taxing private ones to help fund public. But outright ban is quite extreme. There may be no constitutional right to pay, but there is unwritten rule in most liberal democracies that you don’t ban something unless you can show it is harmful. If people want equitable health care, find ways to get wait times low enough that private pay becomes redundant. Never mind I believe in idea essentials mean no one is denied access, not full equity. Problem with equity is it never works in real world unless you bring everyone down to lowest common denominator. I know many dislike this but it is harsh reality. Most of us believe housing is a human right but we don’t force everyone to live in social housing. Food is a right too but we don’t have a government grocery monopoly. Ditto education and pensions but we don’t ban private for either. More importantly Canada’s value of health care based on need not ability to pay is not unique to Canada yet other countries find less intrusive ways to get as close to goal as possible without banning private pay. And according to Commonwealth fund most do better on equitable access than we do. Focus should be on improving public health care and reality is if improved enough these will go out of business. There are not enough rich people for those to rely on rich only and only exist because many in middle class use them. And most in middle class wouldn’t use them if waiting times were low enough.

Final part is evidence from elsewhere. Common argument is allowing private pay will lengthen times in public while shorten for those who can pay. That has some logic as you only have so many doctors. But considering in countries with mixed system most still go public, it is unlikely you will see a mass exodus of doctors. After you reach a certain level, it will become unprofitable for more to leave. We have no such rules in education yet we have no issue with shortage of teachers in public schools despite existence of private schools. And if a concern there are plenty of ways to control this like most European countries do without banning outright. Never mind many who go private and those who work there would just go to US anyways if banned and that means government loses all tax revenue. And while not an expert and I know many who claim to have studied this say evidence shows it is bad idea, I ask one simple question: If so great why has no other country copied ours? You don’t have to be an expert to know if this was best way of running health care at least some other countries would be copying ours. Experts are usually right but not infallible and one problem I find with experts in Canada is they are very much wedded to Laurentian consensus and oppose anything that goes against that even if real world results elsewhere say otherwise. And if such an awful idea, why not let some provinces try and some not. Fact want to ban nationally allows us from ever finding out. If done for a decade or two and things get worse, I would happily change my view. But with our system a mess, it is time to be bold and take risks.

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