Canadian Court Chips Away at National Health Care

[Karmadillo]

http://www.nytimes.com/2005/06/09/international/americas/09cnd-canada.html?hp&ex=1118376000&en=0b16373d15ab0917&ei=5094&partner=homepage

TORONTO, June 9 - The Canadian Supreme Court struck down a Quebec law banning private medical insurance today, dealing an acute blow to the publicly financed national health care system.

The court stopped short of striking down the constitutionality of the country's vaunted nationwide coverage, but legal experts said the ruling would open the door to a wave of lawsuits challenging the health care system in other provinces.

The system, providing Canadians with free doctor's services that are paid for by taxes, has generally been supported by the public, and is broadly identified with the Canadian national character.

But in recent years, patients have been forced to wait longer for diagnostic tests and elective surgery, while the wealthy and well connected either seek care in the United States or use influence to jump ahead on waiting lists.

The court ruled that the waiting lists had become so long that they violated patients' "liberty, safety and security" under the Quebec charter, which covers about one-quarter of Canada's population.

more...

[Tempest]

1. Well, I'm sure

Canadians are going to just love the privatized version of health care the U.S. currently has.

[davepc]

2. A lot of them already do

Go to any Border hospital on the US side and talk to the Canadian patents who are grateful for the pay-as-you-go American health care which allows them to not sit on year long waiting lists for simple diagnostic imaging or non emergency (but needed) surgery.

The Canadian system isn't perfect either.

[KittyWampus]

3. You Wait Weeks & Months In The US As Well. Are Canadians Coming Here

wealthy and can afford to pay through the nose for service on demand?

Not to conflate the Canadian elite with the majority of Canadians.

[davepc]

4. the waiting lists in Canada are ridiculous

I know a girl in Vancouver who worked as a bank teller and get her hand caught in a safe at work. She had to wait 5 months to get the proper diagnostic imaging done to learn she suffered serious ligament damage in her hand and is now currently on a 9 month waiting list to get the proper surgery to fix the problem.

Though I will concede that she does get a great deal on anti-inflammatory and pain medication waiting for her surgery.

[pretzel4gore]

9. but americans w/out any insurance don't have to worry about that!

they never get STUCK on any waiting list! nosirree...and the american families that go bankrupt every day due to medical costs, why the waiting lists for social assistance aren't long either (many US states have little or no social assistance thus no lists haha!)...when americans rob the bank to get the money for mother's med treatment, why they never have to worry about waiting lists for a prison cell with toilet drinking psycho cellmate when they get caught!
poor idiot canadians and their waiting lists for MRI's and hip replacements (btw proceedures only made available within last 20 years...)
if they can't destroy the federal government by ad nauseam attacks on the 'sponsorship scandal' (which was set up with the idea to have those who could be influenced by money inside the canada tent peeing out rather then outside peeing in, during separatism referendum in 1995, which the separatists nearly won anyway! the sponsorship money might well have made the difference, kept canada united, and even if 250 million were 'lost'(?) it seems a bargain!) the pro bush rightwing type and their pigmedia pals now are resorting to the courts; they know that if universal medicare is destroyed, there's not much point then in not just joining the US outright (and let Quebec form its own country)...even the CBC lies relentlessly (for instance they've never mentioned the DS minutes) though it depends on the federal gov for operating money, the cbc was front/centre attacking martin gov. on the 'sponsorship scandal' and have never considered the bush effect when reporting canadians' seeming indifference to the endless revelations about liberal gov. malfeasance....

[davepc]

24. I haven't had health insurance for 3 years now

So I know all about living without medical insurance, and I have a almost 20,000 dollars in medical bills for having my appendix out which i had to pay out of pocket to prove it. That was a fun addition to my budget that year.

I never said that there weren't waiting lists in the United States, but having to wait almost a year to get proper care after getting your hand mangled in a heavy metal door isn't quite my idea of great health care either.

People who have resources want access and they're willing to pay for it. You cant force people who have money to wait in line with everybody else because they'll go to Buffalo or Seattle to get instant care there.

If we have Canadian health care in the United States then Mexico will soon be the home address to a fair number of doctors who are able to charge what they want to people who are willing to pay well outside the reach of any government oversight or regulation. There is already a thriving "health care tourism" industry in India and other countries.

A good system provides an adequate baseline of care for everybody but doesn't force resources offshore to satisfy the demand of people who have means and want instant access. If the socialized system can provide near instant access for everyone, then great, but if it cant then it needs to be fixed or the wealthy who fund it find various ways to 'opt out' legal or otherwise.

[pretzel4gore]

29. the idea was to keep improving the basic single payer system

the single payer system made health an item that couldn't be exploited for profit, it forced the greedy to look elsewhere for biz oopportunity, but!
unfortunately, the US is too close to canada (mexico too)...the fact the canadian system has survived since it 1st set up in the 60's says it was worth something, but as we're members of a dying species living on a doomed planet, it probably doesn't matter....

[K-W]

10. Unlike the US where you cant get proper surgery unless you have money.

Waiting in line is better than being denied care or facing bankruptcy just to afford to live. It may not be perfect but its lightyears ahead of our system.

[iverglas]

28. I know a girl ...

(What are "girls" doing working in banks?)

There's just nothing like a good anecdote. So how's about one from me?

My mum had been having knee pain a couple of weeks ago. I don't know whether she raised it with her doctor at one of her regular appointments, or made a special appointment. She saw him about it pretty much as soon as she decided too, though. He sent her for x-rays.

The x-ray lab, known to over-read x-rays out of an excess of caution (or ass-covering), recommended further investigation: a thickening seen on her tibia *could* have been cancerous. Her doctor had x-rays done at another lab. Still inconclusive. Sent her to an orthopedic surgeon. She had a bone scan done. Still inconclusive. So she called up my mum, maybe 3 weeks after my mum first saw her family doc, and said: let's get an MRI. Can you do it this afternoon? My mum is very claustrophobic and needed time to prepare; she said no. Well, tomorrow? No. Next week then? Okay.

Damn those waiting lists.

Turned out not to be cancer.

If you really want some more anecdotes, I can tell you about all the medical services my co-vivant got within a month of being diagnosed with diabetes -- doctor appointments, lab tests, specialist appointment, ECG, dietician counselling ...

Or all the care provided to my dad during the 6 weeks he was dying of metastacized melanoma 2 years ago.

Or all the damned lab tests and x-rays and mammograms I had myself early this winter.

Or the emergency neurosurgery and abdominal surgery my dad had a few years ago (go into hospital with a head injury that gets written up in the New England Journal of Medicine, come out a few days later having learned you have Crohn's disease and having had to have an emergency intestinal bypass ...). Or his urgent pacemaker implant 3 years ago (go to the drug store to check your BP because you're feeling dizzy, go to a doctor, go to the hospital for an ECG, go back to the doctor, get checked into the ICU, all within about 5 hours, and get sent by ambulance to the cardiac hospital an hour away, three days later).

I could just go on and on.

But the punch line each time would be the same -- NO waiting, and NOT A CENT PAID OUT OF POCKET except for a few prescription drugs (at more or less nominal cost).

If your anecdote is true, it shouldn't have happened. The right-wing federal and provincial governments should not have slashed taxes and health care spending for a decade or so, creating whatever shortage affected that woman's treatment.

Was that your point? Or did you think you had another one?

[glarius]

32. I'm not sure you made it clear you're talking about Canada

Reading your post it wasn't clear....I agree with you on our health care in Canada....You can always find someone who will tell some kind of a sad story, but from my own family's experience with it...we have been well served.....The fact that all the polls show that 90 something per cent of our population want to keep our system says it all,,,IMO.

[Maraya1969]

6. 1/2 of my extended family are from Canada and they like the system

even if it makes for long waits. Ever try to get a dermatologist's appointment in Florida the "Skin Cancer State"

Takes MONTHS.


Even my dentist is making me wait almost 3 months for every followup visit for a bunch of work I am having done. (But I have figured out that is a good thing - because it takes me at least a month to get over the trauma of one visit)

You can go to the walk in clinics and sit with among the coughing and sneezing for three hours if you REALLY need help FAST.

[K-W]

11. Yah, since when is top line or specialized care in the US immediate.

Any doctor with a great reputation or specialist in an underepresented field is booked months to years in advance.

All Canada does is make everyone play by the same rules rather than letting the rich and geographically lucky have immediate care while others face rediculous hurdles to treatment or have no way of recieving care.

[getmeouttahere]

31. I have friends all over Canada....

and not one of them would trade their system for ours.

Also, my friend AND his wife in New Brunswick both had to have cancer treatments almost at the same time and didn't have to wait for treatment. Year long waiting lists are a propaganda tool used by the U.S. govt to keep Americans believing that our system is superior.

[davepc]

33. U.S. Government propaganda?

Jason Fekete
Calgary Herald
July 28, 2004
Page: A1 / FRONT, Edition: Final

...

There are about 25,000 Calgarians waiting for surgery or scans at the city's four major hospitals. And the Calgary Health Region estimates waiting times for surgery are growing at an astronomical rate of 12 to 18 per cent every year.

Alberta Health's website says waiting times in Calgary are as follows:

- 62 weeks for a hip replacement at Peter Lougheed Centre;

- 62 weeks for general surgery at Rocky- view General Hospital;

- 30 weeks for MRI scans at Foothills Medical Centre;

- 54 weeks for knee replacement surgery at Rockyview General Hospital;

- 11 weeks for cardiac surgery at Foothills Medical Centre.

For Warner, the wait has come with a heavy price. She says she has become addicted to painkillers that are a daily staple to help her hobble through her workday.

...

"Our longest waiting lists are in orthopedics and general surgery," said Tracy Wasylak, the CHR's vice-president of surgical services. "We're hoping to put resources into both of those programs this year to drop those waiting lists."

Sick of waiting for her pain to be eased, Warner, meanwhile, said she looked to Montana to expedite the surgery. However, the procedure would cost $25,000 -- leaving her to wait and hope in Canada.
...

I'd provide a link but the Canada.com archives only go back 7 days, though you can purchase it here http://www.canada.com/calgary/calgaryherald/news/archives/index.html. for $4.75 (Canadian, I'm assuming) I found the story on Lexis/Nexis.

Ontario moves to reduce wait times

Friday, May 27, 2005

The Ontario government will provide $154-million more for hospitals this year to shorten wait times for a host of critical-care procedures, including cancer surgeries, hip replacements and cardiac care.

But even the Premier admitted that it remains unclear how much those funds will cut down on clogged waiting lists.
The money, expected to pay for more than 67,000 additional procedures, was billed as the single-largest increase aimed at reducing wait times in the province in more than a decade.

...

But he said "an information deficit" in government data collection means the province does not know how much the money will reduce wait times. "It's been particularly challenging to get good, reliable information when it comes to our cancer procedures," he (Premier Dalton McGuinty) said.

In a survey carried out last summer, the government found the waits for MRIs ranged from four to 50 weeks, depending on the hospital, Mr. Smitherman said. "That's not a system, it's a crapshoot, and we're changing that," he (Health Minister George Smitherman) said.

http://www.theglobeandmail.com/servlet/Page/document/v4/sub/MarketingPage?user_URL=http://www.theglobeandmail.com%2Fservlet%2Fstory%2FRTGAM.20050527.wfund0527%2FBNStory%2FNational%2F&ord=1222534&brand=theglobeandmail&redirect_reason=2&denial_reasons=none&force_login=false


and FWIW I don't think our system is 'superior'. In fact, I think its tragically broken, but I think it has a lot more to do with lack of regulation and accountability in the insurance segment then anything else, that and bureaucratic inefficiency in Medicaid and Medicare (Mark McClellan is a pharmaceutical company hack), promoted by the same people who let the insurance companies run wild.

[redqueen]

38. How does this reconcile with 90% of Canadians being satisfied?

I see there are only a few hospitals mentioned ... has there been any large-scale analysis of waiting lists for all procedures at all hospitals?

Perhaps this problem is localized?

[Spazito]

40. There are waiting lists for elective surgery, there is no question

about that. The article from Calgary is no surprise as the province of Alberta government wants desperately to totally decimate universal healthcare and totally privatize healthcare and make it a for-profit system ala HMOs, Alberta is our Texas-lite province.

Canadians, overwhelmingly, support our current system and want the government to improve it not privatize it.

[iverglas]

41. perhaps not ...

But certainly the right-wing media acting as mouthpiece for corporate interests -- in this case, corporate interests both Canadian and USAmerican, given how the US insurance industry is salivating at the prospect of entering the Canadian market.

Doncha maybe think?

Taking Alberta as the example -- that's a good idea. Alberta's government is, and has long been, the rightest-wing of the Canadian provincial goverments (with competition in the recent past from Ontario and, in some respects, Quebec).

Gee, I wonder whether a provincial government that is foaming at the mouth to get rid of the public health plan and open the market to its profit-seeking corporate buddies might just not be really interested in making the public system work?

Alberta is drowning in money. And still people wait a year for surgery. Alberta has more money than any other province, and still its waiting lists are among the longest. Quite the conundrum, eh?

The anecdotes I related all took place in Ontario. Arguably, Ontario's biggest current problem is a shortage of primary care physicians in some areas. To address the problem after a decade of slashing hospital budgets and health care funding, new places in medical school are being opened up. For instance.

These problems simply did not exist until a decade or so ago, when the right-wing Liberal federal government and a handful of right-wing provincial governments started spending our tax dollars by taking them away from health care and handing them over to the rich in the form of tax cuts. Access to health care declined. Duh.

At the moment, my mum is dithering about whether to have joint replacement surgery (it might not improve her condition, which is essentially unique, being the result of smashing her shoulder up in a bicyling accident 25 years ago). Once she decides to have it, in Ontario, she'll probably wait about 3 months.

Do you really think that a newspaper that is part of the former Conrad Black empire, now owned by a family corporation that controls half the media in Canada, is likely to go looking for people like my mother (perhaps you saw the other anecdotes I offered about her recent health care -- like the same-day MRI) to interview for their stories about health care?

Believe much you hear on Fox News? Imagine how often I look to the Calgary Herald for an accurate reflection of life where I live.

By the way ...

"bureaucratic inefficiency in Medicaid and Medicare"

That's just a chimera. As I understand it, your public health insurance plans are far more efficient than your private-sector operators -- something that is even more true of the difference between Canada and the US in terms of administrative efficiency:

http://content.nejm.org/cgi/content/short/349/8/768

In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada.

After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.

Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent).

Providers' administrative costs were far lower in Canada. <"Providers" being the actual doctors, physiotherapists, etc., themselves, who deal with a single administration, and require no prior authorizations for treatment, in Canada>

[glarius]

46. The Truth about health care in Canada (by request)

This is a post I made on Wed Jan-26-05 03:22 PM

I received a message in my inbox asking me to do a post about the state of health care in Canada.....Here's is what I can tell you:
This is a big country, and you can find people to say just about anything with regards to just about everything...So you will find people who (for whatever reason) will say that our health care system is causing people to die in the streets for lack of care...This is ludicrous...I have heard or read things said by people advocating for privatization of our health care system, that
are completely false..I can tell you that in my family, my husband had care from one of the top heart specialists in the world (he's in Toronto), and successful and timely cataract surgery....We do have to wait for elective surgery, but I've never heard of anyone dying for needed surgery...You already know about our drugs and the vast difference in prices here and in your country...I have heard American politicians on TV say things in order to scare the American public....They say we don't have a choice in the doctor we want...FALSE...We choose our own....I myself have changed doctors in the past several years...And all Canadians have access to all specialists, treatments, and surgery.....They say the Government runs health care and makes all the decisions...Again FALSE....The doctors and hospitals run things and send the bills to the government for payment...Period...The most recent poll I know of on the subject shows that (I forget the exact amount) somewhere between 90% to 95% of Canadians want to keep our present system.....We aren't perfect and can certainly be improved, and the government has recently done a study and as a result is putting more money into the system, but I honestly wish the good people of your country would have the benefit of a similar system....By the way, during the last few days I saw in the news the case of the American man who accidentally shot himself in the head with a nail gun...They said he has no insurance and is stuck with a bill of $100,000....That is insane.....Anyway, I've gone on long enough about
this....Don't let anyone convince you Canadians want to go to privatization....It's just not true.....Good luck...

P.S...In a big country like this, there are bound to occasionally be people who slip through the cracks for some reason or other...So I'm sure there will be some who will have a story to tell of a failure...

[u4ic]

50. Those statistics for Calgary are outdated

the province of Alberta, for general surgery: http://www.health.gov.ab.ca/waitlist/publicReportsPage.jsp

MRI wait times are shorter than the above stated: http://www.health.gov.ab.ca/waitlist/publicReportsPage.jsp


Hip/knee replacement seems to be the biggest problem, although if you're in Ft McMurray, you've got about a 3 week waiting period for it. Cardiac surgery stats are about the same as the article stated.

NOW - look at eye/cataract surgery. http://www.health.gov.ab.ca/waitlist/publicReportsPage.jsp

Gimbel eye centre is private, but is contracted out with the gov't. 90% of patients received service in 84 weeks...that's right. 84 weeks! In fact, a few 'private' centres that the gov't contracts out to in Calgary having extremely long wait times, whereas hospitals are much less...now look at the Royal Alexandra Hospital in Edmonton. 90% of patients received service in 18 weeks. :wtf:

[Canadian Socialist]

53. Do you want to know why the list is so long in Alberta?

Because about 10-12 years ago, the conservative government overspent. Then to make ends met the next conservative government slashed budgets to the bone. King Ralph BLEW UP A WORKING HOSPITAL to sell the land to condo developers; then sold 2 other hospitals to his cronies at way less than market value (IIRC about $.10 on the dollar) who then opened them as "private-for-profit medical centres for such things as vision correction surgery); then slashed nursing staff; then slashed slots at the Universities for nurses! I could go on and on. But you don't live here so you really don't know. It is slowly getting better. But it will take a long time to be back to where we were not even 15 years ago. Can you imagine a city of close to 1 million people only having 3 hospitals? Welcome to Alberta, life's easy if you know the trick... you better not get older and you better not get sick. You're living in Ralph's world.

[Harry S Truman]

52. Me too

I have many friends in Canada ... not ONE would trade their system for ours. No sane person would.

[pretzel4gore]

54. canada's system can't really work well

with the US right beside it...canada should demand that the US institute a single payer medical system too, to prevent the very thing that's undermining canada's system as we speak...if canada was 10x the US in size, then the status quo ok because of sheer size difference, but as the opposite is true(?) canadian politicians have been too polite about this: the US is ruining the canadian system, and it's doing it for NO UNDERSTANDABLE REASON! only a buncha pigs benefit from the US system as is, and who cares about fat greasy pigss?

[applegrove]

5. Since the MRI scans are so expensive, and some people with

money are willing to fork out $$$ - I am not opposed to private centers. If it means a shorter line for people who have no choice to leave the country or pay for private. The government should pay for all else.

There may be a few other areas where private can exist in medicare system. But only a few.

[Maraya1969]

7. They should probably let some people pay for faster

treatment and put the money back in the medical fund. But adding private insurance to socialized medicine doesn't sound like it would work to me.

[applegrove]

8. I agree. The Medicare system is not totally public. There are other

areas where private comes into play. Like nurses & drugs and private doctors for plastic surgery and the like.

You only put the government monopoly where they can keep costs down. With MRI machines and how expensive it is now.. I'm thinking this could be a stop gap measure until prices come down/technology changes.

[Judi Lynn]

12. Canada court paves way to more private health care

Canada court paves way to more private health care
09 Jun 2005 14:35:06 GMT

Source: Reuters

OTTAWA, June 9 (Reuters) - The Supreme Court of Canada on Thursday overruled a Quebec law that banned some private health insurance, paving the way to much wider use of private hospitals to supplement a creaking public health system.

Ending the ban means Quebecers will be able to take out insurance to pay for medical services provided by private clinics, even if these services are also available in the state-funded health care system.

Canadians have the right to free treatment under their Medicare system, but there are often long waiting lists for operations like hip replacements or services like cancer scans.

"Access to a waiting list is not access to health care," Chief Justice Beverley McLachlin and Justice John Major wrote in the closely watched decision that challenged the government's virtual monopoly on providing health care services.
(snip/)

http://www.alertnet.org/thenews/newsdesk/N09580086.htm

~~~~~~~~~~~~~~~~~~~~~~

Ruling Rattles Canada Health Care

TORONTO, June 9, 2005

(AP) Canada's Supreme Court on Thursday struck down a Quebec law that banned private insurance for services covered under Medicare, a landmark decision that could affect the country's universal health-care system.

The justices took a year to rule on a case that began in 1997, when George Zeliotis, an elderly Montreal man, tried to pay for hip replacement surgery rather than wait nearly a year for treatment at a public hospital.

Zeliotis told the high court that he suffered pain and became addicted to painkillers during the yearlong wait for surgery, and he should have been allowed to pay for faster service with private insurance.

"It is indeed a historical ruling that could substantially change the very foundations of Medicare as we know it," said Dr. Albert J. Schumacher, president of the Canadian Medical Association.

Although the ruling was made on the Quebec law, it likely will affect other Canadian provinces that forbid residents from buying private health care insurance for treatment under the country's Medicare system.
(snip/...)

http://www.cbsnews.com/stories/2005/06/09/health/main700681.shtml

[Spazito]

13. Here is the Canadian Broadcasting Corporation article on the

ruling:

Top court strikes down Quebec private health-care law

The Supreme Court of Canada ruled Thursday that the Quebec government cannot prevent people from paying for private insurance for health-care procedures covered under medicare.

The plaintiffs in the case – a Montreal patient and a doctor – wanted Canada's top court to strike down sections of the Quebec Hospital Insurance Act that prevent people from buying health insurance for medical procedures covered by the public health plan.

Four of the seven justices ruled Thursday that the provincial policy violates the Quebec charter. But they split 3-3 on whether it violated the Canadian Charter of Rights and Freedoms, meaning there is no immediate impact on the Canadian health-care system as a whole.

more

http://www.cbc.ca/story/canada/national/2005/06/09/newscoc-health050609.html

[iverglas]

19. it's all very complicated

For those with the time to try to sort it out, here's the link to the decision itself:
http://www.lexum.umontreal.ca/csc-scc/en/rec/html/2005scc035.wpd.html

The issues:

Human rights – Right to life and to personal inviolability – Waiting times in public health system – Provincial legislation prohibiting Quebec residents from taking out insurance to obtain in private sector health care services already available under Quebec’s public health care plan – Prohibition depriving Quebec residents of access to private health care services not coming with waiting times inherent in public system – Whether prohibition infringing rights to life and to personal inviolability guaranteed by s. 1 of Charter of human rights and freedoms – If so, whether infringement can be justified under s. 9.1 of Charter – Charter of human rights and freedoms, R.S.Q., c. C-12, ss. 1, 9.1 – Health Insurance Act, R.S.Q., c. A-29, s. 15 – Hospital Insurance Act, R.S.Q., c. A-28, s. 11.

Constitutional law – Charter of Rights – Right to life, liberty and security of person – Fundamental justice – Waiting times in public health system – Provincial legislation prohibiting Quebec residents from taking out insurance to obtain in private sector health care services already available under Quebec’s public health care plan – Prohibition depriving Quebec residents of private health care services not coming with waiting times inherent in public system – Whether prohibition constituting deprivation of rights to life, liberty and security of person guaranteed by s. 7 of Canadian Charter of Rights and Freedoms and, if so, whether deprivation in accordance with principles of fundamental justice – If there violation, whether it can be justified under s. 1 of Charter – Canadian Charter of Rights and Freedoms, ss. 1, 7 – Health Insurance Act, R.S.Q., c. A-29, s. 15 – Hospital Insurance Act, R.S.Q., c. A-28, s. 11.

Here's the thread where it's being discussed in the Canada forum:
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=190&topic_id=5990&mesg_id=5990&page=
Anybody who wants to discuss it in detail is welcome to come on down.

The decision was split --

1 judge said the legislation violated the Quebec Charter of Human Rights and Freedoms

3 judges agreed, and said it also violated the Canadian Charter of Rights and Freedoms (the Constitution of Canada)

3 judges dissented, and said "The debate cannot be resolved as a matter of constitutional law by judges". They said that the violation of the right to life that was established was not a violation that is not "in accordance with the principles of fundamental justice" (that concept is a broader and therefore more stringent requirement than the "due process" required in the US).

What the effects of this will be, it's hard to say. The majority found that the legislation did not violate the *Canadian* Charter (constitution), and the Quebec Charter is not actually "supreme" the way a constitution is. The Quebec Charter says:

9.1. In exercising his fundamental freedoms and rights, a person shall maintain a proper regard for democratic values, public order and the general well-being of the citizens of Québec.

In this respect, the scope of the freedoms and rights, and limits to their exercise, may be fixed by law.

The Court applies the same test under the Quebec Charter as under the (very differently worded Canadian Charter):

First, the court must determine whether the objective of the legislation is pressing and substantial. Next, it must determine whether the means chosen to attain this legislative end are reasonable and demonstrably justifiable in a free and democratic society. For this second part of the analysis, three tests must be met: (1) the existence of a rational connection between the measure and the aim of the legislation; (2) minimal impairment of the protected right by the measure; and (3) proportionality between the effect of the measure and its objective ... .

Four of the seven judges found that it had failed the test. To be honest, I'm not sure at this point, but I don't think that this necessarily means that the Quebec legislation is unenforceable, since it was not actually found to be unconstitutional.

Me, I'm with what a previous SCC judge said in an earlier case (Edwards Books), which was quoted by the dissenting judges in this case:

In interpreting and applying the Charter I believe that the courts must be cautious to ensure that it does not simply become an instrument of better situated individuals to roll back legislation which has as its object the improvement of the condition of less advantaged persons.

Therein is the difference between right-wing libertarianism and social democracy; as Lacordaire said:

Entre le fort et le faible, entre le riche et le pauvre, entre le maître et le serviteur, c'est la liberté qui opprime et la loi qui affranchit

Between the strong and the weak, between the rich and the poor, between employer and employee, it is liberty that oppresses, and the law that sets free.

[SixStrings]

14. I'm confused.

My Grandmother is fighting cancer. She went into the hospital on a Saturday (last month) - by the next Friday she was up in London getting a 'Cancer Scan'. She now is getting prepped for surgery that will be delayed 1 month while they 'build her up' for the trauma.
Does this sound like a 'creaky' system? This is a poor woman who knows nothing about the system. She was treated very quickly and very professionally. Just one man's perspective - take it or leave it.

[Spazito]

15. The Canada Health Act is still in effect...

this ruling doesn't affect the Canada Health Act that governs our universal healthcare, it deals with specific regulations instituted by Quebec under the Canada Health Act and dealt with the Quebec Charter of Rights, the court did NOT rule with regard to the Canadian Charter of Rights and Freedoms.

[getmeouttahere]

20. Sounds similiar to my father's treatment....

for Multiple Myeloma. He had to have a "build-up" period as well. This is in Oregon, under state-sponsored care.

[area51]

30. Welcome.

A belated welcome to DU, SixStrings.

[Lydia Leftcoast]

16. I love the way they talk as if there are no waiting periods in

privatized health care "systems."

(I'm really upset these days, because my monthly premiums have jumped dramatically, simply because I passed a milestone birthday, and all the alternatives I have looked at are even worse. :-( )

[AX10]

17. I say let's remove those justices for engaging in "judicial tyranny"!

Those judges are unfit for the bench, let's impeach them NOW!

[Spazito]

18. The judges are fine, the federal government just has to implement

their agenda re reducing waiting times and, poof, the case no longer has possible ramifications in other provinces.

[Ayesha]

21. Question about health care in Canada

Is there no private insurance at all in Canada? I have gotten that impression based on immigration info I looked at after the election. They will reject anyone deemed to be a drain on the health care system, whether they actually would be or not. This means that most people with disabilities, including yours truly, can't move there, at least not without a protracted legal fight first. :(

In England, on the other hand, they have both the NHS and private insurance, and from what I've been told that works fairly well as people get faster/additional services via private care, but major surgeries and expenses are covered by the gov't. Not that it works perfectly, but it sounds a lot better than what we have in the USA.

[iverglas]

22. yes and no

Is there no private insurance at all in Canada?

No private insurance is permitted for "medically necessary" services covered by the public plans.

I may not purchase insurance that would pay for my treatment if I am diagnosed with cancer, or break my leg, or contract tuberculosis, e.g.

However, in Ontario, I may purchase insurance to pay for prescription drugs, optometrist services and eyeglasses, private rooms in hospital, dentistry, and various other things *not* covered by the provincial plan.

I have gotten that impression based on immigration info I looked at after the election. They will reject anyone deemed to be a drain on the health care system, whether they actually would be or not.

That really would not be affected by allowing private health care insurance. There would be no guarantee that anyone who undertook to maintain private insurance would do that, and there is no justifiable way of requiring people to enter into enforceable agreements to that effect (really, Canada would be just unlikely to start deporting people for failing to keep up their medical insurance), and so anyone predicted to have high medical expenses in future would be just as much of a potential liability to the public system whether private insurance were available or not.

Canada doesn't really differ from any other country in this regard. In the US, an immigrant without private insurance and without the means to pay for needed care would end up being "a drain" on the public system as well, since as a permanent resident or citizen s/he would be entitled to medicare coverage or some such. I have never had the impression that Canada's medical inadmissibility rules are any more stringent than those of the US.

In England, on the other hand, they have both the NHS and private insurance, and from what I've been told that works fairly well as people get faster/additional services via private care, but major surgeries and expenses are covered by the gov't.

Don't believe everything you're told. ;)

For instance, when you say "people get faster/additional services", you are talking about people who can afford to pay for insurance for those services, or for the services themselves.

For another, I have yet to figure out how anyone could think that subtracting human and material resources from the public system and transferring them to the private system could make the public system better.

The doctors providing the services privately, for example, are the same doctors who provide the services under the public plan -- they just shift some of their hours out of the public plan.

Under the public plan, care is rationed by urgency of need and availability of resources. If someone can simply buy those resources out from under the people in the public plan, regardless of urgency of need, all that amounts to is butting into the queue. It's still *one* queue, it's just that those with the money go to the front of the line.

Unless there are doctors, nurses, radiation therapists and who knows what hiding in caves somewhere, just waiting for private purchase/insurance to be permitted before they come out and add their services to the existing professionals in the public system, instituting a parallel private system alongside a public system is simply going to take professionals out of the public system.

And if we think that the rich -- whose tax dollars are needed to fund the public system, and who already pay disproportionately for that system because they are taxed more heavily -- are just going to be happy to pay for the public system at the same rate as before while also paying for their own insurance/care privately ... well, I'd say we're ignoring everything we know about the rich.

Not that it works perfectly, but it sounds a lot better than what we have in the USA.

Well, of course, I'd have to agree with that!

But the point is that a public system will ultimately only be able to provide the most basic services, to the most destitute, if a private system is allowed to operate parallel to it. The US's medicare system pretty much demonstrates that already. The rich really aren't rushing to fund health care for the poor, let alone the middle class, so it's hard to imagine them agreeing to continue doing so in a country that abandoned the single-payer system it already has.

[Judi Lynn]

23. Kick!

[Sugarbleus]

25. I was afraid something like this might happen...GREED/CAPITALISM

AND ALL THE REST.............IS CATCHING like a virus. Been reading about rumblings similar to this happening in Europe also.

NOT GOOD...

[applegrove]

26. Just heard a few experts on the news. They all stated that this

would not destroy the whole system and they reiterated that our system is the best in the world.

[CHIMO]

27. Not Entirely In Agreement

With some of the ramifications from NAFTA. Seems like we will have to do away with NAFTA to be able to have our own system. Wake up people.

Alberta likes Supreme Court's health-care ruling
Last updated Jun 9 2005 02:41 PM MDT

http://calgary.cbc.ca/regional/servlet/View?filename=ca-scoc-health-care20050609

[AngryAmish]

34. In Blow to Canada's Health System, Quebec Law Is Voided

"The Supreme Court on Thursday struck down a Quebec law banning private medical insurance in a decision that represents an acute blow to the publicly financed national health care system.

The high court stopped short of striking down the constitutionality of the country's vaunted health care system nationwide, but specialists across the legal spectrum said they expected the decision to lead to sweeping changes in the Canadian health care system."

Is this the end of Canada's health care system or is this a blip? I don't know enough about the situation, but I think this is a bad sign.

[Bassic]

36. It's not been voided yet, the Québec government may still

have a way to stop it by using the derogatory clause from the constitution.

[iverglas]

37. heh -- from Quebec, right?

And welcome!

The "clause dérogatoire" -- that's the notwithstanding clause to us anglos (at least us anglos who don't speak Montreal English). ;)

Dérogatoire means "granting an exemption", pretty much. In anything other than European legalese in English, "derogatory" means "insulting". (The "derogating from" sense doesn't exist in everyday English.)

So it's one of those faux amis in our languages. Just thought I'd help out any of our unilingual cousins who might have been confused.

The thing is, the Court found the legislation to be contrary to the *Quebec* Charter, but the notwithstanding clause is in the *Canadian* Charter, which a majority said the legislation did not violate.

There isn't a corresponding clause in the Quebec Charter -- but then the Quebec Charter isn't actually a constitutional instrument, so what I'm not getting is what the effect is: what is the effect, if Quebec legislation violates the Quebec Charter? I'd be tempted to say: so what?

The Quebec Charter is just legislation, even though it looks quasi-constitutional. And in the parliamentary tradition, the legislature cannot bind itself by legislation. It can't hamstring itself by legislating that it must do "X", or many not do "Y". Parliament, and the legislatures, are supreme, and may always do what they want, subject only to the constitution itself (and things like constitutional convention).

Unfortunately, I haven't seen this point addressed yet in media commentaries (and I admit I haven't read the full decision yet), so I'm still muddled. It doesn't seem that the Court actually struck down the legislation, it just found it to be contrary to the Quebec Charter.

[Bassic]

39. Yep I am from Québec, and thank you

for correcting me on the name of the correct appelation for the nonwithstanding clause, I knew that was not the english expression but couldn't think of a better one.

This being said, i think the fact that it was the supreme court that decided on thins makes it somehow possible to use that perticular exit, should the very conservative (though not religious, for those who don't know about the Québec gorvernment) Charest governement want to.

I am also a bit confused as to why the Supreme Court is judging this with respect to the Québec charter. Aren't they supposed to measure things up to the Canadian constitution?

Although, the fact that Québec has yet to sign and recognize the constitution might have something to do with that.

[iverglas]

42. you're not the only one

I know the Canadian Charter, and charter jurisprudence, intimately. And I have read all of the major parties' factums to the Supreme Court (Zeliotis, Chaoulli, AG Quebec, AG Canada), and both of the lower court decisions (Quebec Superior Court and Quebec Court of Appeal). And I don't know the answer.

Ginette Piché, the judge who decided the case at the trial level (Superior Court), did a hugely exhaustive review of the evidence -- the international studies, the history of the Quebec legislation (cabinet ministers from the time it was enacted testified), the history of the Canadian health system. Although I haven't read the full SCC decision yet, I am agreeing with the Canadian Health Coalition so far (emphases in the original):

http://www.healthcoalition.ca/

The people of Canada will be shocked to learn 4 of 7 justices of the Supreme Court of Canada have found that the Québec Charter protects health care rights only for those who can “afford to pay” for private health care. Three of seven justices made the same finding under the Canadian Charter. The decision ignored the weight of evidence accepted by the trial judge and the Québec Court of Appeal.

Unfortunately, Piché's decision is not on the net; the QCA decision is:
http://www.canlii.org/qc/jug/qcca/2002/2002qcca10171.html
in French only. (I know that it has been translated, but the translation is not publicly available.)

As for the notwithstanding clause, what I was getting at was that it doesn't come into play, because it doesn't have to.

As far as I can tell (me being a bit of a scholar in the area, but not as familiar with the Quebec Charter), the Quebec Charter simply is not binding on the Quebec government. The Quebec legislature wrote it and enacted it, and it can ignore it (or amend it, or repeal it ...) if it likes. I just don't know how things could be otherwise. That Charter isn't a constitution, and doesn't require some special majority or a referendum or anything like that to change it.

That is the whole issue of constitutionalization that was argued before the 1982 Constitution was adopted. Entrenching rules to govern Parliament, that Parliament could not violate, is contrary to the tradition of parliamentary supremacy. That's why New Zealand, which modeled its Bill of Rights on our federal Charter, did *not* entrench it in the Constitution -- which means that if the NZ government violates the Bill of Rights, it may look bad, but its legislation can't be struck down.

That's exactly what the Quebec Charter looks like to me. Nice words on paper, but not enforceable.

Here it is, if you or any constitutional scholars in the vicinity want to have a look:
http://www.canlii.org/qc/laws/sta/c-12/20050513/whole.html
(The last two thirds is all about the human rights tribunal, which isn't relevant.)

It does say:

State bound.

54. The Charter binds the State.

-- but it could also say "the sky is orange". If "the state" (French-revolution-ese for the province of Quebec in all its governmental manifestations) wants to repeal or amend it, it may; so why it may not ignore it, I don't know.

As far as the Canadian constitution, when Bill 101 was found to violate the Canadian Charter, Quebec did use the notwithstanding clause in the Canadian Charter. But it simply can't do that here, or if it did it wouldn't have any effect on the ... what, constitutionality? validity? enforceability? ... of the provisions of the Health Insurance Act and Hospital Insurance Act that the Supreme Court found to be inconsistent with the Quebec Charter only.

If you ask me, here's Quebec's real problem: it allows doctors to opt out of the public plan. There are therefore doctors to whom one can go and pay privately out of pocket already.

The issue in the case was solely whether one may purchase insurance privately to cover the costs of seeing a doctor outside the public plan.

If Quebec abolished opting out, the problem would be solved.

Of course, what Quebec actually needs to do is the same as what Ontario and Alberta need to do -- put the money back into the health care system. People go to opted-out doctors, and pay out of pocket (or demand to be allowed to purchase insurance to cover the costs) if they cannot get the services in a timely manner inside the system -- and greedy pig doctors opt out in order to serve the clients who can pay (more than what the system pays) ... and the vicious circle gets bigger.

[Bassic]

43. I agree that doctors opting out is a serious problem

There's one in a small town not to far from where I live (Gatineau) who just did that a few months ago. Now the bulk of the problem resides in the fact taht this guy is the only frickin' doctor on that town, which ispopulated mostly by people who work at the paper plant and old people that only get an old age pension. Now ain't that a nice display of social responsibility.

But I think that the lack of doctors is another big part of the public systems problems. The Collège des médecins du Québec refuses to allow almost any doctor who did not study in Québec or Canada. I've know a guy from France who studied in Montpelier who got refused. They say it is because they are concerned with the fact that foreing doctors dont know enough about the way things are done over here, but of course thats a crappy argument since it can easily be remedied wit a few months formation within hospitals. It is the genral perception that they just dont want the new guys to "steal their jobs"

[iverglas]

47. oh, definitely

But I think that the lack of doctors is another big part of the public systems problems.

If there are opted-in doctors to go to, who in their right mind would go to an opted-out doctor?

The opted-out doctors are simply exploiting the market situation (and their patients) to make a buck. If that situation didn't exist, if there were enough doctors to serve the number of patients, there'd be no incentive to opt out because nobody would go to you. ... As long as doctors didn't start opting out wholesale, of course.

The thing is, the medical profession may piss and moan, but they basically know damned well how good they have it. If people were having to buy insurance like in the US, or pay out of pocket, there'd be doctors on the dole.

They say it is because they are concerned with the fact that foreing doctors dont know enough about the way things are done over here, but of course thats a crappy argument since it can easily be remedied wit a few months formation ("training" ;) ) within hospitals. It is the genral perception that they just dont want the new guys to "steal their jobs"

Absolutely again. Same with the number of places in medical schools.

The medical profession (in its corporate manifestations, like the CMA) wants to operate as if this is still a feudal society, and they hold the keys to the magic kingdom of good health, and only a very select few will be given the keys to let the rest of us in that door.

Fuck 'em. Throw open the doors to the medical schools, and to some extent the immigration doors. (I don't especially want to be draining doctors from the developing world, but I've known two doctors who came here not as economic migrants, one as a spouse and one as a refugee, who were never able to practise, and that's completely pointless.)

Basically, the medical profession creates the shortage, and then tries to profit from it. And neo-fascists like Chaoulli are just the ugliest of a larger unpleasant bunch (not including all doctors, of course).

[FlaGranny]

35. Well, I just had to wait TWO YEARS

to see a doctor!! Two YEARS!!! I live in the U.S. and had no health insurance.

[Freddie Stubbs]

44. Canadian Supreme Court rejects ban on private health insurance

OTTAWA -- Canada's Supreme Court struck down a provincial law banning private health insurance Thursday, a landmark decision that could put in jeopardy the nation's universal health-care system.

The court ruled that the long delays, lack of doctors and other problems with universal health care have put Canadians' health at risk. The decision will allow patients to seek private care outside the system, sparking fears that doctors will leave the national plan to go into more lucrative private practice and create a two-tier system.

The decision takes effect immediately, but the government of Quebec said it plans to ask the Supreme Court to grant it a stay of up to two years to implement the new policy because it could upset the delivery of medical services. It also may spark a flurry of legal challenges in other provinces, legal experts said.

Canada's free health care and inexpensive drugs have bolstered the country's image as being different and superior to its often-overwhelming neighbor to the south, where 45 million Americans have no insurance. The Canadian system arose from a 1984 law that affirmed the government's commitment to provide mostly free health care for all, including 200,000 immigrants arriving each year.

more: http://www.chicagotribune.com/news/nationworld/chi-0506100179jun10,1,16052.story?coll=chi-newsnationworld-hed

[depakid]

45. I think I'll read the decision and the Canadian press

rather than bother with the bias of the Tribune corporation-

There's a reason why the circulation (and quality) of their "news"papers is in a freefall. Once upon a time, the LA Times and the Baltimore Sun were actually half decent sources.

Not anymore....

It's an interesting issue- and a pretty important one. Too important to be left to the Trib for even a first impression.

[iverglas]

48. don't be looking to the Canadian press ;)

Here's a place to start, though:

http://www.healthcoalition.ca/

BREAKING NEWS: The people of Canada will be shocked to learn 4 of 7 justices of the Supreme Court of Canada have found that the Québec Charter protects health care rights only for those who can “afford to pay” for private health care. Three of seven justices made the same finding under the Canadian Charter. The decision ignored the weight of evidence accepted by the trial judge and the Québec Court of Appeal. Click the links below for more information on the decision. ...

Here's another:

http://www.rabble.ca/news_full_story.shtml?sh_itm=2a3ad2f5385a86aa3599f980acea3359&r=1

Thursday's Supreme Court ruling which says Quebec patients should be allowed to buy insurance to cover medical treatments already provided by medicare should serve as a wake-up call to Paul Martin to honour the promises the Liberals have made to patients in four elections, says NDP Leader Jack Layton and Health Critic Jean Crowder.

The court case was pursued by leading private health interests and a Liberal Senator. Its implications are narrow in the immediate term, affecting only Quebec, which has a provincial charter of rights and which is the home of the litigant.

“After 12 years of Liberal government, the privatization Mr. Martin pretends to oppose has grown and we're still waiting for action on the ideas that will protect public medicare and improve it,” said Layton. “Today's court ruling should again sound the alarm for Paul Martin, who keeps mistaking rhetoric for action.”

Across Canada, privatization has increased as a federal Liberal government withdraws from health accountability. ...

and

http://www.canadians.org/news_updates.htm?id=290&step=2&COC_token=23@@79687fd67e5cc59d30ee68368c44927e

Supreme Court ruling opens door Americanization of Canada’s health care

OTTAWA – Today’s Supreme Court ruling is a devastating blow to Canada’s most precious public service, says the Council of Canadians.

“This decision means that U.S. Health Management Organizations (HMOs) could bring their private insurance schemes, which are linked to services in their own private hospitals, to Canada. The result, ultimately, would be the Americanization of Canada’s health care system,“ says Maude Barlow, National Chairperson of the Council of Canadians.

“The Court used examples from Germany, the United Kingdom and Sweden to conclude that private insurance can coexist with a public system. However, these examples do not apply to Canada, as we are subject to NAFTA,” says Guy Caron, Canada-U.S. Relations Campaigner for the Council of Canadians.

Caron explains that under Chapter 11 of NAFTA, Canada cannot give preference to Canadian companies over U.S. ones, even for the provision of health care services. Therefore, U.S. for-profit health care companies can get the same funding for their services from the federal government as is allocated to the Canadian public system.

Those are more like the real story. ;)

[daleo]

49. I think the importance of this is being exaggerated

By the corporate media, much of which wants to create a feeling of resignation among supporters of public health care. The decision hardly means the end of health care, although it may begin a process of slow chipping away, as the title implies. Supporters of health care will want to fight this and roll it back, but it is not the end of the world either way.

The vote was 4-3. Two justices were missing, so it could easily be overruled in the near future.

[liberaliraqvet26]

51. Why can't they have both?

it doesn't make much sense to me that they should be restricted from having private healthcare along side public healthcare for those that can afford it. It would probably take some strain off the public system.