Ruling May Threaten Canada’s Healthcare System

Canada’s Supreme Court struck down a Quebec law banning private health insurance Thursday, a landmark decision that could jeopardize the nation’s universal healthcare system, once regarded by some advocates as a model for the United States.

The high court ruled that the long delays for patients, lack of doctors and other problems have put Canadians’ health at risk and that the government could not ban citizens from seeking private care if it could not guarantee treatment in a timely and reliable way. The decision will allow patients to seek private care outside the national system, stirring fears that doctors will leave the national plan to go into more lucrative private practice and create a two-tier system that benefits the rich.

The decision takes effect immediately, but the Quebec province’s government said it planned to ask the high court to grant it a stay of up to two years to implement the new policy to avoid upsetting the delivery of medical services. The ruling may spark legal challenges to universal healthcare in other provinces, legal experts said.

Canada’s free healthcare and low-cost drugs have bolstered the country’s image as being different and superior to its neighbor to the south. During periodic attempts to revamp the U.S. healthcare system, which has left an estimated 45 million Americans uninsured, Canada has often been held up as a model.

Critics said the court’s action threatened a widely popular program that is part of Canada’s national identity. But delays have cost the system some of its luster, and some said Thursday that the Supreme Court ruling was a vindication for free-market healthcare.

Montreal physician Jacques Chaoulli, an advocate for private care, and a patient, 73-year-old businessman George Zeliotis, launched the legal challenge in 1997 after Zeliotis had waited a year for hip-replacement surgery. Two Quebec courts had upheld the prohibition on private insurance.

Chaoulli represented himself before the Supreme Court and argued that the province violated his patient’s constitutional rights by denying him timely treatment and refusing him the option of private care. Patients who were willing to pay for expedited treatment were not legally allowed to do so.

After considering the case for a year, the Supreme Court largely agreed, noting in a 4-3 decision that patients had died because of the delays. But it stopped short of declaring that it was unconstitutional to ban private healthcare or that the universal healthcare system violated patients’ rights to “liberty, safety and security” under the country’s charter.

“In the case of certain surgical procedures, the delays that are the necessary result of waiting lists increase the patient’s risk of mortality or the risk that his or her injuries will become irreparable,” Justice Marie Deschamps wrote for the majority. “Many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life. The right to life and to personal inviolability is therefore affected by the waiting times.”

The Supreme Court dismissed the argument that “an absolute prohibition on private insurance is necessary to protect the integrity of the public plan.”

Its decision could allow Canada to follow the example of other countries, including Britain, Germany, France, Sweden and Australia, which allow a parallel private system alongside the public system.

Prime Minister Paul Martin tried to soothe fears that the universal healthcare system, known as Medicare, would devolve into a system that left the less wealthy behind.

“We’re not going to have a two-tier healthcare system in this country,” Martin told reporters in Ottawa. “What we want to do is strengthen the public healthcare system.”

He promised that a 10-year, $33-billion healthcare accord hammered out with Canada’s 10 provinces and three territories in September would shorten waiting times while preserving the system.

Michael McBane, national coordinator of the Ottawa-based Canadian Health Coalition, which supports the universal healthcare system, called the high court ruling a “contradiction of core Canadian values that everyone should have access to healthcare on equal terms without financial barriers.”

He said the ruling of the four judges, which included Chief Justice Beverley McLachlin, suggested that if Canadians had “money to pay for it,” they could have quick access to medical care.

Although the ruling applies only to Quebec province, there are worries of a domino effect. Martha Jackman, a constitutional law professor at the University of Ottawa who intervened in the Supreme Court case on behalf of the Canadian Health Coalition, said Canadian leaders at all levels should affirm their commitment to universal healthcare.

“If they don’t want to do that, the Supreme Court has given them some excuses. The question is, what happens now in the rest of Canada,” she said.

Despite the government’s opposition to the privatization of healthcare, new private health clinics are quietly opening in British Columbia, for-profit hospitals are open in Alberta and for-profit MRIs are expanding in Nova Scotia. Their existence has caused friction between provinces and the federal government, which has threatened to cut healthcare funding to those provinces if the programs are not shut down.

John Williamson, federal director of the Ottawa-based Canadian Taxpayers Federation, called Thursday a “good day for patient rights” in Canada. “No longer can people who are seeking healthcare services be tied up or held back by governments, at least in Quebec,” he said.

Williamson said his federation estimated that Canadians spend almost $800 million a year on private medical services in the U.S. The government has even sponsored programs for patients with fast-moving cancers to receive quick treatment in the U.S. at private hospitals.

Dr. Albert Schumacher, president of the Ottawa-based Canadian Medical Assn., said the decision could have an effect on five other provinces -- Ontario, Manitoba, Alberta, British Columbia and Prince Edward Island -- that, like Quebec, prohibited private insurance for medical services.

“Governments better get running and come to the table and start figuring out how to implement this ruling so they’re not hit with substantial numbers of people who want access to private services,” Schumacher said.

Special correspondent Guly reported from Ottawa and Times staff writer Farley from New York.