Several weeks ago I had coffee with a board member of one of British Columbia’s regional health authorities. In the course of our conversation, I mentioned the ongoing constitutional challenge to B.C.’s restrictions on patient access to private health care.
The nub of the plaintiffs’ case is that, if the government is not able to provide timely medical treatment to persons suffering on long waiting lists, it cannot at the same time legally prohibit these patients from taking control of the their own health and arranging for private treatment within the province.
It’s a straightforward question rooted in the Charter rights to life, liberty and security of the person: what right does the state have to control the choices we make about our bodies, particularly when we are suffering acute physical pain, mental distress, and financial hardship as a result of injuries or illnesses?
My coffee companion said the case reminded him of a recent visit he’d had from a delegation of Chinese government officials interested in learning about Canada’s health care system.
Early in the meeting, they ran into an unexpected conversational roadblock. He had only begun outlining the basics of health care administration in B.C. and already his guests seemed confused.
He started explaining the basic principles again, in even simpler terms: The government decides what are medically necessary procedures and those procedures are covered by universal health insurance, free at the point of delivery.
The government then sets a budget and that determines how much health care the province can pay for each year. Residents cannot go outside the system and pay for their own medically-necessary treatments, unless they want to travel to another country.
“Stop there,” the translator said. “It’s that last part that is confusing the delegation. They think you’re saying that Canadians cannot spend their own money on medically-necessary health care.”
Yes, he assured them, that’s right.
The translator pressed him: “You mean to say that if you’re sick and want to pay for treatment, that you aren’t allowed to? Even though it’s your own money and there is a doctor willing to accept it?”
Yes, that’s right.
There was a pause as the translator relayed the answer to the delegation and the delegation conferred among themselves. Finally, the translator spoke up: “They say that even the Chinese communist system is not this restrictive!”
They were right, of course. In no other free country in the world does the government assert a complete monopoly over medically-necessary health care services. And, as the Chinese delegation confirmed, even most unfree countries are more progressive than Canada.
We are taught that our health care system is the jewel of our social democracy and the envy of the world. But rarely does anyone ask: if that’s true, then why does literally none of our peer countries — not the United Kingdom, not Sweden, Australia, or the Netherlands — follow our model?
The reason is that our system produces among the very worst patient wait times, is not cheaper than most other countries, and does not even perform well when it comes to access and quality of health care based on income, the one area in which a state monopoly that should, in theory, excel.
That is why the plaintiffs are in court right now defending the constitutional right of patients to control their own health, shorten unreasonable wait times, and alleviate unnecessary suffering.
This right is well-entrenched in Supreme Court of Canada precedent, but you don’t have to be a lawyer or health care expert to understand the problem at the heart of the case. Even Communist Party of China officials get it.
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