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12.06.05, 19:35
New York Times June 9, 2005
Canadian Court Chips Away at National Health Care
By CLIFFORD KRAUSS
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.
"The evidence in this case shows that delays in the public
health care system are widespread and that in some serious
cases, patients die as a result of waiting lists for public
health care," the Supreme Court ruled. "In sum, the
prohibition on obtaining private health insurance is not
constitutional where the public system fails to deliver
reasonable services."
The case was brought to the Supreme Court by a Montreal
family doctor, Jacques Chaoulli, who argued his own case
through the courts, and by a chemical salesman, George
Zeliotis, who was forced to wait a year for a hip
replacement while being prohibited from paying privately
for surgery.
Dr. Chaoulli and Mr. Zeliotis lost in two Quebec provincial
courts before the Supreme Court took their appeal.
In a news conference, Dr. Chaoulli declared a victory and
predicted that the decision would eventually apply to all
of Canada. "How could you imagine that Quebeckers may
live," he asked, "and the English Canadian has to die?"
Dr. Chaoulli, who was born in France, has long called for
Canada to adopt a two-tier, public-private health care
system similar to those of France, Germany and Switzerland.
Supporters of the current system, however, have argued that
a two-tier plan will draw physicians away from the public
system, which is already short of doctors, thus further
lengthening waiting lists.
Dr. Chaoulli is a passionate if idiosyncratic advocate who
has long been viewed as a lonely character on the political
scene. In 1997, he went on a hunger strike for his cause in
the streets of Montreal, after he was forced to abandon a
private emergency house-call service.
The doctor also went to the University of Montreal law
school to help him make his case, but flunked out after a
semester. He carried on with his legal quest anyway.
Canada's prime minister, Paul Martin, responded to the
court's decision by saying that his government would commit
to lessening waiting times for medical services while
preserving the system.
"We are not going to have a two-tier health care system in
this country," Mr. Martin told reporters. "Nobody wants
that. What we want to do is to strengthen the public health
care system."
But legal scholars and health care experts predicted a slew
of lawsuits challenging provincial health care laws across
the country.
"This is indeed a historic ruling that could substantially
change the very foundations of Medicare as we know it," the
president of the Canadian Medical Association, Dr. Albert
Schumacher, told reporters.
