Last Updated: Friday - 09/24/2010
Week of February 28, 2000
The debate over private health clinics
Gov't says it wants to save medicare; critics says proposed reforms will kill it
By RAMON GONZALEZ
WCR Staff Writer
Premier Ralph Klein's proposal to expand the role of private enterprise in health care has sparked protests across the country, with opponents saying his ultimate goal is to replace Canada's universal medicare with an American-style two-tier system.
Klein's proposal, to be introduced next month, will allow regional health authorities to contract with private, for-profit surgical clinics for procedures, such as hip replacement and cataract surgery, requiring an overnight stay.
Klein says his proposal will protect medicare, eliminate lengthy waiting lists and save money.
"The proposed legislation would prohibit the development of any parallel two-tier health system in Alberta," says a policy paper released by the government in mid-February.
"At the same time, it would let publicly funded regional health authorities look for new and better ways to deliver health services, improve efficiency, and reduce waiting lists through limited contracts with surgical clinics to deliver some surgical services."
The paper says the legislation will ensure no private surgical clinics operate outside the public system.
In late January, Health Minister Halvar Jonson said rather than allowing private hospitals to run amok, the bill will actually place legal controls on how they operate.
"The initiative that we are talking about is to provide the best possible service for what is insured now and to make sure that what is insured now is not subject to a two-tier - pay if you are rich, can't pay if you're poor - standard."
Critics, however, say that Klein is launching a return to the pre-medicare era of private insurance. They speak of business interests waiting in the wings and even exercising influence in the decision-making process.
"There are very large economic interests at stake," University of British Columbia health economist Bob Evans told Southam News in late January. "I'm with Woodward and Bernstein: Follow the money. There has got to be people behind this who stand to make a lot of money."
The Catholic Health Association of Canada (CHAC) is also concerned about the proposals.
"This is much more than simply looking for ways to deal with waiting lists and with federal funding cuts," says CHAC's president Richard Haughian. "This is an attack on the very principles which underlie Canada's national system of public health care.
"It is a move designed to both legitimize and prepare for a parallel private health care system, with all the increased costs and unequal access which will ensue if the Alberta government succeeds."
The archdiocesan Social Justice Commission, worried that Klein's proposal may mean the end of medicare, hosted a pro-medicare meeting Feb. 16.
Concerns expressed by the audience included longer waiting lists for medical procedures, new fees for what were once government-funded services and the possibility that publicly-funded health care will vanish if more for-profit providers are allowed to operate.
Klein's proposal will lead to the demise of medicare and the creation of a two-tier health care system - one for the rich, another for the poor, Liz Reid of Friends of Medicare told the rally.
"The Klein government is committed to bringing corporate for-profit health care into the province," she said, noting that since 1993, the number of private clinics has increased from 35 to over 50.
If the legislation is passed, tax dollars that would have been spent in existing public hospitals will be used to subsidize private, for-profit hospitals, Reid told 150 people at the Catholic Pastoral Centre.
Speaking at the same meeting, Tory MLA Mary O'Neill, a Catholic and a member of Friends of Medicare, defended Klein's proposal, saying its aim is to give the government legal authority to regulate private surgical clinics and to safeguard medicare.
"We'll not allow private hospitals in Alberta," she said. "What we are proposing is to work with the principles of the Canada Health Act."
For-profit health care providers already have an important role in the system, noted O'Neill, saying private laboratories in the Capital Health region now do 80 per cent of the region's lab work. "They are saving us $20 million a year."
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The Social Justice Commission opposes Klein's proposal on the grounds it treats health as a mere commodity to be bought and sold in the marketplace, said spokesperson John Lynch.
"We feel very strongly that you can't bring the idea of corporate profit into the (health care) picture," Lynch said.
"When you go into a two-tier system where you are paying a profit for your medicare inevitably you stand the danger of making your health care system less universal and the poor are the ones who tend to suffer."
Klein has been trying to reform the medicare system from the day he became premier.
In January 1993, he tried to introduce user fees, which were banned by the Canadian Health Act. He followed this with a series of dramatic funding cuts.
Threatened with financial penalties by the federal government and with an election on the horizon, Klein backed off the user fees proposal.
But he has never given up on privatization. And in 1996, he got the federal government to agree to some of his proposals.
That year the federal government reached a working understanding with Alberta that allows physicians to remain in the public system while offering additional services not publicly insured for which patients must pay directly, either from their own pocket or through private health care insurance.
The Canada Health Act requires provinces to provide "medically necessary" health services that are universally available, medically comprehensive, reasonably accessible, portable between provinces and publicly administered.
But the act doesn't define "medically necessary" and each province is free to set parameters.
Under the 1996 working understanding, some Alberta patients are now paying at private clinics for services deemed non-medically necessary, like cataract surgery and MRIs.
In eye clinics, elderly patients coming in for cataract surgery are being told they can get a free artificial lens covered by medicare, or they have the option of getting a better lens that will be less painful to install and will involve less recovery time. But it can cost up to $750 per eye. Most patients, figuring the medicare lens is substandard, are paying.
Patients who need magnetic resonance imaging (MRI) can get it faster if they pay $750 to a private clinic, according to Friends of Medicare.
Critics fear similar things are likely in the surgeries that are contracted out. Given a choice of a basic medicare hip joint or a better one suggested by a surgeon, most patients will probably pay extra for the latter.
Reid said there is no evidence to suggest the clinics will lead to efficiency and lower costs.
She said that in Calgary, where all cataract surgery is done by contract with private clinics, the cost of that surgery is 50 per cent higher than when it is done in public hospitals in Edmonton.
In addition, the waiting times are longer in Calgary than they are in Edmonton, where 80 per cent of cataract surgery is done in the public system.
Author Kevin Taft, who wrote a critical report on the proposed reforms, said all available research shows for-profit health systems are costlier and less efficient than public systems.
Government officials dismiss arguments that its reforms will open the door for American health corporations to move in.
But, in a pamphlet, Friends of Medicare says the North American Free Trade Agreement requires signatory governments - Alberta included - to extend the same rights to foreign companies as it extends to home-grown business.