The Canadian Medical Association threw its support behind a parallel, private health-care system at its annual meeting in Edmonton on Wednesday.
In a historic vote, delegates decided by a two-to-one margin that patients should be able to go outside the public health-care plan and use private insurance if they can't get necessary medical care quickly enough.
It's a major change for the association, which until now has been unequivocal in its support for a strong public system. The last time the CMA voted on such a motion was in 1996.
But times have changed, said those who supported the motion during the public-private debate, which was supposed to end on Tuesday but was carried over to Wednesday.
Supporters of the motion said too-long waiting lists are an urgent problem, the system is faltering and it needs help from the private sector.
"Governments have had 40 years to get the monopoly system right and the casualties are piling up -- one of them has been my wife," said Dr. John Slater of Comox, B.C.
Although it's being called "an historic change," the statement should come as no surprise. Many Canadian doctors bitterly opposed the introduction of the public health care system, most famously in the Saskatchewan Doctors Strike of 1961. Some private practitioners will always have a problem with a publicly-funded, single-payer system.
What might have surprised many people is the Harper government's reaction to the announcement.
Health Minister Tony Clement has curtly rebuffed the Canadian Medical Association's call for greater privatization of medicare, saying the government will not allow doctors to work simultaneously in both the public and private health systems.
"Any collection of doctors are entitled to their opinion and there are many things we agree with them on, but on the issue of physicians having a dual practice or two-tier system, we're not going down that road," said Clement in an interview Wednesday.
He noted that Prime Minister Stephen Harper last year rejected the same idea in a letter to the government of Alberta.
"The position of the government has not changed. We still agree with and wish to abide by the Canada Health Act. I'm expecting all provinces will abide by the same action."
. . .
Clement said he is not surprised that the issue keeps coming up, but the government has no intention of changing tack. Doctors can opt out of the public system if they wish but they can't work both systems at once, he said.
The federal government can withhold transfer payments that violate the Canada Health Act.
"This issue comes up periodically because of various reports by the great and the good, and the CMA pretty well on a regular basis raises this issue," said Clement.
"It's quite lucrative for physicians to be partially in and partially out because they can in effect top up a guaranteed income with a private income as well.
"When it comes to dual practice . . . that's not the path we're choosing to take."
Clement was responding to a letter to Harper from Doris Grinspun, executive director of the Registered Nurses Association of Ontario, calling on the government to reject the CMA proposal.
This tells us at least two things.
One, messing with Canada's excellent public health care system is not politically viable. Examining it, tinkering with it, fielding different ways to improve it: all good. Taking one step down the path to dismantling it: never.
And two - and this ought to be apparent to everyone by now - Stephen Harper is not George Bush III.
When Harper's Conservatives were elected to a minority government, shortly after we moved to Canada, many liberal and progressive Canadians were predicting doom, convinced that the USification of Canada was underway. I argued vehemently against such alarm, not so much defending Harper, as convinced that these panicked Canadians didn't truly understand what was going on in the United States. If you think Stephen Harper is BushCo Lite, than you don't understand what full-strength BushCo really is. Similarly, I felt that progressive Americans horrified that Canada had now joined Jesusland were misinformed in the other direction.
Now we're 18 months into this government, and I'll try not to say "I told you so" too loudly. I'll never vote Conservative, and naturally we never want to see these folks get a majority government, where they might do some real damage. But come on, folks. They may be called Conservatives, but it's still Canada.
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Let's hear it for nurses. Not all health care professionals are as selfish as the CMA. The Registered Nurses of Ontario issued a strong statement condemning the CMA's proposal. Other nursing groups have been equally vocal. Even before the CMA's announcement, nurses in Edmonton were handing out free tickets to Michael Moore's "Sicko".
The move was meant to remind Albertans of what they don't want to see happen to public health care, says United Nurses of Alberta vice-president Bev Dick.
"They have to constantly be on guard to protect our strong public health-care system. I think Albertans are aware of previous governments' attempts in this province to dismantle that system and allow for-profit people to come into this province," she told CBC News.
Lone Primate has an excellent post about the CMA's announcement, and Harper's reaction: "Thin Edge of a Very Fat Wedge".