Open Letter to Prime Minister Paul Martin and the Leaders of the Opposition
The Quebec government is about to release a white paper proposing changes to its health-care system, possibly including legislative changes allowing doctors to practice in both private and public health-care systems. At the same time, it appears you will be in the midst of an election campaign as early as next week. While finalizing your policy platforms, remember that Canadians want to know what actions you will take to strengthen our publicly funded, not-for-profit health-care system while preventing further incursions of for-profit health care. Keep in mind that the public deserves to know precisely what you intend to do so that all Canadians, no matter where they live or what their income, will have universal access to high quality health care.
That means you will need to state clearly whether you support the current ban on private insurance for medically necessary services and the prohibition on physicians operating in both the private and public systems – a prohibition that the Chaoulli Supreme Court ruling did not comment on, and remains in force unless the Charest government legislates it away.
For its part, the Registered Nurses’ Association of Ontario (RNAO) will be assessing each of the party’s platforms, looking for commitments to iron-clad conditionality for federal transfers for health care, a national health human resources plan, and vigilant enforcement of the Canada Health Act. Nurses will take that analysis to the public and urge them to join us in common cause to defend medicare.
RNAO will also be looking for indications that you understand what underpins the health-care issues of today and tomorrow. For instance, how do poverty, homelessness and pollution feed into health disparities, and what can we do about it? Do you have the courage and conviction to demand that all federal transfers be conditional on not-for-profit health-care delivery? Will you commit to tracking the link between health spending, delivery mode (for-profit and not-for-profit), and health outcomes?
Given the Chaoulli decision, Canadians need to know how you will address the question of wait times. Your actions must be guided by the right vision and values, and your answers need to be rooted in solid research and evidence. And the evidence on wait times is clear. A recent study shows countries with parallel public and private health-care systems have the longest wait times. England and New Zealand, which have parallel hospital systems, appear to have larger waiting lists and longer wait times in the public system than countries with a single-payer system like Canada.
Studies from Australia and England have found that the more care provided in the private sector in a given region, the longer the wait times for public hospital patients. Our own Canadian experience provides similar results. In Manitoba, when cataract surgery was available in both private clinics and public facilities, the median wait time in the public sector was 17.9 weeks, while it was 5.4 weeks in the private sector (1998-99). Wait time for surgery in the public sector was longer for patients whose surgeons worked in both the private and public sectors 26 weeks as compared to 10 weeks for those whose surgeons worked only in the public sector.
In addition to these research findings, the simple truth is that establishing a two-tier health-care system will not add a single nurse or doctor to the ranks of health-care professionals available to serve the public. Indeed, a two-tier system will siphon off resources from the public system, and weaken the public’s support for it. That’s why we need you to pursue a wait time reduction strategy that protects the single-payer system, strengthens the public system, and stems the tide of privatization of delivery of health services.
There is little doubt that the Chaoulli decision has whetted the appetite of for-profit interests, both inside and outside Canada, eager to enter the new markets they hope to exploit. They aren’t waiting for a federal election to seize the opportunities they see, and you shouldn’t wait for the writ to drop before declaring to Canadians how precisely you are going to protect and strengthen public medicare.
We, like all Canadians, eagerly await your responses.
Joan Lesmond, RN, BScN, MSN, Ed. D. (c)
President, Registered Nurses’ Association of Ontario
Doris Grinspun, RN, MSN, PhD (c), O.Ont
Executive Director, Registered Nurses’ Association of Ontario