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Medicare in the crosshairs

by Gregory P. Marchildon

9-bookcoverJeffrey Simpson has been the national affairs columnist for the Toronto Globe and Mail for almost three decades. Since the turn of the new century, Simpson has written numerous critical columns on the state of health care in Canada. He has not only been a reliable weathervane for the changing critique of medicare but, as a leading mainstream journalistic voice in English Canada, he also shapes the views of his readers. It is not surprising, therefore, that considerable attention has been lavished on his latest book, Chronic Condition.

The good news is that the book goes beyond simply rehashing Simpson’s past critiques. More space is devoted to the facts – the statistics and individual stories on which Simpson builds an argument for major change. The bad news is that on the basis of these facts Simpson ends up drawing some very questionable if not erroneous linkages, and this puts into serious question both his diagnosis and his policy cure for what ails Canadian medicare.

Since the 1990s, a stream of books and think tank essays have criticized the Canadian model of universal, tax-financed medicare. At first the critics argued for more private delivery of government-financed medicare services. This was always a red herring given that in Canada the vast majority of doctors and their clinics are private for-profit operators. And while it is historically true that most hospitals in Canada were owned by religious orders, charities and municipalities and hence were not-for-profit, they were not owned by provincial governments. This has changed somewhat with the introduction of regional health authorities in the 1990s, but in some provinces, such as Ontario, hospitals remain private not-for-profit organizations separate from government. In any event, there is nothing in the Canada Health Act that prevents provincial governments from allowing the private delivery – for-profit or not-for-profit – of medicare services

By the 2000s, the brief against medicare had shifted to the single-payer model of funding. This became most obvious in the 2005 Chaouilli decision by the Supreme Court of Canada. A slim majority held that the government of Quebec could not hold a “monopoly” on funding health services if it permitted wait times for surgery that might put patients at risk. In such situations, provincial residents should have the right to purchase private health insurance permitting them to obtain more timely health services. Although Chaoulli was not the killer punch to medicare that proponents had hoped, other cases have been launched that strike at the heart of the Canadian model of medicare.

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About the Author

Greg Marchildon
Greg Marchildon is Professor and Canada Research Chair in Public Policy and Economic History at the University of Regina.


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