Conservative case for two-tier health care is weak

Monday, July 19, 2004


Written by Scott Piatkowski

For the second time in his political career, Frank Klees has managed to make headlines. The first time occurred when he withdrew in a huff from the race to lead the Canadian Alliance due to his outrage over a donor’s alleged attempt to leverage a large donation in exchange for a promise of second-ballot support to another candidate. This time, the Ontario PC leadership candidate and former Harrisite cabinet minister has earned media attention for coming out enthusiastically in favour of two-tier for-profit health care.

“My personal opinion… is that those individuals who choose to seek health-care treatment elsewhere, that they have the right and the opportunity to do it,” suggested Klees last week. “I believe we need choice in the system. I believe we have to have that debate.... What I am suggesting is perhaps there is room for another principle to be incorporated into the Canada Health Act, and that is choice. Let's just have an open debate about whether choice is an appropriate thing and in fact whether it would contribute to the sustainability of our health-care system in this province.”

Klees is hardly alone among Conservatives in favouring a two-tier approach (not that the Liberals are much better, but I’ll save the full details of their hypocrisy for a future column). When the Romanow Report was released in November 2002, Stephen Harper called it its direction “entirely wrong” and its recommendations “pie in the sky”. With the exception of acknowledging the need for more money, Harper didn’t have a kind word for the report. “The direction of this report, the making the system less flexible, moving to banning alternative delivery, to trying to dictate to the provinces the expansion of the system in a whole bunch of targeted boutique ways, all of these ways are completely unhelpful and unrealistic.”

A Harper press release called the report “rehashed status quo” and complained that it would prevent “alternative delivery mechanisms” (I just love those code words), with any new federal money coming “at the expense of private sector involvement”. Harper argued that “the health care commissioner has squandered a perfect opportunity to give our Medicare system a much-needed overhaul and to ensure that it’s ready to meet the challenges of the future. Instead of an innovative prescription, Canadians have been offered a placebo – an $8.5-billion sugar pill – that won’t cure anything… The commission rehashes the health care promises of the 1960s and ignores the realities of today.”

“The greatest irony is that the commission’s report is entitled “The Future of Health Care in Canada,” concluded Harper. “Rather than looking forward, Mr. Romanow and the Liberals have simply shown they’re stuck in a time warp listening to the Greatest Hits of the Sixties.” During the recent election campaign, Canadians heard a much more moderate line from Stephen Harper (though, at least, he saved himself the embarrassment of holding up a hand-lettered “No two-tier health care” sign during the leaders’ debate). He was relying on a strategy best articulated by his colleague Myron Thompson, who told The Calgary Sun, “For now, we’ve got to do what we’ve got to do to get elected.”

During the Conservative leadership campaign, candidate Belinda Stronach (now, by the thinnest of margins, an MP) also argued for two-tier medicine. “We have equal access to an inadequate system at the moment, and when you talk to Canadians you know it's not working. There are many examples we could draw on where the private sector could play a role and deliver better health care.” When confronted by reporters about the fact that her suggestions would violate the Canada Health Act, Stronach countered that she was “not prepared to say we shouldn't look at innovative solutions to relieve pressure on the health-care system. And we must be open in looking at the solutions. But we must ask: At the end of the day, does it compromise the promise of equal access to health care? We must not compromise that principle. But we know the system is not working, and we must relieve the pressure.”

Like Stronach, Klees argues that, “If you have a lineup of 100 people and one person chooses to opt to get health care somewhere else, that shortens that line by one person and it makes the public system that much more accessible.” Of course, that’s both absurdly simplistic and – based on experiences around the world in jurisdictions with two-tier health care -- absolutely incorrect.

Allowing a separate for-profit stream to exist alongside our public health care system won’t create any new doctors or new nurses; it will merely divert them away from the public system. Far from “relieving the pressure” or “shortening the line”, two-tier health care would actually make existing problems with the health care system worse. The result would be that those with money would get care quickly, while those without would continue to wait in an even longer line. That may be fine with Klees, Stronach and Harper, but it’s not OK with Canadians.


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