Tory's plan for two-tier health care

The trend to offload costs to private pockets is endemic to the Canadian medicare system. Not only is it evident in Tory's plan but it is also achieved through delisting items to be covered by insurance. In Manitoba it is also achieved through such devices as tray fees etc. when an operation is carried out in a private clinic. Of course the Canadian system is quite limited in terms of many other countries. Most dentistry is not covered nor is most eye care and drug plans vary widely from province to province. This is from the Star.

Tory's plan for two-tier health care

Sep 23, 2007 04:30 AM
Thomas Walkom

John Tory is proposing a radical change to Ontario medicare. The nub of this change is not, as the Conservative leader suggests, letting private clinics deliver publicly funded medicare services. That's already an established fact.

Ontario has private blood labs, private radiology services and private abortion clinics. All are paid medicare rates by the Ontario Health Insurance Plan. None is allowed to charge patients extra for a medically necessary service.

As far as medicare goes, their existence is uncontroversial.

Tory's plan is considerably more ambitious.

First, he would let private clinics offer so-called extras to patients willing to pay out of pocket. That's a fillip open to blatant abuse.

When Alberta allowed private eye surgeries to offer extras in the early `90s, clinics leaned hard on patients to dig into their wallets. One offered cataract surgery patients an improved plastic lens, better eye drops and a prayer – all for an extra $750.

Second, and much more important, Tory would rescind a ban against doctors operating in both the private and public systems.

This ban, on so-called double dipping, has been in place in most provinces since the late `60s. In effect, it forces doctors to choose: They can opt out of medicare – with the exception, since 2004, of those who work in Ontario, although, presumably, Tory would rescind this ban as well.

But if they do opt out, they have to stay out. They can't make their basic wages from medicare and then use private-pay patients to top up incomes

The Canadian Medical Association, under the presidency of medicare critic Dr. Brian Day, is vigorously urging provincial governments to trash this requirement. The reasons are obvious.

A full-scale parallel private system is virtually impossible unless physicians are able to work both sides of the street. Some doctors can make a go of it, particularly those who service workers' compensation cases (for bizarre historical reasons, workers' comp lies outside of medicare.) But most can't survive without access to the bread and butter of public medicare.

Tory says his proposed clinics wouldn't require medicare patients to pay extra. And, of course, they would not. Extra-billing is illegal under federal law. But they would, presumably, also offer faster services to those willing to pay out of pocket.

Otherwise, what would be the point of eliminating the double-dipping ban? Why allow doctors to operate in both the public and private systems unless you also allow a private system?

And once that is in place, so are all the problems of two-tier health care – including bigger lineups in the public system as doctors focus on more lucrative private patients.

The Liberals are under attack for many things, including their decision to let private firms build and lease publicly operated hospitals. But the fundamental question in these cases has to do with money; experience shows that such partnerships cost the public more.

Tory's scheme, however, is qualitatively different. He's not just talking about letting private clinics deliver medicare services. His plan would set the stage for a full-scale, private, parallel system.