In Blow to Canada's Health System, Quebec Law Is Voided

In Blow to Canada's Health System, Quebec Law Is Voided

By CLIFFORD KRAUSS

TORONTO, June 9 - The Supreme Court on Thursday struck down a Quebec law banning private medical insurance in a decision that represents an acute blow to the publicly financed national health care system.

The high court stopped short of striking down the constitutionality of the country's vaunted health care system nationwide, but specialists across the legal spectrum said they expected the decision to lead to sweeping changes in the Canadian health care system.

"The language of the ruling will encourage more and more lawsuits and those suits have a greater likelihood of success in light of this judgment," said Lorne Sossin, acting dean of the University of Toronto law school.

Patrick Monahan, dean of the Osgoode Hall Law School of York University in Toronto and a well-known critic of the national health care system, was even more emphatic about the import of the decision. "They are going to have to change the fundamental design of the system," he said. "They will have to build in an element of timely care or otherwise allow the development of a private medical system."

The Canadian health care system provides free doctor's services that are paid for by taxes. The system has generally been strongly supported by the public, and is broadly identified with the Canadian national character. Canada is the only industrialized county that outlaws privately financed purchases of core medical services.

But in recent years patients have been forced to wait longer for diagnostic tests and elective surgery, while the wealthy and well connected either sought care in the United States or used influence to jump medical lines.

The court ruled that the waiting lists had become so long that they violated patients' "life and personal security, inviolability and freedom" under the Quebec charter of human rights and freedoms, which covers about one-quarter of Canada's population.

"The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care," the Supreme Court ruled. "In sum, the prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services."

The case was brought to the Supreme Court by Jacques Chaoulli, a Montreal family doctor who argued his own case through the courts, and George Zeliotis, a chemical salesman who was forced to wait a year for a hip replacement while he was prohibited from paying privately for surgery. Dr. Chaoulli and Mr. Zeliotis lost in two Quebec provincial courts before the Supreme Court decided to take their appeal.

In a news conference, Dr. Chaoulli declared a victory and predicted that the decision would eventually apply to all Canada. "How could you imagine that Quebecers may live," he asked, "and the English Canadian has to die?"

There was no immediate impact on the national system outside Quebec, since the justices split by a vote of 3 t0 3 on the question of whether the Quebec ban on private medical insurance violated the Canadian Charter of Rights and Freedoms, Canada's bill of rights, as the two plaintiffs contended.

However, specialists predicted that the decision would have widespread importance.

Margaret Somerville, professor of law and medicine at McGill University, said the ruling "is extremely important" in large part because "the provinces that want to run some form of a complementary private system would probably be able to do so now."

Alberta provincial officials have long suggested that they wanted to develop a private health care system, while private diagnostic and special surgery clinics have been cropping up in Quebec, British Columbia and Ontario in recent years.

The federal government has threatened to hold back financial aid to provinces that pressed ahead with private health care, but Ms. Somerville said Ottawa would be less likely to do so now.

Dr. Chaoulli, who was born in France, has long called for Canada to adopt a two-tier, public-private health care system similar to those in France, Germany and Switzerland. Supporters of the current system, however, have argued that a two-tier system will draw doctors away from the public system, which already has a shortage of doctors, and only lengthen waiting lists.

Dr. Chaoulli has long been viewed as a gadfly in political and medical circles. He went on a hunger strike in the streets of Montreal in 1997 after he was forced to abandon a private emergency house call service.

Prime Minister Paul Martin responded to the decision by saying that his government was making progress in shortening waiting times for medical services. "What today's decision does do, however, is accentuate just how important it is to act immediately, how urgent this situation is," he acknowledged. But he rejected the notion that the ruling would bring about fundamental change.

"We are not going to have a two-tier health care system in this country," Mr. Martin told reporters. "Nobody wants that. What we want to do is to strengthen the public health care system."

http://www.nytimes.com/2005/06/10/international/americas/10canada.html?oref=login