The Magazine

Socialized Medicine on Life Support

The Supreme Court of Canada finally gets one right.

Jun 27, 2005, Vol. 10, No. 39 • By DAVID GRATZER
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GOVERNMENT HEALTH-CARE ENTHUSIASTS in the United States have long looked to Canada as a leading light of health care fairness and equity. From a distance, Canada may seem to have it all: modern medicine and universal insurance. Up close, the story is quite different. On June 9, the Supreme Court of Canada called the system dangerous and deadly, striking down key laws and turning the country's vaunted health care system on its head. The ruling aptly symbolizes the declining enthusiasm for socialized medicine even in socialist nations. American legislators--such as those in the California Senate who approved a single-payer plan this month--should take note.

The Supreme Court of Canada is arguably the most liberal high court in the Western world, having recently endorsed the constitutionality of gay marriage and medical marijuana. Most legal scholars expressed surprise that the justices even agreed to hear this appeal of a health care case twice dismissed by lower courts. Involving a man who waited almost a year for a hip replacement, the bench decided that the province of Quebec has no right to restrict the freedom of a person to purchase health care or health insurance. In doing so, they struck down two Quebec laws, overturning a 30-year ban on private medicine in the province. The wording of the ruling, though, has implications beyond Quebec, and could be used to scrap other major parts of Canada's federal health care legislation.

The decision isn't simply a surprise, it's an earthquake--as if a Soviet court had ruled that not only could a Russian entrepreneur open a chain of restaurants, but he could issue stock to finance the scheme.

What would drive the bench to such a profound ruling? Chief Justice Beverley McLachlin and Justice John Major wrote: "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."

This outcome would not have been possible without the persistence of one man: Jacques Chaoulli. A Montreal physician, Chaoulli was so angered when a government bureaucrat shut down his private family practice that he went on a hunger strike. After a month, he gave up and decided that only the courts could help his fight.

With an eye on a legal challenge, Chaoulli tried his hand at law school--but flunked out after a semester. Undeterred, he sought the help of various organizations to support his efforts. None would. He decided to proceed anyway, choosing to represent himself. His legal fight, costing more than a half million dollars, was funded largely by his Japanese father-in-law.

But Chaoulli was not completely alone. He asked one of his patients for help. A former chemical salesman with a bad hip, the patient agreed. Their argument was simple: Quebec's ban on private insurance caused unnecessary suffering since waiting lists have grown so long for basic care.

The woes of Chaoulli's patient are all too common. Canadians wait for practically any diagnostic test, surgical procedure, or specialist consultation. Many can't even arrange general care. In Norwood, Ontario, for example, one family doctor serves the entire town, and he can only take 50 new patients a year. The town holds an annual lottery to choose the lucky 50.

According to Statistics Canada, approximately 1.2 million Canadians lack a family doctor and are looking for one. Others seek more urgent care. Toronto was shaken recently when the media reported that a retired hockey legend was forced to wait more than a month for life-saving chemotherapy because of a bed shortage at the largest cancer hospital in the country. American companies now routinely advertise in major Canadian dailies, offering timely health care--in the United States. No wonder that, a few years back, more than 80 percent of Canadians rated the system "in crisis."

And now the Supreme Court of Canada agrees. Moreover, it's not alone in tiring of the shortcomings of socialized medicine. Throughout Europe, the story is one of a slow but steady abandonment of public health care.

British prime minister Tony Blair recently won reelection on a platform that called for tripling the number of surgeries contracted out to private firms. Across the Channel, private medicine flourishes. Tim Evans of the influential think tank Centre for the New Europe observes: "There is no ideological debate about who provides the care [in continental Europe]. . . . There are only good hospitals and bad hospitals, not public and private ones." Even in Sweden, patients choose among public and private hospitals. St. Goran's, the largest hospital in Stockholm, is privately run and managed.