Thursday, January 25, 2007

On accessories

CanWest reports that while the province which tried to undercut single-payer health care most vocally has changed its message under new leadership, Quebec's provincial government has moved to the front line of the health-care battle by specifically allowing double-dipping:
A new legal loophole in Quebec will allow private surgical clinics to bill patients and the government at the same time, in apparent violation of the Canada Health Act.

Under Bill 33, adopted by the National Assembly last month, clinics will soon be able to charge patients "accessory fees" for the use of a private operating room, equipment and even some personnel.

Such a loophole, a McGill University legal scholar warned Wednesday, will lead to wealthier patients jumping the queue for "priority access" to surgery as long as they pay an accessory fee.

Yet at the same time, taxpayers will be paying part of the salaries of the physicians in these private clinics, said Marie-Claude Premont, associate dean of graduate studies in McGill's law faculty...

The government adopted Bill 33 in response to a ruling by the Supreme Court of Canada that overturned the Quebec prohibition on private surgical insurance. The legislation now makes it possible for private surgical clinics to open in Quebec.

The doctors in those clinics would still remain in the public system, however, billing the provincial medicare board for surgery. That means patients could go to a private clinic and use their medicare card to pay for the surgery.

However, Bill 33 also allows doctors in such clinics to "post in public view ... the rates for services, supplies and accessory fees."

The implications of the loophole did not come to light until this week when a Montreal doctor and some partners opened a private surgical clinic. Doctors at the clinic will perform knee arthroscopies, hernia repairs and other day surgeries, billing Quebec health insurance for each procedure.

At the same time, patients will be charged $1,300 for the use of the facilities, equipment and some personnel...

When asked whether such fees were legal, an aide to Health Minister Philippe Couillard responded that the new law will resolve the question.

"Under Bill 33, accessory fees will be outlined in detail - what can be an accessory fee and what cannot," said Isabelle Merizzi.

"There will be an obligation on the part of the clinics, if they decide to go that route, to post their accessory fees so that that there is never a misunderstanding for the patient."

At no point in the interview did Merizzi explicitly rule out the kinds of fees the clinic now charges. She added the government will sign agreements with the medical federations in the coming months to decide on the various fees. Although Bill 33 was adopted on Dec. 13, it will only come into effect by government decree.
Needless to say, there's a serious problem with Quebec purporting to "resolve the question" by declaring that "accessory fees" are somehow legitimate despite their apparent violation of both the Canada Health Act and Quebec's existing health insurance legislation. But since Couillard doesn't seem to have budged from his long-standing pro-privatization stance, the question now is who's going to be able to do anything to correct the situation.

Unfortunately, the only other potential means of redress is through the federal government - and it's hard to be optimistic that the Cons will be willing to enforce the Canada Health Act to prevent an obvious case of two-tiered health care from coming to pass. While Harper was willing to criticize Ralph Klein's privatization measures, that was based purely on posturing rather than taking action against any actual Canada Health Act violations. In fact, the Cons put an end to what little enforcement was already taking place when they took office.

And those didn't involve issues of Quebec's health-care system, which only complicate the picture even more. Are the Cons willing to risk a confrontation with a provincial government whose fate is seen as intertwined with their own? If they were actually concerned about preserving universal accessibility, the answer would be "yes" - but it's hard to be optimistic that the Cons won't value the perception of pandering to Quebec more highly than access to health care.

Of course, it's worth pressuring the Cons to prove that their claimed commitment to universally-accessible care was more than just lip service. But it seems far too likely that Quebec's move to legitimize double-dipping will go unchallenged. And if that proves to be the case, then despite his claims to support the principles of the Canada Health Act, Harper may well go down in Canadian history as the PM who did the most to undermine universal health care.

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