The Right Honourable Stephen Harper
Prime Minister of Canada
Office of the Prime Minister
80 Wellington Street
Ottawa, ON K1A 0A2
August 7, 2007
Dear Prime Minister:
On the event of the Canadian Medical Association advocating a larger
role for private health care, I am writing on behalf of 560,000 members
of the Canadian Union of Public Employees, urging you to enforce the
Canada Health Act and achieve public solutions to strengthen Medicare.
In an April 3, 2006 letter to Alberta Premier Ralph Klein, you affirmed
the principle of equal access and squarely opposed the dual practice
model now being advanced by the CMA. Since then, your government has
stood firm on dual practice but has allowed private clinics to
proliferate, eroding universal single-tier health care.
On the question of physicians practicing in both the public and private
health systems, you correctly stated: “Dual practice creates conflict
of interest for physicians as there would be a financial incentive for
them to stream patients into the private portion of their practice.
Furthermore, dual practice legitimizes queue-jumping as it provides an
approved mechanism for patients to pay to seek treatment at the front
of the line. Moreover, such dual practice may be magnet for rural
physicians to migrate to urban centres.” Your Health Minister Tony
Clement last week repeated those criticisms, pointing out that
physicians keep raising dual practice because it is lucrative, letting
them “top up a guaranteed income with a private income”. We trust that
your position on dual practice will not change, and we urge you to
apply the same logic to private clinics.
You claim to uphold the accessibility principle, and yet your
government allows queue-jumping and the rapid expansion of for-profit
clinics. When speaking to the Alberta government last year, you said
“citizens want faster access … but access should also be equitable and
not determined by a person’s ability to pay”. To match those words and
meet your obligations under the Canada Health Act, you must demand full
monitoring and reporting by provinces, investigate violations, and
financially penalize provinces that allow violations of the Act.
In Vancouver, Montreal and other cities where private clinics deliver
medically necessary services, a person’s wealth increasingly determines
access to health care, and your government stands silent. Again last
year, you failed to demand adequate reporting on the Canada Health Act,
and your penalties for violations were paltry. In fact, by your
endorsement of “care guarantee” models that channel money to private
clinics, invite competitive bidding, and allow private insurance for
medically necessary services, you are actively inviting privatization
and two-tier health care. Finally, on the question of private
insurance, your government is sending mixed messages. Your statement of
April 2006 correctly linked private insurance and queue-jumping: “My
concern is whether the expansion of private insurance would include
publicly funded health services, leading to faster access for those who
can afford private insurance.” You also speculated that delisting “may
increase the scope for coverage by private health insurance, thus
potentially limiting access to coverage for those who cannot afford it
or are not eligible because of pre-existing health conditions”. Again
though, your actions have not matched your words. Your government has
openly praised Quebec’s “care guarantee” which allows private insurance
for medically necessary services. If you are sincere in wanting
single-tier health care, you will challenge Quebec and the Canadian
Medical Associaton advancing private insurance for medically necessary
services.
Our 170,000 members who work in health care know that the CMA’s “safety
valve” of private clinics and private insurance is actually a “revenue
valve” for profit-driven doctors and investors. And they know, working
on the front lines and with patient advocates, that public solutions to
financing and wait time pressures are available for governments
committed to Medicare. To rein in health care costs, we need a national
pharmacare strategy that includes first-dollar coverage for essential
drugs on a national formulary, bulk purchasing, evidence-based
prescribing, and stricter controls on drug marketing. To reduce waits,
we need governments at the federal and provincial/territorial levels to
invest in health human resources and public infrastructure and to
advance centralized lists, case management, team-based care, and
population health planning. Public non-profit home, community, and
long-term care need immediate investment and national standards. Above
all, the solutions must strengthen and expand Medicare as a
publicly-funded and publicly-delivered program meeting Canada Health
Act standards.
We await a demonstration that your government takes equal access to health care seriously.
Sincerely,
PAUL MOIST
National President
cc: Hon. Tony Clement, Federal Minister of Health
Colin McMillan, CMA President