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.
cc: Hon. Tony Clement, Federal Minister of Health
Colin McMillan, CMA President