There has been some confused discussion lately about the issue of private health care in Canada. Canadians are the most confused about this, and they have been ever since most private medical care was made illegal about 20 years ago. In fact, most of them (based on a survey I've done consisting of frequent chats) don't even know that most private medical care is illegal, and the reason they don't know this is because the language used to discuss the issue is so bizarre and obfuscatory.
Instead of announcing that they were outlawing most private medical care, the Canadian government(s) merely announced that they were eliminating "extra billing". "Extra billing" was the practice of a doctor billing the government health plan for a service, and at the same time billing the patient an additional (usually small) amount. If a doctor charges a patient and does not charge the government then this is completely private medicine and should not be called "extra billing". Nonetheless, under the guise of eliminating extra billing, virtually all private medicine was outlawed in Canada. (Fine Print: private medicine that was not claimed to be covered by the government, such as dental work and cosmetic surgery, remained legal. Also, very recently, some private MRI clinics have been permitted in some provinces.) After being used as a subterfuge for outlawing private medicine, the phrase "extra billing" was never (to my knowledge) used again. Instead, whenever the issue arose, it was described as being about "single-tier versus two-tier health care". "Single-tier" was the good thing, the status quo, where every Canadian (except the rich, the powerful, the well-connected, the ...) had access to the same level of health care. No one discussed why two-tier (which should, of course, be called continuous-tier) is okay when it comes to housing, vacations, etc. Outside of Canada, the term "single payer health care" was used to describe the Canadian system, virtually guaranteeing that almost no one would understand the situation.
This article in the New York Times discusses a recent Quebec court decision that kinda says that the government doesn't have the right to outlaw private medical care. Or maybe it says that the government doesn't have the right to outlaw private medical insurance (implying that private health care is already legal, just not private medical insurance). Or maybe it says that it's okay to outlaw private medicine as long as the government provides good public medical care. Actually, I have no idea exactly what the court decided, and the author of the article clearly couldn't care less.
But he does care to tell us that Canada's health care system is "vaunted" and "is broadly identified with the Canadian national character" and that this decision is a "blow to Canada's health system". The fact that "Canada is the only industrialized county that outlaws privately financed purchases of core medical services" is presented as a positive fact about its national character, and no explanation is given about why the existence of private medical care in England, France, Germany, Sweden, ... has not been a blow to those countries' health care systems.
The article tells us that this vaunted system has long waiting lists for "diagnostic tests and elective surgery", but it omits the fact that patients often wait over two months for cancer treatment. Or the fact that my friend who was unable to move because of sciatica was told that he had to wait over a month -- and risk paralysis -- before he could see the appropriate specialist. (He received faster treatment because of the connections of one of his friends.)
And what -- except for the horror of two tiers -- is the reason for outlawing private medical care? After all, one would think that for any given level of public expenditure, allowing private care would improve the level of medical care for everyone. The only reason given in the article is that "a two-tier system will draw doctors away from the public system, which already has a shortage of doctors ...". This is not the way things work with housing or mail delivery, but I suppose it's possible that the quality and quantity of doctors is fixed and independent of demand. Except that two of the three main Canadian parties -- the Liberal and the NDP -- actually claimed that there were too many doctors! And the NDP government of Ontario actually took positive measures to reduce the number of doctors:
By reducing the number of first-year medical students this fall, the University of Toronto takes a leap toward improving the health-care system.The fact is that Canada will have as good a health care system as the government is willing to fund, and allowing private health care will only make it better.
I feel that this horrible "too few doctors" argument holds the clue as to why private health care was made illegal and why the public system became so bad. In fact, according to my completely unscientific study, the public health system started to go into sharp decline right around the time that private care was illegalized. The government(s) wanted to reduce public health care expenditures by reducing the quality of health care offered, and my theory is that they felt this would be better accepted by the people if the people had no basis for comparison to see just how bad things were becoming. Of course people knew what was available (for many) in the United States, but this idea still worked for many years and allowed the state of Canadian health care to deteriorate badly.
The argument that became "don't allow private medical care, or else people won't support our crappy public system" started out as "don't allow private medical care, so that people will allow our system to become crappy".