Chaoulli Case 2005

1. Chaoulli Case2005 Waiting Times and Privatization of Health Care

2. Ruling • That access to private health care ought to be permitted when the public system fails to provide health care in a timely manner. • In a 4 to 3 decision, the Court found the Acts violated Quebecers’ rights to life and security of person under the Quebec Charter; as such the ruling is only binding in Quebec. Three of the seven judges also found that the laws violated section seven (right to life, liberty and security of person)of the Canadian Charter of Rights and Freedoms.

3. Facts • Having suffered in the past from numerous health problems including a hip replacement, 73-year-old salesman George Zeliotis became an advocate for reducing waiting times for patients in Quebec hospitals. • Chaoulli was the physician treating Zeliotis and who wanted to open a private clinic. • In Quebec, private health insurance and provision is not allowed. This is different than some other provinces.

4. Reasoning • None of the justices rejected the idea of a public system. Rather, for various reasons, some of them felt that the stress and health problem caused by excessive wait times (which would have been reduced if a second, private tier of health care was available) was a violation of Quebecers’ right to life and security of person. Because a majority did not feel this way with respect to the Canadian Supreme Court Case, this ruling ahs application only in Quebec.

5. Effects? • Is this a wake up call to Canadian and provincial governments to make alterations to the Canada Health Act, etc.? • Is this the beginning of a dismantling of the public health care system in Canada?

6. Lawrie McFarlane response • Ruling was ill advised and threatens our public health care system. • Though lengthy wait times area problem and do produce deleterious health effects, the problem here was a short term anomaly. It was produced by orthopedic surgeries such as hip and knee replacement (up 42% & 92% respectively) rising faster than anticipated because a new surgical procedure introduced. • Analogy to a private court system?

7. Marcia Angell response • A move to US health care system • Pre Canada Health Act 1972: ~$300/person/year in both US and Canada with similar life expectancy. • 2005 all Canadians covered; ~ 45 million Americans not covered • US $6697/person/year vs. Canada $3326/person/year • Bankruptcies not seeking health care lower life expectancy fewer visits to doctor less time in hospital

8. Marcia Angell response • Inefficiencies in US system • Overhead • Less prevention • Cherry picking • Medicare (for seniors) actually works much more efficiently in US than the rest of its health care • Canadian system efficiencies but needs more money

9. Other alternatives • Is the US system the only other one to consider. • No – it’s the ONLY one in the developed world like it • Health care costs are rising faster than any other thing gov’t pays for unsustainable? Zero sum game education, welfare, roads, etc. • We fare badly compared to other OECD countries that have a mix of public and private • Can physicians as private entrepreneurs. • Too much for pharmaceuticals