Supreme Court put governments on notice on deadly surgical waits

VICTORIA - That big Supreme Court ruling doesn't mean the end of medicare.
Unless governments decide that's what they want.
The judgment simply said that if governments fail to deliver reasonable care, then people have the right to go elsewhere.
And the court found that governments have allowed the health care system to deteriorate so badly that reasonable care is no longer available.
Government policies have meant that people are suffering terribly, and dying, as a result of long waits for surgery and other treatment, the justices ruled. "A health care service that does not attain an acceptable level of quality of care cannot be regarded as a genuine health care service," the court found.
And under those circumstances, the justices ruled in a four-to-three decision, the Quebec charter of rights gives individuals the freedom to go and buy private insurance to guarantee care.
The judgment was a damning indictment of governments across Canada.
People are suffering "physical and psychological suffering and risk of death" due to long waits, the court found. "There is unchallenged evidence that in some serious cases patients die as a result of waiting lists for public health care."
Governments now face two choices.
They can make the public system work, by delivering reasonable care.
Or they can continue down the current path, knowing they are ensuring that people with money will be able to buy treatment while average citizens risk suffering and death as they wait for care.
Governments will likely stall for a while longer. Premier Gordon Campbell says the case shows the need to "modernize" the Canada Health Act, reducing the government's responsibility for providing care. Federal Health Minister Ujjal Dosanjh promised wait time guidelines by the end of the year.
The Supreme Court justices anticipated the politicians' responses.
"Governments have promised on numerous occasions to find a solution to the problem of waiting lists," the judgment noted. Despite all the talk, "governments have lost sight of the urgency of taking concrete action."
No kidding. In B.C., median waits for 11 types of non-emergency surgery have risen over the past four years; they have fallen for only five types. People are waiting one-third longer for knee replacements than they were four years ago. The LIberals, in opposition, complained those waits were too long.
The current ruling only applies to Quebec. The Supreme Court was split three to three, with one abstention, on whether the Canadian charter of rights carries the same implicit right to private surgery when governments don't provide reasonable care.
But it would be foolish for governments to stall.
Ultimately, the solution is simple. Governments need to define basic health care, including issues like how long someone must suffer while waiting for surgery, and how cases will be given priority. And then they need to deliver that level of care.
It will be tough for governments to dodge the issue, given the court ruling and the potential political consequences of coming out against equal access to health care.
Canadians have accepted that children from a poorer family are entitled to the same level of care as their wealthier neighbours. They recognize that if a shortage of doctors and nurses is one cause of the long waits, then the shift of medical staff to a parallel private system will make things worse for those who can't afford private care.
And they know that allowing two-tier care does nothing to reduce health care costs; it simply changes the way the services are paid for, and who gets treatment. In fact overall health spending would rise.
The Supreme Court did Canadians a great service by setting out the issue clearly.
Governments have failed to deliver acceptable health care, and refused even to offer a definition of what standard of care people have a right to expect. People have suffered as a result, and the problem is growing worse.
Now is is time for them to act.
Footnote: The Supreme Court noted that many European countries maintain successfully maintain side-by-side public and private insurance systems. But in each European example, a commitment to an excellent public health care system was the starting point, and the reason that the public system continued to be popular.