In my July 3rd blog posting, I was critical of B.C. Health Minister Kevin Falcon’s views on financial ability as a determinant of access to health care. Now, in an article in the Times Columnist entitled A prescription for the minister of health: ‘Individual choice’ is liberal code for a market-oriented system, Vancouver psychiatrist Dr. Randall F. White points out that when Falcon served as B.C’s Transportation Minister, he focused largely on public-private partnerships. It appears that Falcon’s affinity for the private sector has carried through into his new role as Health Minister. Out of all of the provinces, B.C. has demonstrated the greatest shift towards privatized health care, with multiple for-profit clinics that manage to silently violate the Canada Health Act (CHA). Unfortunately for the vast majority of B.C. residents, it seems that Falcon will continue pushing the province in the same direction. As what happens in one province has often influenced other provinces, a further increase in lenience around CHA-violating acts of health care service privatization in B.C. could lead to the same lenience across Canada, forcing our country to move towards an inequitable two-tiered system.
Beyond the CHA, some provinces have chosen to develop their own additional health care service legislation. The Medicare Protection Act in B.C. was recently amended to draw attention to some new principles, such as “individual choice” and “personal responsibility.” Québec legal academic Marie-Claude Premont explains that this type of language is very market-oriented and that it suggests that health care be viewed as a typical commodity rather than a unique social service, or pre-condition for well being. Even if they are appealing at first glance, the words “choice” and “responsibility” imply that everyone has the opportunity to “choose” quicker or better health care and ignores the reality that poverty, inequality, social exclusion and economic insecurity are the fundamental determinants of health – not individual failure to take responsibility. Placing health care services into a market context means treating health care as a privilege for some, when it should be a right for all.
Simplistically using such attractive, commercialized language in the discussion of the future of Canada’s health care system ignores enormous research that has revealed that not-for-profit health care services are more efficient and of better quality than privatized services. Instead of resorting to legislative language which is intended to facilitate privatization, B. C. needs to start reading up on what works and what doesn’t work in health care. Next time someone explains to you that what our system needs is more “personal choice,” don’t blindly swallow the pretty words. Think about the language that frames the argument, and what implications it has for the future of the Canadian health care system. “Choice” may sound liberating and empowering, but the real question is: choice for who? Choice for all, or choice for those who can afford it?