Five months post-Chaoulli--are we any further ahead?

• Author: Rossall, Jon P.
• Position: Today's trial

June 9, 2005 proved to be a memorable day for medical/legal commentators across the nation. There hasn't been this much controversy arising from a Supreme Court decision since the halcyon days of the mid-1980s' constitutional goldrush.

Chaoulli was the benchmark Supreme Court decision wherein a majority of the Court determined that delays in the provision of public health services to citizens of Quebec may amount to a violation of their constitutional right to life, liberty and security of the person. In the result, the legislative bans on the purchase of private health insurance and the provision of private health services in public facilities were found to be unconstitutional.

So, what do we have to show for all of this? Newsprint, hot air, and not a whole lot of action other than a continued commitment to explore solutions within the existing system. If nothing else, the decision has sanctified the work of the Wait Time Alliance, an initiative jointly sponsored by the Canadian Medical Association, the Canadian Associations of Nuclear Medicine, Radiation Oncologists, Radiologists, and Orthopaedics and the Canadian Cardiovascular and Ophthalmological Societies to identify acceptable waiting times for various medical procedures. Aside from that, however, life goes on and the provincial government continues to throw money into the medical services void.

In a controversial article first published in June 2005 in the Winnipeg Free Press entitled "Medicare's Fate: Are We Fiddlers or Firefighters?", Steven Lewis (adjunct professor of health policy at the University of Calgary) commented caustically on the post-Chaoulli era. He wrote, "A word of caution to the private-clinic owners and National Taxpayers' Federation shills licking their chops over the imminent demise of medicare and the triumph of profiteers: It ain't over 'til it's over."

Lewis analyzed the anticipated reactions to the decision, and postulated that there would be "... at least a short-term burst of private-clinic expansion, financed by investors offering lucrative salaries and spiffy quarters to physicians." He believed that some clinics would seek status as private hospitals and that some hospitals, "blessed by their government", would be tempted to rent facilities to privately insured doctors to turn a profit. And, he predicted that insurance executives and businesses would survey the market, on the premise that most private health insurance is employee/employer driven. It...