Quebec must enforce medicare rules

Commission Castonguay

Everyone in Quebec must have heard by now that the province is leaning toward introducing an element of privatization into the health-care system. But until the provincial government introduces and passes the necessary legislation, and until Ottawa changes the Canada Health Act, the Charest government must at least go through the motions of seeming to rein in the clinics and doctors circumventing the existing rules.
Health Minister Philippe Couillard must be seen to demand that doctors participating in the public system stop accepting money from clinics or patients as well. Doctors who want to be paid privately for their services have the option of leaving the public system altogether, but not of "double-dipping."
Now Quebec's Health Insurance Board has found a Montreal company, Medecina Co., has been paying extra to medical specialists who are part of the public system, to see patients within 72 hours. The board has also reprimanded two private clinics, RocklandMD in Montreal and Opmedic clinic in Laval for charging patients fees for use of medical equipment, facilities and support staff - all in contravention of the Canada Health Act. Extra charges in a hernia operation, for example, run to about $2,000, according to Couillard.

The Charest government is well aware many Quebecers want to be allowed to choose for themselves whether to pay for faster service. Quebec is not home to almost half the private medical clinics in the country - 16 out of 33 - by accident. There is a market for the service.
Quebecers' willingness to pay makes a mockery of the health-insurance board's suggestion this week that patients should report any attempt by a doctor to be paid extra. If Quebecers are paying extra, it's because they want to. Few patients, we think, will be reporting anyone.
Couillard might be moving to stop extra-billing - for the moment - but clearly he is also is creating the circumstances under which further privatization of the health-care system can happen. Last month, in its budget speech, the province set up a working group to study the problem of health-care financing. The man chosen to preside over it is former Liberal cabinet minister Claude Castonguay. His positions in favour of user fees and of subcontracting to the private sector are well known. It seems likely that in him the government chose a man whose views coincide with their own.
Who better than Castonguay, popular as the father of Quebec's public health-care system, to push the system in a new direction, possibly toward a mix of private and public care?
The Charest government must in decency take some steps to uphold the current law until it is changed, which could be some time yet. While we're waiting, we should all recall that the public system has such awful waiting lists precisely because successive provincial governments failed to provide an adequate number of doctors and supply of equipment.

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