Private highway, one-way street : the Deklein and fall of Canadian medicare

Amidst growing concerns (at least some of which seem justified) among the Canadian public about whether their health care system will be there for them if/when they need it, the Government of Alberta has again fanned into flame the smouldering issue of the role of the private sector in Canada’s health care system. Premier Klein’s proposal, declared on November 17, 1999, to introduce legislation allowing private, for-profit facilities to offer over-night care, has raised the spectre of a parallel private hospital system potentially undermining Medicare. The provincial government argues, to the contrary, that private facilities will be under contract to the Regional Health Authorities and will be reimbursed for all insured services through the public Medicare program. They will add much-needed capacity to provide additional insured services for Albertans. Where is the threat in that? After all, physician services have long been provided by private practitioners and funded through public Medicare. Yet if the proposal is as straightforward as the premier suggests, why has it aroused such controversy? Who, after all, is against strengthening the capacity of Medicare to provide necessary services? On the other hand this initiative is not wholly new. Twice in the last four years the premier has brought forward proposals to extend the scope of private delivery, and has withdrawn them in the face of intense opposition and controversy. Why is this objective so important to the Premier? There would seem to be more at stake here than meets the eye – and there is. On closer examination, the apparently innocuous extension of the role of private facilities comes with dubious benefits, but considerable risks to the integrity of the public system. We describe these risks in some detail.