The Danny Williams Principle

If the Newfoundland Premier can go to the U.S. for private medical care, why can't Canadians get it in their own country?

What does it say about the state of Canadian health insurance when Newfoundland Premier Danny Williams chooses to have his heart surgery in the U.S.? Some pundits say it means nothing while others have insisted the premier could have obtained his medical care somewhere in Canada.

But the details of Premier Williams’s case are irrelevant to the main question, which is, if it is OK for a Canadian politician to get private medical treatment in America, why is it illegal for regular Canadians to get private medical treatment in Canada? In other words, why do provincial governments make it illegal for Canadians to spend their own money to preserve and improve their own health? Why are ordinary Canadians forced to wait in a government-imposed queue for access to necessary medical care?

Danny Williams’s decision is not unique. According to the most recent Fraser Institute estimate in 2009, Williams would be only one of approximately 41,000 Canadians who annually seek non-emergency medical care outside of Canada. Consider how absurd it is that the only way for Canadians to pay privately for better or quicker medical care is to leave their own country.

Our annual international report comparing Canada to other countries with universal health insurance systems shows that Canada is virtually alone in prohibiting people from spending their own money to get quicker or better health care.

Who is to blame for this? Despite commonly held beliefs, the federal Canada Health Act does not prohibit private insurance for medical services—the act only prohibits user charges under public insurance. It is actually the provinces that prevent ordinary Canadians from doing at home what Premier Williams chose to do in the United States. In fact, six provinces (accounting for about 84 per cent of the national population) legally ban direct private payment for necessary medical services, and six provinces (accounting for 90 per cent of the national population) legally ban the purchase of private health insurance for necessary medical services.

Most provinces also prohibit parallel billing by health care providers. In these provinces, hospitals and physicians are not allowed to accept private payment or private insurance reimbursement while accepting public payment from the provincial health insurance system. Health care providers must choose to work either for private payment or public payment, but cannot elect both. Most doctors are not willing to surrender their billing rights in the public system, and therefore do not even make their services available for private payment.

This is how governments effectively ban private health insurance and medical care in Canada.

Few Canadians can afford to travel to America in search of faster or better care. When provincial insurance doesn’t supply timely access to necessary medical care, ordinary Canadians are forced to wait. Annual Fraser Institute research shows that wait times for many medically necessary procedures are excessive in Canada. Averaged across the 10 provinces, the median wait from seeing a GP to treatment by a specialist was 16.1 weeks up from 9.3 weeks in 1993.

Our research using government data has also shown that Canada’s health insurance system supplies far fewer physicians, as well as medical technologies like MRI machines, CT scanners, and Lithotripters per population than are available in the United States. Relative to American health care, Canada’s system is slow to invest in new medical technology, while many existing pieces of medical and diagnostic equipment in Canada are outdated and in need of replacement.

It is therefore not surprising that Danny Williams, and several other high profile politicians before him, have chosen to get medical treatment outside of Canada when they fall seriously ill. Their cases capture headlines, but they are just a few of the tens of thousands of Canadians who seek medical treatment in the U.S. every year without being noticed by the media.

It is time that we all stop tolerating ideological excuses for a system that prohibits ordinary Canadians from spending their own hard-earned money to buy timely access to medical goods and services. I wish Premier Williams a speedy recovery. I hope that when he returns to Canada, he will muster the courage to fight for the freedom of all Canadians to make their own choices about their own health care, without having to leave the country; something that is allowed in every other nation with universal health insurance.