July 19, 2009

It just gets better and better Quebec is offically separated from Canada when it comes to health care that is."

Why aren’t you expanding your claim to the Province of Quebec

By Melvin J. Howard

Because Quebec has seen the free trade light they are not waiting around for the rest of Canada to come out of the dark ages. Through a little know piece of legislation called Bill 33 the Province of Quebec has allowed private surgical clinics to bill patients and the government at the same time. Under Bill 33, adopted by the National Assembly, clinics can charge patients ''accessory fees'' for the use of a private operating room, equipment and even some personnel. Two-tiered systems end up costing less and operate more efficiently, said Démocratique du Québec Leader Mario Dumont, "They do much better than we do" with mixed health-care systems, he said. The working group on health financing for Quebec was led by Claude Castonguay, a former Liberal cabinet minister who has been an advocate of greater privatization, user fees and private insurance in the system. Quebec's Liberal minority government appointed Castonguay in 2007 to oversee the closed-door committee on health-care financing. Update on September 30th, the role of private surgical clinics will be greatly expanded. In addition to hip and knee replacements and cataracts, private clinics will be able to do a wide range of procedures, including mastectomies, hysterectomies and bariatric surgery. The new regulations will also assign these surgical procedures away from hospitals to the private surgical clinics. Hip replacements, for example, will be done exclusively in clinics. The Quebec government has gone even further they will now allow physicians and surgeons to practise simultaneously in both participating and non-participating hospitals and clinics. You gotta love Quebecois are you sure Quebec is apart of Canada. From an outsiders point of view it looks murky at best but that’s another story. I am now declaring Canada’s healthcare system from trade treaty obligations is now null and officially void.

If this is not a NAFTA and GATS challenge I don’t know what is. The Government of Canada’s argument has been public financing was the principal exemption of healthcare from trade treaties. Let’s just say Canada needs to press the refresh button private health care in Canada is there to stay the rabbit is out. The Supreme Court’s decision in Chaoulli v. Quebec has made that very clear. Canada failed to anticipate the possible conflicts of domestic, international and constitutional law when it made commitments in the area of private health insurance at the WTO. Come on Canada now is the time to admit and acknowledge the oversight between your health care system and trade policies. The expansion of private health insurance and clinics, changes the scope of your public system why do you have to be in denial? Your system is no longer shielded from national treatment, MFN or NAFTA obligations.

I am also pretty sure there are some GATS issues as well in regards to national treatment and market access obligations but I will leave that to the respective governments and the WTO dispute panels. But I just can’t help but think in particular an area that was classified for GATS purposes as a “financial service. Canada has had a comparative advantage in one area for a long long time and what is that area INSURANCE. Hello Blue Cross Private Insurance wake up WTO/GATS calling. Canada made a commitment in “life, accident and health insurance services,” subject only to the limitation on market access that these services “must be supplied through a commercial presence” (i.e., through direct investment and establishment within Canada).

Now that the Chaoulli decision has been made Canada’s arguments that “health insurance services” are clearly restricted to supplemental health insurance services provided by private insurers should also be challenged. There should be competition the assumption that medically necessary services are “public” and that supplemental insurance is “private” is up for debate what is medically necessary? Canada’s public health insurance plans should be forced into competition with private suppliers. Canada’s Medicare’s monopoly or single-payer insurance is no longer protected. I know some insurance executives maybe I should give them a call. Can you say national treatment rights to U.S. companies that compete for health services! I salute Quebec and to their honour I am learning how to speak French. Voici à votre santé !