December 21, 2000

December 21, 2000 | Commentary on Health Care

The Ghost of Healthcare Future

Imagine a world in which you're forbidden to spend your own money to obtain medical care. Imagine that, regardless of your personal needs, you're forced to rely on the government for health care, no matter how long it takes or how substandard it may be.

A far-fetched Orwellian nightmare? Hardly. That's precisely how the Canadian health-care system operates. Yes, the same system liberals often tout as a model for the United States -and one that, absent serious reform enacted early next year by the new Bush administration and Congress, could fairly be labeled the Ghost of Health Care Future.

Canadians are no happier about it than we would be. A fierce debate broke out during their recent elections over whether citizens living in the provinces of Quebec and Alberta should be allowed to spend their own money to purchase MRI scans. (MRI scans produce high-quality, three-dimensional pictures of organs and bones and are used to diagnose serious ailments.)

It sounds unbelievable, but in seven of Canada's 10 provinces, it's illegal for citizens to pay out of their own pockets for medical services that are covered by the government-run health care system. And in the remaining three provinces, private payment is all but forbidden.

Unfortunately, the lucky few in Alberta and Quebec may not stay that way for long. The only reason province officials have been allowing citizens to pay for their own MRIs is because they're still not sure whether Canada's central government considers the scans "medically necessary," the vague standard that determines what is or is not a "covered service." CAT scans and EEGs, for instance, are considered medically necessary, and therefore can't be purchased privately in Canada.

This is apparently fine by recently re-elected Canadian Prime Minister Jean Chretien. Arguing that private payment might somehow be unfair to Canadians who cannot afford to pay for MRI scans, he's threatened to withhold $1 billion from Alberta and Quebec until they shut down their private clinics.

Never mind that the waiting list in Quebec to get government-funded MRIs is now 15 months. Not surprisingly, half of the province's MRI scans are done privately. If the 10 clinics that perform them were shut down, it would leave only five MRI machines for all of Quebec's 7.3 million residents.

Canadians have few options. They can wait in line for treatment (which, depending on where they live or what the procedure is, typically takes weeks or even months). They can use personal connections for expedited, but illegal, medical attention. Or they can travel across the border to the United States to get the care they need. Needless to say, only the rich can choose from the latter two options. As Mark Steyn, a columnist for Canada's National Post, wryly notes, Canada's got "all the coerciveness of the Cuban system, with none of the efficiency."

Many Americans will be tempted to think this couldn't happen here. But it already has. During the balanced-budget debate of 1997, the Clinton administration pressured Congress to adopt a provision that restricts Medicare patients from spending their own money on medical services. A Medicare patient can legally contract privately for a "covered" Medicare service if, and only if, his or her doctor agrees to drop out of Medicare, and give up all other Medicare patients, for two full years - an unlikely proposition, to say the least.

In 1999, an unusual coalition of senior-citizen groups and the Washington chapter of the American Civil Liberties Union challenged the constitutionality of this provision in federal court as a violation of personal liberty and privacy. Lawyers for the Clinton administration sounded suspiciously like Canadian officials, arguing that it would be unfair to allow patients to go outside of the Medicare system to buy better care at a higher price.

The U.S. Court of Appeals for the District of Columbia ruled that a Medicare patient could pay a doctor privately for a medical service as long as the federal government considers the medical service both " unnecessary" and not "unwarranted." Bottom line: American seniors -today, now - can't simply do what they want with their own money when it comes to health care.

But stopping any class of Americans from spending their own money on medical services, on terms and conditions that seem right to them and to their doctors, is a profound violation of personal freedom. It also illustrates why the next president and Congress should make every effort to reform Medicare - before Canada's methods spread beyond Medicare and infect us all.

James Frogue was a former health-care policy analyst and Robert Moffit is director of domestic policy studies at The Heritage Foundation.

About the Author

Robert E. Moffit, Ph.D. Senior Fellow
Center for Health Policy Studies

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