A strange but useful decision.

Strange but useful are the ways to describe the recent Supreme Court decisions in the Chaoulli v. Quebec case. Strange because the justices made the unusual choice to hear the case after two lower courts ruled against the appellants. The lower courts decided that the Quebec government had the power to prevent Dr. Jacques Chaoulli from offering an insured medical service to George Zeliotis, a long suffering patient on a medical waiting list for treatment. For a fee, Dr. Chaoulli took him on ahead of other patients on the waiting list and provided service quickly.

The Supreme Court took a year to come up with two conclusions. By a 4-3 decision, they declared that Mr. Zeliotis' right to "life and to personal inviolability" under the Quebec Charter of Human Rights and Freedoms was violated because of the long waiting lists. However, the Court could not come to an agreement on whether his rights under the Canadian Charter had been violated. This leaves the matter open to more challenges and appeals in the future.

The Court offered a number of comments which seemed more political and administrative than judicial. When we get through the comments, we conclude that the judges agreed that had there been no waiting lists, the ban on health care services outside the public system would be considered reasonable and legitimate. Supporters and opponents of our medicare system view this as the end of medicare and as an opening for private insurers, private clinics and hospitals draining off the resources of the public sector.

This may or may not be the case, depending on how we react. The Supreme Court of Canada is not the Sacred Court of Canada because people like former Saskatchewan Premier Allan Blakeney and his Attorney General Roy Romanow insisted on the "notwithstanding clause" in the Charter. This gives provinces the power to override court decisions under the Charter. (Three provinces Alberta, Saskatchewan and Quebec have used this clause since 1982.)

Politicians who claim loyalty to Canada's medicare system at election time should make it clear that they are prepared to make use of this clause if necessary. Otherwise, acting as if they are powerless will only encourage a parallel health care system based on ability to pay.

Despite our criticism of the Supreme Court, its decision is useful because it focuses new and urgent attention on the waiting-list problem. The federal and provincial governments had already decided to act before this ruling came down. More money and effort is going into plans to reduce waiting lists in the next few years. The Supreme Court ruling should encourage governments to move up their schedules and start spending more money to eliminate waiting lists sooner than 2007.

While money is needed, it is not the whole story. Canada spends more private and public money per capita on health care than most western European countries, where the average age is older than in Canada. Yet by all measures, western Europeans are as healthy or healthier than Canadians. The Americans spend considerably more money than any other country and yet they do not have improved health results for money spent.

Those countries that do well in managing their health expenditures also spend more per capita on housing, education, income security, recreation, fitness, sport and cultural services, than Canada does. These services and institutions go a long way toward contributing to a healthy lifestyle. The cost of these comprehensive, non medical, social programs is considerably less than the cost of health care services alone.

We point this out because we are certain that mindless Canadian politicians will find additional funds for health services by cutting other social programs. This is short term thinking that will cost us in the long run. We need to look critically at both health and social services as complimentary parts of a greater community health and wellbeing system. We must cease making the frequent assertion that we have the best health care system in the world. This declaration keeps us from facing the problems built into the system as it now exists. It prevents us from doing the necessary and constant re-examination and re-evaluation of our system. Are we making the best possible use of personnel and resources in the service of patients or are we serving the needs of institutions and professionals? We should be declaring that Canada's health care system is a fine work in progress requiring constant improvement and we should get on with the job.