Alberta opens door to two-tier health care

Commentary
By Andrew Longhurst

Alberta just took a major step toward expanding two-tier health care in Canada. In December, with surprisingly little scrutiny, Bill 11 set the stage for a private health insurance market for medically necessary care, a shocking break from a system where such care has always been provided to residents for free under the Canada Health Act.

Here’s what that means in practice: Bill 11 creates a duplicative private insurance market for physician and hospital services, care that we normally receive without being billed. Under the new legislation, providers can now charge for these same services.

That will be possible because Bill 11 allows “dual practice physicians,” doctors who work in the publicly funded system while also providing privately paid services, to operate in both systems at the same time. While Quebec permits limited forms of private insurance and physician opt-outs, Alberta’s approach would go further. These Alberta doctors and the corporations they work for will be able to decide, on a case-by-case basis, whether out-of-pocket payment is required.

Imagine you inform your surgeon that you can’t afford thousands of dollars for a medically necessary procedure, so you’re shown the door and sent to the back of the line.

Until now, Canada has only had a private insurance market for extended health care, often sponsored by employers. Bill 11 changes that. Employers and individuals may be forced to buy private insurance to get the care they need and avoid out-of-pocket payments.

The insurance industry’s interest in Bill 11 is hardly surprising.

The Canadian private health insurance lobby association appears to have had direct access to the provincial government in the development of Bill 11, which changes the Alberta Health Care Insurance Act. The lobby group stated on the public record that it is part of a working group with the provincial government to implement Bill 11, but that may not be widely known by Albertans. Bill 11 opens the door to billions of dollars in public health care spending moving into private hands.

By introducing this legislation, the Alberta government is encouraging the growth of a system dominated by private insurance and for-profit providers. Public wait times will increase as doctors and nurses move into the private system.

In the United States, private insurance plays a dominant role in financing medically necessary care. This is uncharted territory for Canada. Thanks to the cost-efficient public insurance plans that enable us to get the care we need, which include insured hospital and physician services under provincial health plans, we have not had to buy private coverage for medically necessary services. It’s part of what makes Canada different from the U.S.

And Canadians can expect similar legislation to spread if other provinces follow Alberta’s lead. Saskatchewan Premier Scott Moe, for one, is already signalling that his province may follow suit.

While Alberta’s legislation likely contravenes multiple sections of the Canada Health Act, the federal statute that sets conditions provinces must meet to receive full federal health transfers, there is also a serious risk that Alberta’s new health care market will attract U.S. investors. Investor-driven delivery of medically necessary care would lock in a for-profit model at odds with Canada’s public system.

The rest of the country should pay attention. If Alberta’s efforts succeed, U.S. capital will follow, and we won’t have U.S.-style health care; we will have U.S. health care.

Andrew Longhurst is a senior health policy researcher at the Canadian Centre for Policy Alternatives.