In the recent federal election, the Conservative Party of Stephen Harper said in its platform document that “A Conservative government will, in conjunction with the provinces allow for a mix of public and private healthcare delivery, as long as health care remains publicly funded and universally accessible.”

In June 2005, the Supreme Court of Canada ruled on private health insurance in Quebec. In a 4-3 ruling, the high court struck down Quebec’s ban on private health insurance for medically necessary services, saying the ban violated guarantees of life and personal security under the Quebec Charter of Rights.

The 1984 Canada Health Act, passed unanimously by Parliament, sets out the conditions that permit federal transfers of healthcare funds to the provinces. The terms include no extra billing for insured health services, no user fees, portability within Canada and access to all medically necessary services provided by hospitals and doctors without financial or other barriers to access.

In accordance with the Act, each province or territory is required to operate a not-for-profit public insurance plan to fund healthcare services. The Act requires dollar-for-dollar penalties if a province or territory should allow extra billing or user charges. The intent is to maintain national healthcare standards and to ensure universal access to health care services.

Under the Canadian Constitution, health care is a matter of provincial jurisdiction. The provinces have the sole constitutional right to make laws regarding health care. Federal participation stems from its spending power and the billions of dollars the Government of Canada contributes every year to provincial health care programs.

In early February, the Quebec Government introduced healthcare reform proposals in response to the Supreme Court decision on private health insurance. The proposals would maintain public sector financing of the healthcare system but open the door to private funding and private sector service delivery. Doctors could work in the private sector but they would have to first remove themselves from the public system.

The Quebec Government’s insurance plan would pay for patients to have surgery in private clinics in the province or anywhere in North America if the public system could not accommodate their needs within six to nine months of a specialist’s diagnosis. Stephen Harper has endorsed this proposal and has suggested that it become a model for all of Canada.

Two weeks following the Quebec proposals, Ralph Klein, Premier of Alberta introduced a third option for Alberta. The Klein option would permit doctors to work in both the public and the private healthcare system. It would permit private financing of non-government delivery of services. People would be allowed to pay for faster access to essential services.

Picture this scenario: a surgeon who works four hours a day in the public system takes the afternoon off to perform surgeries in a private clinic or in a section of the hospital reserved for private practice. In the morning, he or she would treat patients who are at the back end of a year long waiting list. In the afternoon, he or she would treat patients who had been on the waiting list for just a few weeks.

The condition of morning patients, hobbled by a twelve month (more or less) waiting period would likely have deteriorated from the time of diagnosis to operation. The condition of afternoon patients would be much better because the wait from diagnosis to treatment would be much shorter – the likely result: fewer complications, better outcomes and shorter recovery times for the afternoon patients.

Good news for those who can afford to pay. Good news for the doctors who can charge a premium for their afternoon services.

The Alberta model would create a two-tier revenue stream for the doctors and a two-tier delivery system for patients. People with money could jump the waiting queue for surgical procedures. People dependent on the public system would be relegated to long-term waiting periods for surgical procedures.

If the Klein option becomes reality, the Canada Health Act would penalize Alberta by holding back federal healthcare funding but the oil-rich province could afford the loss. New Brunswick could not.

If Alberta defies the Canada Health Act and sets up its two-tiered system, the Province will require more doctors and nurses. When you siphon off publicly paid practitioners to a private system, even if it’s only part time, you reduce the numbers available to the public system.

If that happened in Alberta, it would trigger a major out-of-province recruitment program. Imagine an Alberta doctor/nurse crusade in Atlantic Canada promising major increases in personal income if they would move to Alberta. The invitation would be hard to resist, especially for youngest and brightest.

The implications for New Brunswick would be profound.

The Province already faces doctor/nurse shortages. A drain of medical professionals to Alberta would compound the problem in spades.

To give him his due, Klein’s ‘Third Way’ appears better than the ‘U.S. Way’ where some forty million people have no health coverage but if the Alberta proposal should become reality, it could be the first step in moving Canada towards the U.S. model.

The Quebec approach may be even more threatening because Klein’s frontal attack on the Canada Health Act will likely be rejected by Albertans for its impudence while the Quebec approach flies quietly under the protective radar of the Canada Health Act.

In my view Quebec’s proposal is regressive and would set the stage for the incremental commercialization of healthcare, a step that could eventually put our most talented healthcare professionals and their services out of reach for a significant number of Canadians.

The Harper pretense that Quebec’s proposal is okay because it conforms technically to the Canada Health Act is misleading and dangerous.

Atlantic Insight is a published Blog inventory of opinion articles published weekly in New Brunswick's print media as written by W.E. (Bill) Belliveau, who is a resident of Shediac, New Brunswick, and business owner operating his Moncton-based marketing consultancy, Bell Strategic.