Regardless of whether or not this week's Supreme Court ruling leads to two-tier health care in Canada, the government's course of action should be the same.
If banning private health insurance is unconstitutional because, in the face of unacceptable waiting lists, individuals require the option of persuing their own remedy, then the answer is to set targets for what an acceptable wait time is, and then ensure that the system meets or betters these targets.
There is no question that this action is required from our governments if they intend on saving single-payer. So far, the response has been underwhelming, and the federal health minister claims that wait times are already being reduced. But it is obvious that, if wait times are not sufficiently reduced, two-tier is here. Otherwise, anyone frustrated by a wait will sue.
However, perhaps it is the case that -- as James McDuff and some commenters suggest on Ahab's Whale -- the court ruling doesn't allow for practical wait time standards that will permit the on-going private health insurance ban, and therefore two-tier is inevitable. If this is the case, I'd argue that setting mandatory wait time targets for the public health care system is just as important, if not more. And, the sooner, the better.
Single-payer lovers' greatest fear about two-tier is, and should be, that the existence of a private system allows for the further decline of the public system.
Consider the oft-mentioned example of MRI scan waiting lists. Imagine, in ten years time, a private system allowing citizens to jump the queue for MRIs. It is possible to envision the existence of the private system as an excuse to avoid further spending aimed at cutting the public system's waiting lists. People who are impatient will be told they have an option. This dynamic is what can slide the public system into second-rate status, and reduce it to being a choice only for those who can't afford better.
The additional risk is that, as more citizens acquire private plans, the political support for sufficiently funding the public system will be eroded.
Setting standards of care (including maximum waiting times) that must be attained, therefore, is not just necessary as a way of meeting constitutional requirements. It is also necessary as a way of protecting the public system from erosion by private competition.
Of course, standards of reasonable care were required even before this court ruling. Decency requires good health care for everyone.
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