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Hotel California Health Care

Sally C. Pipes
Medical Progress Today
July 21, 2005

Single-payer health care is making news in California thanks to State Senator Sheila Kuehl, whose bill to have California’s government run the state’s entire health care system has passed the Senate and will surely pass the Assembly. Her supporters and Californians should look at what is happening north of the 49th parallel, where single-payer health care is also hitting the headlines. If Ms. Kuehl and company are successful, it provides a preview of what’s to come.

It’s long been known that taxpayer supported single-payer health care is the best health care system available, if one is healthy and doesn’t have a job. It’s also long been apparent that Canada’s government monopoly health care system has a problem with meeting demand for its free services, the results of which are long lines for everything from seeing a primary-care doctor (4.2 million Canadians can’t find a primary-care doctor) to securing diagnostic procedures, advanced treatment and surgery, and life enhancing procedures such as hip and knee replacements. Such inconveniences, backers of the system explain, are small prices to pay for a system that, at least on paper, covers all the medical needs of every Canadian.

What’s less well known, and certainly not understood, is a critical feature of the Canadian system that Ms. Kuehl would import to California. Canada joins North Korea and Cuba as the only countries where it is actually illegal to purchase private insurance to cover services allegedly provided by the government. In other words, what Canada has and Ms. Kuehl proposes is a Hotel California health care system where, as the song goes, “you can check out any time you like, but you can never leave.”

Thanks to a recent Supreme Court ruling, Canadians may soon be able to check out and actually leave with the assistance of private insurance. The case was brought by a patient, George Zeliotis, and a doctor, Jacques Chaoulli. Mr. Zeliotis, like scores of other Canadians, was forced to wait in agony for more than a year for a hip replacement, an intolerable period during which he became addicted to painkillers and thought he might die. Dr. Chaoulli was repeatedly denied the right to operate a home-based medical practice and establish a private clinic. The pair sued, charging that Quebec’s prohibition on private insurance violated the rights protected by Quebec’s Charter of Human Rights and Freedom to “life and personal inviolability.”

The court agreed, finding what those of us who have lived under the system already knew. A single-payer government system doesn’t control costs, it merely shifts them from expenditures on a government ledger to non-monetary costs borne by patients who face diminished lives and lost earnings while waiting their turn. Moreover, and straight to the point, the court showed that waiting lists are not just an unlucky glitch in Quebec's health care system: they are a fundamental, "real and intentional" rationing mechanism found in any system where there are no incentives not to consume an "unlimited" amount of health care. Such a system cannot be saved with waiting-time "targets".

The court then detailed the real-world consequences, noting that “the delays are widespread and that in some serious cases patients die as a result of waiting lists for public health care.” The court added, “Many patients on non-urgent waiting lists are in pain and cannot fully enjoy a real quality of life.”

Ruling that the government cannot run the health system both badly and monopolistically, justices asserted that Canadians should not be forced to endure endless waiting times as the price of maintaining a public system.

The ruling is causing uproar in Canada, where national identity is strongly tied to contrasting its “humane” health care system to that of the United States. Leading politicians are assuring Canadians that there will not be a parallel private health care system in Canada, despite the Supreme Court ruling, which only applies to Quebec.

They are burying their heads in the sand. Until Canadians can pay for private care, the queues are certain to get longer. Californians should take note.

Sally C. Pipes is President and CEO of the Pacific Research Institute. She is a Canadian living in the United States and is the author of Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer. Her email address is

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