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News Release

Maintaining the principle of
universal access to health care

15 January 1995

Letters to the Editor
The Globe and Mail

Diane Marleau has acted with courage and integrity in insisting that provincial governments maintain the principle of universal access to health care. She has acted wisely when she has informed provincial governments that they will be penalized for allowing user charges, including private clinics. British Columbia has responded appropriately in resolving to comply with the federal directives. In contrast, in a series of editorials attacking Ms. Marleau, the Globe and Mail has joined the ranks of those conducting an assault on the principles of Canadian national health insurance.

What the Globe, in its editorial of January 11, characterizes as "hoary philosophical grounds" is nothing less than the principle of equal access to high quality care regardless of income. When we tolerate health care in private clinics for those who can pay, we are permitting two-tiered care. When governments subsidize such clinics with public dollars, they are actively encouraging the destruction of equal health care for all Canadians.

The Globe editorial suggests that private clinics can save money. The experience in the United States, which spends over 14% of its gross national product on health care, in comparison to less than 10% in Canada, shows us the fiscal consequences of two-tiered health care. A universal, single-payer health system is the most efficient way of delivering medical services.

Further, the Globe suggests that private clinics, by siphoning off some patients, can improve service in public facilities. Both health personnel training and medical technology development are funded from the public purse. Private clinics drain these resources, and thus weaken the public system. Private clinics do indeed provide an escape valve, but its effect is to reduce the pressure to maintain high quality public health services.

The call for a two-tier system comes at a time when the Globe and Mail, along with a number of other powerful voices, is advocating a cut in social expenditures, including health. Those with higher income who have the strongest political voice in our country will benefit most from a two-tiered system and governments will have little incentive to maintain the public tier that most Canadians use. If those with privilege and political power much seek health care within the public system, governments will find a way to ensure continuing high-quality care within that system.

Congratulations, then, to Diane Marleau for working to save a magnificent system under intense threat.


Gordon Guyatt, M.D.
Ian Scott, M.D.
Medical Reform Group of Ontario

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