CANADA: Canada's Supreme Court has struck down a provincial law banning private health insurance, a landmark decision that could put in jeopardy the nation's universal healthcare system.
The court ruled that long delays, lack of doctors and other problems have put Canadians' health at risk.
The decision will allow patients to seek private care outside the national system, raising fears that doctors will leave the national plan to go into more lucrative private practice and create a two-tier system that benefits the rich.
The decision takes effect immediately, but the government of Quebec province said it plans to ask the Supreme Court for a stay of up to two years to implement the new policy because it could upset the delivery of medical services.
It also may generate a flurry of legal challenges to universal healthcare in other provinces, said legal experts.
Canada's free healthcare and cheap drugs have bolstered the country's image as different from and superior to its often-overwhelming neighbour to the south.
During periodic attempts to revamp the US healthcare system, which has left an estimated 45 million Americans uninsured, Canada has often been presented as a model.
Critics charged that the court's action threatened a widely popular programme that has become part of Canada's national identity. However delays have cost the system some of its lustre, and critics said that the Supreme Court ruling was a vindication for free-market healthcare.
Montreal physician Jacques Chaoulli, an advocate of private medical care, and his patient, George Zeliotis (73), launched the legal challenge in 1997 after Mr Zeliotis had waited a year for hip-replacement surgery. Two Quebec courts had upheld the prohibition on private insurance.
Dr Chaoulli represented himself before the Supreme Court and argued that the province had violated his patient's constitutional rights by denying him timely treatment and refusing him the option of private care.
After considering the case for a year, the Supreme Court largely agreed, noting in a 4-3 decision that patients had died because of the delays.
It stopped short however of declaring that it was unconstitutional to ban private healthcare or that the universal healthcare system violated patients' rights to "liberty, safety and security" under the country's charter.
"In the case of certain surgical procedures, the delays that are the necessary result of waiting lists increase the patient's risk of mortality or the risk that his or her injuries will become irreparable," wrote Justice Marie Deschamps for the majority.
"Many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life. The right to life and to personal inviolability is therefore affected by the waiting times."
The Supreme Court dismissed the argument that "an absolute prohibition on private insurance is necessary to protect the integrity of the public plan".
Prime minister Paul Martin tried to soothe fears that the universal healthcare system, known as Medicare, would devolve into a system that leaves the less wealthy behind. "We're not going to have a two-tier healthcare system in this country," he said.
He promised that a $33 billion 10-year healthcare accord, hammered out with Canada's 10 provinces and three territories last September, would shorten waiting times while preserving the system.
Despite government opposition to healthcare privatisation, private health clinics are quietly opening in British Columbia, for-profit hospitals are open in Alberta and for-profit MRIs are expanding in Nova Scotia.