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"The rich will always be a minority, and I believe in minority rights."

--Sir John A. Macdonald

In a shot across the bow of the Canadian ship of state, the Supreme Court of Canada on June 9 voted 4-3 to allow full-scale private health insurance in Quebec. The decision is widely expected to have broad ramifications. It has ignited the national medicare debate. And, may we add, it critiqued the under funding by the ruling Liberals of our health system. Paul Martin's shocking giveaway of $100 billion in tax breaks during the nineties was a grave abandonment of the common good.

Four of the seven justices, including Chief Justice Beverly McLachlin, argued that the present ban on private insurance contravenes the Canadian constitution in that every citizen has a right to timely health care, and where government fails to provide it, private insurance should be allowed.

Observers have pointed out that the decision seems to demonstrate the truth of earlier warnings, including those in the exhaustive Roy Romanow report, which predicted that once private insurance is permitted in the Canadian system, those with deep pockets will jump to the head of the line.

We fear there will be a steady erosion of resources, both human and material, available for the rest. As the Australian model has shown, doctors follow the money, and those people who can afford private care will be reluctant to pay for the public system. The disastrous American model, which leaves 45 million persons without health care, should ring alarm bells. The U.S. health-care system in the wealthiest country ever shows us the slope down which we are in danger of moving. Even among those with insurance, larger deductibles and increasing amounts of money being paid by patients, along with stratospheric drag prices are driving Americans to medical insolvency. A recent Harvard study found that two million Americans per year are victims of medical bankruptcy.

There is no doubt that the present crisis of long wait-times and a shortage of medical personnel was widely foreseen. With an aging population needing more medical services and a federal government caught in the grip of deficit mania during the 1990s, it was just matter of time before the present crisis would erupt. The justices of the Court were persuaded that the wait-time for this Quebec patient-petitioner was unconscionably long.

Now the politicians are on the griddle. The Liberals, because of Paul Martin's early failure to stare down Bay Street and adopt a more rational deficit reduction strategy, are hoist on their own petard. As Jack Layton has pointed out, decisions have human consequences. The Conservatives have understood that Canadians highly value medicare and have moved to the policy centre, while championing experiments in private-public financing, which may ultimately cripple universality and accessibility. The NDP seems to be absolutely committed to the one-insurer system.

A context of individualism and an attachment to absolute charter rights have had an impact on our thinking. The Supreme Court's decision favours an individual's right to jump the queue and purchase private insurance over the historic Canadian preference for universal, publicly-funded Medicare. The argument that someone with enough cash should be able to buy relief from pain, appears like common sense to today's individualistic ears. But there are only so many doctors and so much money, and the untrammeled right of the rich to buy their way will jeopardize the common good.

Maude Barlow of the Council of Canadians made an important point. In refuting those who point to European-style public-private mix as superior, she reminds us that we don't have a free trade agreement with these countries. We do, however, have NAFTA, where the roles are dear. While we presently have an exemption for health car e, which has kept the huge U.S. for-profit health corporations out, if we privatize any part of our system we must give equal access to private American companies and HMOs. Not only would U.S. health corporations have the right to set up shop in Canada, they would have the same right to public funding.

The churches would do well to spend some energy explaining and advocating for the five principles of the Canada Health Act, and lobby for increased funding in support of it.

The threat to publicly-funded Medicare is a grave threat to families and the common good. It is profoundly a life issue. Ontario should invoke the notwithstanding clause if needed to save Medicare.