Canada Requires a New Act Which Enshrines Health Care as a Right
There is broad and fierce opposition across the country to the
aggressive expansion of privatization of health care and putting health
care decisions in the hands of supranational private interests. People
are demanding that governments stop paying the rich and increase
funding for
health care and other social programs. Across the country, working
people are rallying to demand that the right to health care be provided
with a guarantee, alongside unions, health care professionals, seniors'
organizations and many others.
In Alberta, Bill 11 sets out the legal framework for greatly expanding what is referred to as two-tier health care with private insurance to cover medically necessary health care services. So too in Quebec and Ontario, workers and their unions are fighting against the direct dictate of government ministers empowered to privatize the entire health care system.
Canada is said to have a public health care system which defines us as a nation, with the Canada Health Act as a nation-building project which sets us apart from the U.S. Establishing public health care was an advance for society, where matters of health and even life and death were not based on a person's wealth, but by virtue of their humanity. Public health care has the aim of raising the level of society and the well-being of all its members to live with dignity and security with equal rights and care as needed.
This advance was incomplete, with many aspects of a healthy life excluded, including the social determinants of health, to the extent that Indigenous Peoples lack even clean water. Now, as a consequence of the anti-social offensive, the most basic services provided by the health care system are in crisis.
Acknowledging the experience of Canadians, Quebeckers and Indigenous Peoples in fighting for their right to health care is crucial to waging this battle. It concerns hundreds of thousands of people who suffer as a result of the actions governments are taking.
The acute shortage of health care workers and professionals, lack of facilities for acute care and long-term care, wait times in emergency rooms and for ambulance services are at crisis levels. This and long surgical wait-lists all show that the issue of a two-tier system must not be reduced to pro and con privatization or to the demand that the "principles" of the Canada Health Act be upheld or that this or that government should "do the right thing." The demand which opens society's path to progress is that health care must be guaranteed as a right and the people must have the decision-making power to make it so.
What a Study of the Canada Health Act Reveals
In 1998, the Hardial Bains Resource Centre (HBRC) commissioned a study on the Canada Health Act. The aim of the study was to verify whether the Canada Health Act determines what are called the national standards and lists what rights to health care it enshrines. The conclusion reached by the study confirmed that when it comes to defining the actual standards of health care, all the Act has is some policy objectives. What it calls "national standards" have to do with administering the funds that the federal government transfers to the provinces and setting up an accountant in the provinces to receive the funds and then report to the Auditor-General on how they were spent. That's all. Accounting practices. The Canada Health Act is not about guaranteeing the right of Canadians to health care because such a right is not recognized.
First came the Medical Care Act of 1966 which took effect nationwide by 1968-1972 to provide a public insurance system for medically necessary hospital and physician care. When the Medical Care Act was enacted in 1966, cost-sharing between the federal and provincial governments was to be on a 50-50 basis. Then came the Canada Health Act of 1977, which replaced cost sharing with block funding and no longer tied federal contributions to actual provincial spending. Then came the Canada Health Act of 1984 which set out five "core principles" -- universality, accessibility, comprehensiveness, portability and public administration. The Act does not guarantee publicly-delivered or funded health care to meet the needs of the people. It is a financial agreement setting out the relationship between the provincial and federal governments regarding public funding of health care.
Under Canada's Constitution, health care is a provincial responsibility, and the Canada Health Act does not mandate how provincial governments carry out the delivery of health care services. As a financial arrangement, the Canada Health Act does provide for financial consequences in the event that a province or territory introduces or maintains extra billing, user fees or full private payment for health care services which are covered under the provincial insurance plan.
The federal government also transferred "tax points" to the provinces for a wide range of social services including health care. When Paul Martin was Finance Minister (1993–2002) in the government of Jean Chrétien, the federal Liberals carried out major cuts to transfers to provinces, including health care transfers. When he became Prime Minister, Martin changed the Canada Health Transfer. Federal health care cash transfers to the provinces had come to about 19 per cent of provincial funding, and fell to around 12 per cent following Martin's cuts. Today, as privatization of health care services increases, federal cash transfers for health care have gradually risen to around 22 per cent of all public health care spending.
As written, the Canada Health Act discourages extra billing for private services by deducting from the Canada Health Transfer an amount equal to that paid by patients for insured services. In practice, the federal government simply ignored many, if not most, instances where patients paid for insured services. Where intervention does take place, the amounts deducted are minuscule compared to overall transfer payments. Then negotiations take place which return most of the funds withheld to the province on promises of "good behaviour" in the future. This is precisely what happened in Alberta when deductions were made because private diagnostic imaging (DI) centres were offering very fast access if patients paid privately. They charged patients, who they call "clients," up to four times what the provincial government paid for the same tests.
Alberta "corrected" itself by passing legislation which permits DI centres to charge patients to perform tests without a physician referral, with reimbursement if a serious condition is found on the test. This is intended to evade further deductions, because patients do not need to present a physician's referral and therefore the test can be declared to be "not medically necessary."
The
Supreme Court weighed in on the question of private insurance for
insured services in 2004, in the Chaouilli case, when the court ruled
that private health care and insurance were constitutional. Lawyers for
Dr. Jacques Chaouilli and a patient argued that "the lack of timely
access to
provincially-insured health care services coupled with legislative
restrictions on access to private care amounted to a violation of
section 7 of the Canadian Charter of Rights and Freedoms."
Section 7 of the Charter states that "everyone has the right to life,
liberty and the security of
the person and the right not to be deprived thereof except in
accordance with the principles of fundamental justice." The court
acknowledged that the Quebec government was putting lives and health in
jeopardy by failing to provide adequate resources. It concluded that
the government had failed to
deliver health care in a "reasonable manner" and that, under these
circumstances, a two-tier system provided a remedy and was
constitutional.
The government of Paul Martin intervened in the Chaouilli case, arguing before the court that the demand for health care is "limitless," which is to say that rationing and depriving people of timely care is actually responsible fiscal management and managing scarce resources. This has become the mantra of governments ever since.
The Chaouilli decision was widely opposed by Quebeckers. In 2006, the Quebec government took one step back and enacted Bill 33 which mandated that surgeries performed in these private clinics would be paid for by the public health system. This was a similar development to that in Alberta where in 2000 the Ralph Klein government had introduced the first Bill 11 legalizing private hospitals. Due to public opposition, Klein was also forced to amend the legislation to disallow the private hospitals to charge patients directly. Both Klein and Quebec Premier Jean Charest continued, despite broad opposition and evidence to the contrary, to justify the establishment of private clinics by claiming they would improve wait times, a claim that has been proven false many times over since then. Even though these arrangements remain in place, they are now violated with impunity by private clinics in many provinces which openly advertise hip replacement surgery at a cost of from $20,000 to $38,000.
The Alberta government's current Bill 11 is designed to finish what was started in 2000 and establish a full two-tier system for a yet unknown number of health care services. It could allow surgeons by specialty, and even family doctors, to practice in both the public and private system. This would allow them to offer patients a "choice" between paying for quick service and joining a long wait-list in the public system.
What is clear from what the Canada Health Act does and does not do, and the state of health care across the country, is that the right to health care is not upheld by any current legislation whether federal, provincial or territorial. Supranational narrow private interests dominated by suppliers of modern equipment, AI software, Big Pharma and the like are seizing more and more control to serve their own private aims of maximum profit. New arrangements are needed. The summation of all the battles which the people have waged for the rights of health care workers, against cuts to health care, rampant privatization and the conditions of seniors' care is that the aim must be to provide the right to health care with a guarantee on a universal basis.
The demand of the people is for a free, high-quality, publicly delivered health care system where the highest quality care available to society is provided when it is needed. The absence of a public authority which takes decisions to ensure the well-being of the population, not narrow private interests, is a matter of great concern. Over the years people from all walks of life and from every corner of the country have participated in countless actions to lay their claims.
Universal, unconditional access to health care, as well as housing, food, education and all that is necessary for humans to thrive are basic human rights which belong to people by virtue of being human. The right to health care must be guaranteed and the people must make it so by becoming the decision-makers.
Now
is the time to take up the fight for a new and modern constitution to
guarantee the rights of the people. A modern constitution is needed to
put in place new arrangements established by the people themselves for
the democratic renewal of the political process so that the people of
Canada,
Quebec and the First Nations, Métis and Inuit become the
decision-makers. Health care workers who have dedicated their lives to
providing the people with health care will play their leading role in
providing solutions based on their expertise, experience, knowledge and
dedication.
The fight includes the refusal to accept a situation in which basic social policy, which determines the kind of society we have, is decided by those in positions of power and privilege. The people are fighting for the recognition of their rights. This is the stand the Communist Party of Canada (Marxist-Leninist) upholds under all conditions and circumstances, in the fight for the unity of the Canadian people in defence of the rights of all, the interests of the most vulnerable, the interests of the unemployed, the homeless, migrants, youth, seniors and everyone. This is the banner that the Party has planted, based on the analysis that the demand of the times is to create a society which recognizes the rights of all and their claims upon it by virtue of the fact that they are human.
This article was published in
Volume 56 Number 37 - May 30, 2026
Article Link:
https://cpcml.ca/TML2026/Articles/T560374.HTM
Website: www.cpcml.ca Email: editor@cpcml.ca