The legal barriers put in place to discourage private medicine were nothing compared to the shitty quality of care driving Canadians to hurdle those barriers. As the Supreme Court of Canada noted in the 2005 case, Chaoulli v. Quebec, “Access to a waiting list is not access to health care.
As we noted above, there is unchallenged evidence that in some serious cases, patients die as a result of waiting lists for public health care.” That decision set aside only Quebec’s ban on private health insurance, leaving other provincial barriers in place. But the same pressures that blew apart one province’s restrictions drove an explosion in private health care elsewhere. “In British Columbia, private clinics and surgical centers are capitalizing on patients who might otherwise pay for faster treatment in the U.S.,” the Los Angeles Times reported in 2009. “Private clinics continue explosive growth,” the Canadian Medical Association Journal added two years later, noting that many “private clinics were openly violating” restrictions on billing private parties while contracted with government Medicare.
This year Quebec officials moved to legalize many of the fees that private providers were already charging. That makes sense, since those providers were delivering actual care when the state system could only offer “access to a waiting list.”
The U.S. certainly isn’t North Korea or Pakistan; it isn’t even Canada. But the laws of economics apply here too. The Affordable Care Act—Obamacare—is already running afoul of the Canadian Supreme Court’s warning that “access to a waiting list is not access to health care.” Two years ago, news reports cautioned that top hospitals were declining to participate in the program. Last year, CNN reported that “In many areas, the largest hospitals are not participating and many doctors are not accepting the coverage.”
In fact, small but growing ranks of providers are refusing all coverage. Freed from burdensome bureaucratic overhead, they offer less expensive care in return for direct payment by patients.
Those doctors aren’t doing anything illegal, but the Americans who refused to pay the premiums for Obamacare-compliant coverage are breaking the law. Millions of Americans were forced this year to pony up fines to the IRS (which has been tasked with enforcement), with many millions more exempted, and an unknown number just flying under the radar. The penalties were a bargain compared to the inflated price of obedience to the complex and expensive government mandates.
Economies and cultures may differ, but the U.S. faces the same economic pressures that confront the regime in totalitarian North Korea, bureaucrats in poor Pakistan, and elected officials in prosperous Canada. The choices are the same too: They can criminalize medical care provided outside official channels. Or they can recognize and legitimize the arrangements that patients and providers make when governments can only offer Bernie Sanders’ empty vow of “a single-payer national health care program” that guarantees nothing more than a spot on a very long list.