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The dangerous ideas of Dr. Jacques Chaoulli

Like thousands of other people, my mom is waiting for surgery, and the line is pretty long, and meantime, she's in pain, and the longer she waits the worse it gets. She's not complaining, mind you. But Dr. Chaoulli is. He argues that if the public system can't give my mom reasonably timely care, she ought to be able to get it elsewhere. "The reason I went to court was because I wanted to help the patients," he told me.

Dr. Chaoulli is either the greatest hope for serious reform to Canadian health care in our time, or Public Enemy No. 1. It all depends on whom you ask. Both sides agree on one thing, though. His one-man crusade for patients' rights (oops, to wreck the system) is a big deal. Constitutional lawyers, several of whom are weighing in on his side, say it's the health-care case of the decade. So does Senator Michael Kirby, who, you may recall, is the author of an exhaustive report on how to reform health care that now lies mouldering on the shelf along with all the other ones.

"Government cannot have it both ways," says Mr. Kirby, one of the many intervenors in the case. "You cannot take responsibility for provision of an essential service without meeting reasonable service standards."

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Dr. Chaoulli argues that people should be allowed to buy private health insurance -- which is currently illegal -- for services the system can't or won't provide in a timely manner. He also thinks people should be able to buy these services from private doctors and hospitals if they want. To help argue his case, he recruited an elderly man who had waited more than a year for a hip replacement and was mad as hell about it.

Would this dangerous innovation lead us down the slippery slope to health-care hell? The critics argue yes, and invariably raise the spectre of the evil empire to the south. Give people choice, they say, and that's the end of health care as we know it. So far, the judges agree. Dr. Chaoulli has lost twice in lower courts, which ruled that allowing private health insurance would probably destroy the public system. What they said was that if my mom's rights are being violated, too bad.

Dr. Chaoulli argues that his proposals would bring Canada in line not with the United States, but with radical nations like Sweden and Australia, where public and private systems co-exist side by side. Australia, for example, has 509 private hospitals that supply a third of the hospital beds.

The doctor himself comes from socialistic France, where private hospitals, private insurance, and user fees are ubiquitous. Are poor people mortgaging their homes for health care and dying in the streets? Well, no.

"The power of brainwashing is very strong," he says. "When you've had a brainwashed society for decades, it is not easy for one person to reverse it."

Michael Kirby and 10 other senators are intervening on the doctor's side -- sort of. They say there's a middle way, which would allow us to preserve the system but hold the government's feet to the fire. Their idea is something called a health-care guarantee. The government guarantees that mom will get her surgery within a reasonable period of time, or else mom has the right to get it elsewhere and be reimbursed. Mr. Kirby also says what other politicians secretly know but will never, ever say: Real reform through politics is probably impossible. The system will only change when the courts make it.

Bankrolled by his sympathetic in-laws, Dr. Chaoulli has taken a two-year break from medicine to fight the case. He figures he has spent $600,000 of the family's money. Why is he so passionate about this?

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"Why? It is because freedom is not a gift, like an apple on the tree. You have to fight for your freedom. If you don't fight, you are not a free man."

So forget all the election noise about the extra billions that politicians are promising to throw at health care. It won't make any difference. What will is what the Supremes make of that dangerous Dr. Chaoulli.

mwente@globeandmail.ca

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About the Author

Margaret Wente is one of Canada's leading columnists. As a writer for The Globe and Mail, she provokes heated debate with her views on health care, education, and social issues. She is a winner of the National Newspaper Award for column-writing.Ms. Wente has had a diverse career in Canadian journalism as both a writer and an editor. More

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