Beyond the Chaoulli ruling
Debates on our health system need to be based in evidence
A version of this commentary appeared in the Huffington Post, Vancouver Province and iPolitics.ca
Healthcare financing in Canada is no small business.With a staggering $200 billion spent on healthcareservices annually — that’s more than one dollar spenton healthcare for every $10 of the total economicactivity in Canada — debates about healthcare servicesfinancing ought to be taken seriously.We certainly have no shortage of pundits, from the leftand the right, weighing in on the state of the Canadianhealth care system. Too bad the debates aren’t oftenbased on the facts.In a recent study for
, my colleaguesand I analysed four and a half years worth of mainstream media coverage and political commentary on thelandmark
Chaoulli v. Quebec
ruling. This was the decision by the Supreme Court of Canada which ruled thatprohibiting private medical insurance was a violation of the Quebec Charter of Human Rights and Freedoms,particularly in light of the long wait times for some health services. The ruling, which is only binding inQuebec, ignited an immediate and fierce public debate on private vs. public health financing that continuesacross the country today. After pouring over transcripts of all discussions in Quebec’s National Assembly, including relevantparliamentary committees, and a broad sample of mass media in print, radio and television, we found that inmore than half of all the statements made in policy debates on healthcare services financing, speakersdefend a given policy avenue without justifying their position with any evidence whatsoever.In the remaining statements, individuals justified their preferences based on comparisons with informationfrom non-healthcare sectors such as education, based on juridical constraints or based on constraints setby current practices.In only a dismal one tenth of all the statements made about the Chaoulli decision did the speaker useevidence or some factual health related information in support of their position.We also found that both sides of the polemic were guilty of placing ideology above evidence — but notequally.Those espousing public funding of health services accounted for three quarters of the fact-basedstatements, while the statements of those in favour of privatization tended to focus more on legalustifications (‘let’s respect the law’). Another interesting difference: those in favour of publicly funded health care tended to reinforce thenegative outcomes of the ruling (‘we should keep public financing or else…’) whereas the privatizationproponents emphasized positive future outcomes. And it is noteworthy that, often, the advertised positiveeffects put forward in pro-private statements were at odds with available scientific evidence.