Canadian medical students supporting medicare sign now

We, the undersigned Canadian medical students, recognizing our future role as physicians and our duty to be advocates for our patients[1], urge the Canadian Medical Association (CMA) to support publicly funded and accessible medicine. We were disappointed to see CMA delegates vote on August 17, 2005 in support of allowing private health insurance and private-sector health services[2].

As outlined in the CMA Code of Ethics[3], we are required to "consider the well-being of society in matters affecting health" and recognize that community, society and the environment are important factors in the health of individual patients. It is our duty to respond to challenges to our system such as the June 9, 2005 decision by the Supreme Court of Canada in the Chaoulli case, striking down the prohibition of private health insurance[4]. The Code of Ethics also calls us to recognize the responsibility of physicians to promote equitable access to health care resources. Patients should not be discriminate[d] against on such grounds as age, gender, marital status or socioeconomic status. The ability to pay for private insurance should not enter our decision making process and affect the type of care we give. Physicians should be involved and vocal in ensuring our society grants all citizens the right to health care.

Two-tier medicine with a parallel private health care system threatens this right. Patients who can afford to pay for private health insurance will be able to jump the queue. Access will not be based on need, but on socioeconomic status. Some may argue it is a violation of human rights to prevent individuals who can afford it from seeking more rapid care. However, we feel it is no more just to create a barrier to care for those who cannot afford to pay. In addition, Canadian examples show that the private system will take physicians away from serving the public system[5]. Evidence demonstrates that wait times in the public system increase when there is an existing private system[6].

The Kirby and Romanow Commissions cautioned against this move towards two-tier health care delivery. The majority of Canadians consistently put accessibility for all ahead of more rapid access for those who can pay out of pocket[7,8].

We firmly support the Canada Health Act principles of universality, comprehensiveness, accessibility, portability and public administration.

We urge the CMA and its members, who are our mentors, teachers and supervisors, to support public medicine.

We disagree with the motion passed at the CMA Annual General Meeting, stating that patients who cant get timely access to care should be allowed to rely on private health insurance and private-sector health services. We feel strengthening the public system should be the CMAs priority, as it was in 1995.

In conclusion, we do not want to be the generation of physicians who practices under a two-tier or private healthcare system, and feel that publicly funded and accessible health care is the best for the health of our future patients. As the CMA has stated previously, "It is in the interest of all Canadians to have a publicly funded health care system where access to health care is based on need, not the ability to pay[9].

References
1. Frank JR et al. Skills for the new millenium: report of the societal needs working group, CanMEDS 2000 Project. Annals Royal College of Physicians and Surgeons of Canada 1996; 29: 206-216.
2. Sibbald B. CMA supports private health insurance. CMAJ 2005: 173(6) Online: www.cmaj.ca/cgi/rapidpdf/cmaj.051035v1
3. CMA Code of Ethics (2004) http://policybase.cma.ca/PolicyPDF/PD04-06.pdf
4. Chaoulli v. Quebec (Attorney General), 2005 SCC 35, 9/6/2005.
5. DeCoster C et al. Waiting times for surgery: 1997/98 and 1998/99 update. Manitoba Centre for Health Policy and Evaluation. www.umanitoba.ca/centres/mchp/reports/pdfs/waits2.pdf
6. Tuohy C et al. How does private financing affect public health care systems? Marshaling the evidence from OECD nations. Journal of Health Politics, Policy and Law 2004; 29(3): 359-396.
7. Commission on the Future of Health Care in Canada. Commissioner: Roy J. Romanow. "Building on Values: The Future of Health Care in Canada Final Report". Nov 2002. www.hc-sc.gc.ca/english/pdf/romanow/pdfs/HCC_Final_Report.pdf
8. The Standing Senate Committee on Social Affairs, Science and Technology (Chair: Hon. MJL Kirby). The Health of Canadians: The Federal Role - Final Report, Volume Six: Recommendations for Reform. Oct 2002. www.parl.gc.ca/37/2/parlbus/commbus/senate/com-e/soci-e/rep-e/repoct02vol6-e.htm
9. Canadian Medical Association/Canadian Orthopedic Association. Submission Regarding Chaoulli and Zeliotis vs. Quebec. www.cma.ca/index.cfm/ci_id/40068/la_id/1.htm

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