Private health insurance needs consent

Loreen Pindera1 describes the Quebec health ministry's recently released white paper, which recommends private health insurance as a means of reducing waiting time for “elective hip, knee and cataract surgeries, and to cancer-related surgeries.”2 According to the white paper, “This is the first step: the mechanism could be extended to other types of hospital services. . . .”2

However, the Romanow Commission “heard from Canadians through the Citizens' Dialogue and other consultations [that] the large majority of Canadians do not want to see change in the single-payer insurance principle for core hospital and physician services.”3 Given this evidence of citizens' resistance to changes such as those proposed for Quebec and to ensure respect for the autonomous choices and preferences of Quebeckers, it seems to me that any proposed changes in hospital and physician care must have explicit “informed consent” from the public.

Moreover, the method of consultation for most Quebeckers (by Internet only) and the short period allowed (consultations are now closed) excluded those who do not have a computer and limited the options for those who do. I believe that the only ethical way for the Quebec government to implement its recommendations would be a province-wide referendum specifically addressing its proposals for private health insurance for services currently covered by publicly funded health care. Such a referendum would permit citizens to decide on the sort of health care system they want and would be congruent with practices in other democracies, such as Switzerland, which holds referenda on important issues like this one.