Canada's black-market clinics

The scenario isn't imaginary, and it is not in some totalitarian backwater still mired on the wrong side of the Cold War. That's Canada.

"We're not allowed to have private health insurance in Canada," Christina Woodkey said after driving to Montana so she could have $50,000 surgery to relieve back pain. Under Canada's nationalized health care system, this "nonessential" surgery would have been held up for two years. Pain drove her to raise the money and cross the border.

Those details come from a revealing story last week in which Los Angeles Times reporter Kim Murphy underscored the bizarro world where there's an ongoing court battle to determine if the 1985 law banning private health insurance violates the Canadian constitution.

That's not the only health care battle in Canada. An American company is trying to use the North American Free Trade Agreement so it can invest in building a clinic in Vancouver. Technically, such health centers outside the government system are illegal in the Great White North. The L.A. Times reports that the U.S. company already has competitors that simply ignore the law. Black-market clinics run by Canadians have sprung up in several provinces to serve those sick of waiting in long lines for care. While they await a court decision, provincial governments unofficially look the other way.

Despite the fact that Canada's single-payer system is not part of the major health care bill currently before the U.S. Congress, there are provisions in several versions of health care legislation in the House and Senate that could push us in that direction. In particular, requirements that health care plans meet increasingly tight standards will restrict the number of plans from which Americans can choose.

As the remaining plans grow and take over an ever-larger share of the market, those pushing change hope that increased buying power will enable the plans to force down prices. Fewer providers handling more people at a lower cost means less care overall. That dynamic could re-create Canada's lines here and give rise to a medical system outside that refuses to be involved in the government-dominated insurance system. Indeed, American Medicare recipients already face a growing number of doctors who won't accept new patients covered by the government program.

Advocates of universal health care in Canada oppose a parallel private system because it will create one level of health care for the rich while the poor are stuck with insufficient government care. That egalitarian anxiety is the same motive animating many self-styled health care reformers in America. In a rush to rewrite the laws, these politicians might get exactly the unintended consequences that have arisen in Canada: a horrible nationalized system for the masses and a private black-market option for a few with enough cash to pay for it.