SUPREME COURT JEOPARDIZES WOMEN'S RIGHT TO HEALTH: Jurists' Private Insurance Ruling Especially Negative for Women
Lippman, Abby, Quesnel-Vallee, Amelie, CCPA Monitor
On June 9,2005, a bare majority of justices of the Supreme Court (four of seven) overturned decisions of two lower provincial courts by ruling that there was a constitutional right for Quebecers to buy private insurance to obtain services already available in the public health system. While applying only to Quebec and potentially to be stayed for 18 months, this decision nevertheless opens the door for anyone in Canada with sufficient funds to try to buy their way off waiting lines by getting care in the private sector - and, by extension, to more privatized care in general.
The decision of the Supreme Court in the Chaoulli case has been welcomed by some, rightfully criticized by many, but missing in the discussion to date has been attention to its particular - and negative - direct and indirect effects on women. Poorer than men, with jobs that are more often precarious, non-unionized and part-time, and with higher rates of disability, women may disproportionately suffer from the effects of this decision, both as users of and as workers in the health care system.
Women are the major users of health services (notably because of their reproductive roles and higher rates of chronic disease), the majority of workers in the health system, and disproportionately the unpaid providers of care for others. This means that women have special interests in the expansion of Medicare, and not in its reduction or elimination.
The Court's decision not only ignores these existing gender-based inequities, but opens the door for a system that has the potential to increase them. As such, this decision does not concord with the Canadian commitment to improving the status of women.
Women in Québec have already been paying the price of the "virage ambulatoire" (cost-reducing policies put in place in the 1990s that sought to reduce hospital care) and reorganizations in provincial health care systems. For over a decade, women-whether as paid health-care workers, users of the system, or unpaid caregivers-have been disproportionately harmed. The decrease in budgets to the CLSCs (local community health clinics) and the closing of hospital beds, for example, have shifted the responsibilities-and the costs-for necessary home care and postoperative services onto women who have been required to "volunteer" their care for others-and themselves. Similarly, fewer physicians at CLSCs, and the still incomplete changes to improve primary care access, deprive women of the holistic community-based primary care that they need.
Allowing private insurance and services, as the Supreme Court's decision may do, makes access to care a matter of ability to pay rather than a matter of need. This would jeopardize equity and lead to further differentials in status between the rich and the (majority female) poor. With fewer financial resources, women will be precluded from this market but, worse, will face deterioration in the public system on which they count if physicians and nurses leave for higher-paying jobs in private clinics.
For health care workers, too, expansion of the private system is likely to bring risks. Whether or not they are "for profit," private services' employees generally face lower wages and poorer working conditions-both risks to health-with nonskilled workers such as aides, cleaners, food service providers, etc., the majority of whom are women, particularly hard hit.
Although the Supreme Court decision currently applies only to Québec, elsewhere in Canada, too, women especially have been feeling the impact of varying health care "reforms" for the past decade or so. This can be seen in the changed (for the worse) paid and unpaid work conditions and in reduced access to appropriate care. And none of these consequences will be addressed by having private insurance should other provinces use the Court decision as a way to reduce their waiting lists. To the contrary all of these tendencies will likely be worsened by any further diminishing of the public system on which women are particularly dependent. …