The CMA's Chaoulli Motion and the Myth of Promoting Fair Access to Health Care

In 2005, the Canadian Medical Association (CMA) adopted a motion at its annual meeting calling for the introduction of private health insurance in Canada, when "timely access to care cannot be provided in the public health care system." This motion followed a Canadian Supreme Court decision in Chaoulli, in which a majority of the Court recognized the existence, under the Quebec Charter of Rights and Freedoms, of a right to private health care in the absence of 'timely access to care' in the public health care system. Participation in public debates over health care fits the important policy role of a professional medical organization. However, the debate over the expansion of private health care services in Canada also reflects the potentially contradictory interests of these organizations. As many other professional medical organizations, the CMA has a double mandate, to both promote the interests of its members as well as the public's interests in the "highest standard of health and health care." This chapter first analyzes how the CMA's motion reflects a historical tendency of the organization to put the financial interests of its members ahead of the public's interest in a fair and affordable health care system. This clear commitment to its members' interests, we argue, raises concerns about the organization's significant influence on health care policy. The chapter further highlights some of the core ethical and professional problems that will increase as a result of the expansion of parallel private health care in Canada. Referring in particular to the challenges of regulating professional conflicts of interest within a private health care system as it exists in the United States, the authors argue that the CMA ought to critically analyze the potential impact of these changes on the professional obligations of its members rather than blindly support an expansion of parallel private health care.