The Quebec government recently responded to the Supreme Court's Chaoulli decision with the introduction of Bill 33. That case ended Quebec's prohibition on the provision and purchase of private medical insurance. The justices concluded the prohibition violated the Quebec Charter of Rights and was split on whether it violated the constitutional protections in the Canadian Charter of Rights and Freedoms. Essentially the Court found that government cannot sentence patients to endless waiting lists and also prohibit their choices to pay for quicker access to care. The Quebec government responded with new legislation that will allow a very limited and rigid role for private medical insurance for patients in Quebec.

The private insurance is only permissible for knee, hip and cataract surgeries-those procedures with the longest wait lists. However, the legislation allows that list to be broadened by simple regulation.

Bill 33 also provides a government guarantee to access to health care services. If the government system is incapable of providing an elective surgery in time, then the government can choose to pay for the procedure to be performed in a private clinic.

Unfortunately, Quebec is the only province to respond to the Chaoulli decision even though it has national implications. For example, here in British Columbia there is a similar prohibition on the provision and purchase of private medical insurance. Given the Supreme Court's ruling, it is not clear whether that prohibition is constitutional; yet the provincial government has done nothing to address the uncertainty.

In fact, shortly after British Columbia's new health minister was appointed, the Canadian Taxpayers Federation (CTF) issued an open letter urging the government to repeal the private insurance prohibition. After six months, the new health minister George Abbott responded in the unfortunate but expected manner: the government will work to shore up the public system so no one needs private care. And who gets to decide "need" in this case: the government. Patients and taxpayers were once again told that health decisions were not theirs to make but rather the exclusive purview of politicians and bureaucrats.

A recent brief prepared by the federal government's Library of Parliament concluded,: "The Chaoulli decision has opened the door to duplicate private health care insurance, at least from a legal perspective. As a result of this ruling, it is no longer possible to simply debate the question of whether or not a private market for health care insurance should exist. Rather, the question now is how best to make use of the duplicate private health care insurance market given the lessons learned from other countries' experience."

In fact, Premier Campbell did promise to look to alternative health care systems in Europe and even went on a taxpayer-funded junket to several countries. He also promised in the Speech From the Throne to engage in a public dialogue on health care reform. To date, the conversation has been one-sided. Nonetheless there are some welcome signs the province is recognizing the need for meaningful change. Indeed, Minister Abbott has acknowledged that provincial health authorities will be contracting out to private clinics much more often. That's a good first step: cutting wait times and improving hospital capacity. But health care reform must move much further.

The provincial government should be taking note of Quebec's new legislation and asking how it would work in British Columbia. Health care reform is going to happen with or without government but it is preferable that our elected politicians embrace that change and stop kicking and screaming along the way.