Just Medicare: What's In, What's Out, How We Decide

K.V. Nagarajan is a professor of economics at Laurentian University.

Health laws and their impact on the health care of Canadians are not
widely understood. This 2004 National Health Law Conference volume goes
a long way in filling the gap. The 18 essays cover a wide range of
topics: Charter challenges, women’s reproductive issues, Aboriginal
health, physician behaviour, pharmaceutical marketing, and health
research policy.

The main theme is that, despite so many laws, the system is far from
being just and fair. Two of the most egregious examples discussed are
women’s reproductive rights and the state of Aboriginal health care.
Despite winning the right to obtain abortions, women still face a system
that is inaccessible and abusive. Moreover, difficulties in obtaining
emergency contraceptives are “part of the larger injustice of
obstacles women face in accessing health care.” Aboriginals are caught
in complex jurisdictional, departmental, and legislative divisions
amounting to virtual abandonment.

As for physicians, regulations to curb kickbacks and self-referral
through private deals are inadequate, leading to compromises on patient
care. The role of big drug manufacturers in marketing is shown to
involve highly questionable practices. Medical research has become so
commercialized that it is operating under an “Enron-like environment,
where financial pressures may create pressures to bend the rules.”

The authors offer constructive legal and regulatory recommendations.
Their eye-opening book should be required reading for Canadian
politicians and health policy-makers.