Erin O’Toole would support more choice in health care. Would he undo Canadian medicare in the process?

OTTAWA - Conservative Leader Erin O'Toole says he would support provinces in introducing privately led health-care innovations" to offer more choice and less waits," so long as there remains universal access" and free medical services for the public.

Liberal Leader Justin Trudeau says that means O'Toole believes in a for-profit, private health care system and he will not tell people what exactly he wants to do with that."

On the contrary, O'Toole fired back, I support the health system we have right now."

But the Conservative leader dodged a direct answer Tuesday on how deeply he supports the introduction of private health services within a public system. And when asked to explain why he supports Saskatchewan's practice of allowing those who can afford it to pay for quicker access to diagnostic imaging - which can lead to earlier surgeries or other treatments - O'Toole again declined to offer a broader explanation.

I support universal access in our system, public and free," the Conservative leader said. And I also support provinces making sure that they can offer more choice, faster service and less waits for their citizens."

Health care has emerged as a key wedge issue in the pandemic's fourth wave, as the Liberals and Conservatives clash on the campaign trail over COVID-19 vaccinations, public and private health care, and seniors' care.

The Liberals point to O'Toole's statement last year during the Conservative leadership race that he supports Saskatchewan's model of innovation, which allows patients to pay up to $950 for an MRI at a private clinic.

But O'Toole is unrepentant. If Saskatchewan, Alberta, Ontario, or Quebec want to innovate to provide better health care, I support that," he said Tuesday.

Why? Because it gives Canadians more choice. The more choices Canadians have in health care, the better. It reduces wait times, and it frees up more money to reinvest in health care. My view is consistent with the belief that Ottawa shouldn't be dictating to Quebec, Ontario, Saskatchewan or any other province."

The Liberals say they moved to curb the private role in health care - O'Toole says they have tolerated it while in government - and threatened a clawback" of federal transfer payments for health care if Saskatchewan does not eliminate patient charges for MRIs.

O'Toole seized on that statement to accuse Trudeau of threatening to withdraw health funds in a pandemic," and being willing to compromise" people's health.

But the Liberals first issued the warning to Saskatchewan and other provinces three years ago. That's when then-health minister Ginette Pettipas-Taylor said Ottawa was formalizing the long-standing federal position that medically necessary diagnostic services received in private clinics are considered insured health services" - meaning they are to be covered by government, and should not be considered user-pay services.

Health Minister Patty Hajdu later concluded that there was also evidence of residents paying out-of-pocket to secure faster access to diagnostic services in other provinces, including British Columbia, Alberta, Manitoba, Quebec, New Brunswick, and Nova Scotia."

Hajdu said the enforcement date of the government's ban on patient charges for those kinds of MRIs was set to April 2020 to give provinces time to align their health-care systems with the requirements of this policy."

But she also warned that provinces and territories which continued to allow patients to be charged privately would be subject to deductions from federal transfers under the Canada Health Act" by March 2023.

Speaking Tuesday, Trudeau didn't save his criticism for the Conservatives, charging that the New Democrats always talk a good game" but never have a concrete plan to deliver. The choice is clear in this election," he said.

NDP Leader Jagmeet Singh, who vowed Tuesday that a New Democratic government would eliminate for-profit operators in long- term care sector, shot back that neither of his rivals can be trusted on health care or long-term care for seniors.

Singh pointed to what he characterized as the Liberal record of supporting a role for the private sector in long-term care.

It's clear both the Liberals, Justin Trudeau, and the Conservatives believe in for-profit care," said Singh. We're the only one saying it should not be for-profit. It should be not-for-profit."

Dr. Katharine Smart, the new president of the Canadian Medical Association, said in an interview that every election we see the topic of privatization come up, and it's a challenging one, because I think on the surface, it's appealing, right? You think, Oh, yeah, let's off-load some things from the public system.'

But I think the real conversation is about why are we not adequately funding publicly the things that people need to be healthy. So, if these surgeries and these diagnostic imaging are things that people need, why is the funding not adequate to allow the provinces to deliver those within the system we have?"

The CMA says five million Canadians do not have access to a primary-care physician, and the problems in the system run deep.

We know in other countries that have gone down the road of privatization, it creates inequities in terms of wait times and who's getting what services," Smart said.

So I think what we're really calling for is to actually invest in our publicly funded system in an adequate way that allows the services that people need to be delivered in a sustainable way. And that's what we're not seeing."

Political parties are batting around vague ideas" and numbers but have not provided a level of detail necessary on health care, she said.

The devil's in the details."

Tonda MacCharles is an Ottawa-based reporter covering federal politics for the Star. Follow her on Twitter: @tondamacc