How is it legal to have private clinics in Canada?

We have been looking into private clinics here in Toronto, to extend the options for our daughter, who has been to a succession of public system doctors and specialists over the years, and still lacks a definitive diagnosis and treatment for her (rather obscure) problem.

Both she and I are a little shamefaced about this, as we both harbour some generalized left-wing misgivings about private medicine, and believe that healthcare should be free and universal, as indeed it is here in Canada. And yet there ARE peivate clinics here in Ontario, and in most other provinces. How is this possible? How is it legal?

Saskatchewan introduced a universal hospital care plan back in 1947, but it was not until the 1984 Canada Health Act that private healthcare aas effectively outlawed throughout the country, mainly to guard agaist the wave of extra billing, user fees and copays that swept the country in the 1970s. However, it turns out that there is no blanket ban on private medicine in Canada, and technically any doctor that wants to set up a private practice can do so, provided they completely opt out of the public system. They must choose one or the other. The Canada Health Act seeks to remove any conflicts of interest (e.g. the temptation to siphon patients away from the public practice to their more lucrative private practice). In addition, most provinces ban private health insurance, making it difficult for a private sector doctor to find business, and some provinces also restrict private doctors from charging more for procedures than they can charge under the provincial healthcare plan.

However , there is a small Canadian private sector for medically necessary healthcare, estimated at aroud 1%, and many doctors are agitating for a more Euroean-style hybrid system. Because they are operating in something of a legal grey zone, private clinics tend to open up up quietly, and fly as far as possible under the radar of the press.  I was actually surprised at the choice that was available to us, right here in Toronto. I still don't really understand how they are able to offer these services privately - it is not really something that the piblic system is not able to offer (unless you argue that their ability to offer a complete 5-hour medical assessment, complete with immediate medical tests, snacks and gourmet coffee, is something the public system cannot offer, limited as they are to ten minute consultations by harrassed, overworked doctors).

Defenders of the single-tier system argue that expanding private medicine would siphon talent and resources away from the country's already over-stretched public health system (although that's actually not what has happened in European countries with two-tier systems). Some argue that private healthcare clinics tend to push unnecessary, even dangerous, testing, although it is not quite clear what the evidence is for that.

Proponents of a two-tier system counter that allowing those who can pay to take advantage of private medicine would free up more space in the public system for everyone else, resulting in shorter wait times for everyone. They point out that the existence of private clinics does not violate the principle of universal healthcare for everyone regardless of incomes, it is merely supplementary. They say they offer managed and preventative healthcare, rather than reactive event-based care, like in the public sector. They also give examples of people whose medical problems have become worse while they waited for procedures in the public sphere, in some cases leading to deaths, deaths that could have been avoided by the existence of private clinics with lower wait times. 

You can kind of see both sides of the argument, and you can also see where the arguments fall down. The bottom line, though, for us at least, is that, if the public system has let us down in this particular case, then we will explore all available alternatives, principles be damned. And, luckily for us, we can pay. Most of our dealings with public healthcare have been excellent, I would say, but we will do what we need to in order to safeguard the health of our family, even (God forbid!) to travelling to the States if need be.