A shakeup may be coming to Canada’s health care system and, like any earthquake, it could wreak catastrophe for thousands of lives.
Thanks to our universal health care system, Canadian citizens can visit a doctor for a regular check-up, heal a broken bone, get a hip replacement, cancer screening or MRI scan, and receive health care services for a multitude of other ailments at no cost. Patients don’t pay for these services out-of-pocket because health care providers are usually reimbursed by the provincial government at a negotiated fee-for-service rate.
However, Dr. Brian Day, the founder of the for-profit Cambie Surgery Centre, is aiming to change this arrangement with a lawsuit that constitutionally challenges the province of British Columbia and the state of Canada. The lawsuit is fighting for the privilege to charge patients unlimited amounts for the same services provided by the health care system. Nicknamed “Dr. Profit” by defenders of public health care, Day spearheads the plaintiff side of the lawsuit alongside his clinic, another clinic, and four patients wealthy enough to afford the cost of private treatment. On the other side are the BC Ministry of Health Services, the Medical Services Commission, and the Attorney General of BC as defendants, plus the federal government, which has special standing in the case. In addition, the BC Health Coalition, Canadian Doctors for Medicare, and the BC Anesthesiologist’s’ Society, along with some patients and individual doctors, are intervenors in the case. Day’s argument is that Canada’s public health care system carries such long wait times for treatment that for-profit clinics, which tend to have shorter wait times, should be able to provide the same services and set their own fees for patients to pay out-of-pocket. According to Save Medicare, “the clinics lawsuit challenges the single most important feature of the Canadian model: that health care be provided according to a patient’s need and not his or her ability to pay for treatment.”
The plaintiffs are asking the Court to rule that B.C.’s prohibition on user fees, extra-billing (charging patients more than the legal amount), and the ban on duplicative health insurance (the sale of private health insurance for services that are already covered by public health insurance) violate the Constitution. They argue that these rules also violate the two sections of the Canadian Charter of Rights and Freedoms that give persons the right to life, liberty and security and that makes every individual equal before and under the law. Going to court for the right to extra-bill patients suffering from health conditions? Talk about grabbing more than a fair share.
There are a few ways this lawsuit is significant to the future of public health care in Canada. Firstly, if privately practicing health care firms receive the right (which is really just a privilege in this case) of charging their own fees for medical services that are already covered by the public system, then this would create financial barriers for people who often cannot afford to incur large expenses outside of their regular spending: low-income families, students, people who live paycheque to paycheque, single-parent households, and families with a member who has a disability or a health condition. Secondly, if this case wins then health care professionals would potentially spend less time working in the public system and more time in the private system.
Lastly, if this challenge succeeds, it would deteriorate the quality of public health care. The “slippery slope” argument applies: as more people decide to pay the high fees of private health care rather than wait for public health care, less people will be using the public health care system. Less usage of the system makes the system less likely to receive funding, thus worsening its quality and increasing its wait times, which creates a positive feedback loop that would attract even more people to private health care. This increase in privately funded health care comes at the expense of public health care that is accessible to everyone, and will bring Canada closer towards a for-profit system like in the United States. It would bring Canada towards a health care system where private insurance companies can deny health care to people most likely to regularly access health care; in other words, the people who need care the most. It would essentially de-democratize our universal, accessible system and favour those who can afford it.
Lastly, private insurance companies and for-profit facility owners like Day would be able to get rich by charging unlimited amounts to suffering people. Day launched the lawsuit in 2009 after his clinics were going to be audited by the federal government following complaints from patients that they had been illegally overbilled. Instead of paying back his clients the difference, he launched the lawsuit arguing that he should be able to charge whatever he wants.
Canada’s health care system, just like its peacekeeping and diplomacy history, is reputed generally worldwide to be incredibly effective but in actuality experiences some less than ideal shortcomings. Our health care system’s shortcomings are numerous, with long wait times for medically necessary treatment especially concerning. But the solution to long wait times for critical conditions is not for the rich to be able to pay their way towards care while shrugging off the ones who cannot pay. In fact, a recent study from the Canadian Centre for Policy Alternatives highlights that “international evidence shows that increased private delivery of health care is more expensive and less safe, and will destabilize the public health care system.”
The court case takes place at the BC Supreme Court in downtown Vancouver on September 6th at 0900. The Council of Canadians has issued a call out to “pack the courts and defend public health care,” so come out and show your support for universal, accessible health care.
By Abby Pelaez
* All views expressed in this blog post belong to the author and don’t necessarily reflect the views of CYH.