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The Battle Lines Are Drawn

A single-payer public health care system or A two-tiered health care system with for-profit services

Headline: Landmark 2005 Quebec Case (Chaolulli) The Supreme Court of Canada stated that the evidence shows that delays in the public health care system are widespread and patients die as a result of waiting lists for public health care.
Headline: For-Profit Clinic Lawsuit May Transform Health Care, A. MacLeod, 17 Apr 2014, The
Headline: The five-year old case against the B.C. government over extra billing and patient access to private surgery centres will finally be heard in B.C. Supreme Court during a two-month trial starting in September (Fayerman, Apr. 3, 2014, Vancouver Sun).
Headline: Dr. Brian Day’s health lawsuit against the B.C. government over private care delayed (R. Shaw, Aug.22, 2014, Vancouver Sun).
Headline: Medical System Under Siege. Update: Trial Postponed (BC Health Coalition, Sept. 3, 2014).

This reporter has the task of writing an article clarifying the arguments on both sides of this crucial issue. The scope of the topic is overwhelming, where should I begin? Then I remembered what the King said to Alice: “Begin at the beginning,” the King said, very gravely, “and go on till you come to the end: then stop” (Lewis Carroll, Alice in Wonderland).

Dr. Brian Day, a Vancouver orthopedic surgeon and co-owner of the Cambie Surgery Centre, first launched litigation back in January 2009. In 2012, six patients joined the lawsuit as plaintiffs, all of whom contended their health suffered while they endured long waits for care in the public health care system. The crux of the case is whether patients should be able to pay – with cash or through private insurance – for care in private clinics if they can’t get timely care in the public system. (Fayerman, Apr. 3, 2014, Vancouver Sun). Dr. Day explained that “the trial will certainly go ahead, just not on Sept. 8,” and the delay will allow both sides to “settle some issues outside of court and to make the trial more efficient.”

BC Health Coalition who are interveners in the case, considers this controversy “a dangerous legal attack on Canada’s public health care system,” and is soliciting funds, “please donate to the campaign.” Dr. Brian Day estimates legal fees for his side could be as high as $2 million. He is asking other private surgery centres across B.C. to “chip in” to a legal fund; and he is seeking donations from members of the public. You might inquire “what is going on here?” “Why is Dr. Day so confident?” “Why is he suing the B.C. government; rather than the B.C. government suing him and closing down his facilities?” There is a precedent- setting judgement by the Supreme Court of Canada involving Chaoulli/Zeliotis vs Quebec and Canada:

On June 9, 2005, by a majority of 4-3, the Supreme Court of Canada ruled that Quebec’s ban on private insurance for publicly insured health care services violates the Quebec Charter of human rights and freedoms. Three of the same four judges also concluded that the ban violated the Canadian Charter, while three judges held that it did not…As a result, while the Court ruled that there was a violation of the Quebec Charter, it did not rule that there was a violation of the Canadian Charter ( ).

This decision has been trumpeted as a victory by advocates of privatization and two-tiered health care. However, other provincial governments understand it as being limited to the application of the Quebec Charter and to the province of Quebec. Herein lies the dilemma. On the one hand, Dr. Day insists that if the public system fails to deliver care within a reasonable time (including through publicly funded wait time guarantees), individuals have the legal right to purchase private insurance. Moreover he claims that B.C.’s Medicare rules violate the Charter of Rights and Freedoms which gives people the right to seek faster health care through private facilities if they are unhappy with the public system. The government, on the other hand, has said the taxpayer-funded public health care system is based on the idea that access to medical care is based on need, not the ability to pay. According to the BC Health Coalition (M. Dutt & R. Tutte, May 1, 2014, Vancouver Sun) there is “no evidence that for-profit health care results in better outcomes….Studies in Canada, Europe, and the UK show that patients who can’t pay, and whose doctors work in both public and private systems have the longest waits.”

Dr. J. Edwin Coffey (McGill Journal of Medicine, Nov.2008, p.75-76), in his article “The case for increased privatization of Canadian health care,” refuted the claims of the Attorney Generals of Quebec and Canada and their expert witnesses concerning the likely impact of lifting of the ban on private health services and insurance namely:
(a) Increased overall expenditures, as these would be mainly paid voluntarily by private patients and their insurers;
(b) Attraction of patients with less acute conditions to the private sector, leaving the sicker patients with the public sector, as the public sector already looks after the sicker patients and be relieved of many patients with less acute conditions;
(c) Physicians would tend to lengthen public wait lists in order to direct these patients to their private facilities, since if this should happen the government could establish a framework of practice for public physicians who wished to practice part-time in the private sector.

Dr. V. Brcic (Canadian Doctors For Medicare, Oct. 4, 2012) responds to these claims:
It is undeniable that Medicare is underfunded for some services (but not for most), and that some patients are waiting too long for procedures. It is true that Medicare is not living up to its full potential, and we need to change that….Since when do doctors run away from the system that pays them, and pays them well, instead of trying to improve it? …We must remember that medically necessary procedures are generally covered by provincial insurance plans, paid for by our tax dollars whether they are delivered through public, not-for-profit settings or private for-profit settings. But it costs more to deliver the same care in for-profit facilities….There are two paths for Medicare: the path where the wealthy few get speedy care, and the rest of us wait longer, or the path of solidarity we’ve already chosen, where we care for each other based on our health needs, not our ability to pay.

I would encourage each reader to become better informed about this immanent controversy and court case. It will affect us all. The more knowledgeable we become; the more actively we engage in our society; the more our society will reflect our wishes and our values.

Dolores Luber
Disclaimer: This article represents an exploration of the issues involved. It is not meant to agree with or support either side of the argument. Jewish Seniors’ Alliance has not taken a position on the issues discussed in this article.

JSA Members Respond
We encourage our readers to write in with their reactions and feelings about this topic.

Dolores Luber
After reading the disturbing case studies of patients who did not receive the medical care they needed, I am in favour of a two-tiered system. I believe the public should insist on a more-responsive public health care system which would eliminate the need for private care. However, the horse has left the barn; for those who can and do prefer private care, I do not see it as the end of Medicare. Quebec’s waiting lists have diminished and service is faster since 2009.

Binny Goldman
I personally agree with the two tiered system and feel it should be available to those who need it as it should not detract from the system of medicare we already have in use and can actually be beneficial.

I am in favour of a system that provides uniform medical service to everybody. I cannot imagine doctors sharing their time both working independently and for the government. If they want to work independently they should have the right to do so. Their pay should come from clients and not from government coffers.

Edith Shier
Excellent outline of the two systems and the interaction possible. I personally, am in favor of having both to choose from – if the patient can afford it.

I believe it is best that medical services not be provided ‘for profit’ and I strongly believe it is best if medical services be provided without social or economic barrier to all members of the public. I believe it is best if the professional standards of the healthcare providers should be determined collaboratively in dialogue amongst the professional association—the College of Physicians, centres of care such as hospitals and the provincial regulatory body—the Ministry of Health; their dialogue built upon considerations of all facets of current medical research, from community medicine to epidemiology. Given that the government in power has a duty of care towards its citizens, they have the primary responsibility of ensuring an efficient resource allocation and budgeting towards an effective administration of medicine within the province; that is, making resources available to ensure timely provision of service and appropriate professional development with current research standards and technology deployed. And how they manage this administration becomes, of course, a matter of their tenure and survival in power.