PRIVATE CLINICS DENOUNCED DESPITE THE NEED THEY FILL
Listening to B.C. Health Minister Adrian Dix denounce private health care clinics last week, you might have forgotten they were fostered more than 20 years ago under the previous NDP administration.
Dix vigorously promised the NDP will activate changes to the Medicare Protection Act on Oct. 1, changes the Liberals introduced in 2003 but didn’t proclaim. The aim: to stamp out “extra billing.”
The act allows for fines of up to $20,000 when doctors and clinics “extra bill.” It’s too bad we don’t really know what that means or if the law is even constitutional.
Oh, there’s talk of greedy doctors bilking patients. But in reality, the status of the law and its restraints on private care are the issues before the B.C. Supreme Court in a marathon trial.
It has featured incessant government attempts to declare the opinion of those who work in the health care system, including ministers, as irrelevant.
And — what a surprise! — the case is set to resume in court.
The face of the litigation,
Dr. Brian Day, was sure the announcements by Dix, an integral part of that old NDP administration, were designed to sap the time, energy and funding of the clinics and patients behind his case. “The timing is very suspicious,” he complained. “I suspect they realize they will lose that case, and are challenging us to come up with resources to start another against the new law. I personally believe it’s an insult to the legal process and the judge.”
Day maintained the 59 private surgical clinics and about 17 private clinics offering MRI scans were established after a change in government health care funding decades ago that triggered the rationing of services that caused the waiting lists.
Before the late 1980s and early 1990s, queues were unheard of.
He and his supporters established Cambie Surgeries in 1996, midway through the NDP’s last stretch in office, to meet a need. He insisted they have been encouraged by every government of the day since.
NDP premier Ujjal Dosanjh was quoted in the HEU newsletter at the time saying “it would do us no good to shut down Day’s clinic if we can’t provide those services elsewhere.”
Day said it was the same after the former Liberal government took office in 2002. Premier Gordon Campbell and health ministers Colin Hansen, Dr. Margaret MacDiarmid and Kevin Falcon supported the clinics because they were essential.
The Liberals passed the Medicare Protection Amendment Act in 2003 to appease the militant nurses union (which is opposing Day in the court case) and the federal government, which was threatening to reduce the health transfer payment.
The provisions weren’t proclaimed because the Liberals never intended to enforce them. The government couldn’t afford to meet the demands in the public system.
That remains the elephant the government wants to ignore — if the public system produces harmful waits, constraints on access to private care are unconstitutional.
The Supreme Court of Canada in 2005 ruled in a Quebec case that constraints, like those planned in B.C., could not be justified in the face of such suffering and perhaps even death.
“We don’t want a two-tier system, one for Quebec and another for the rest of us,” then premier Campbell said afterward in defending the clinics.
Day’s litigation has exposed the hollowness of many national shibboleths — most especially the claim that Canada has an egalitarian, universal access system. In fact, it’s a patchwork of 11 systems. Each province has its own list of what constitutes covered care and a list of what is reciprocally covered with other jurisdictions.
As for everyone being treated equally, in this province, injured employees covered by WorkSafeBC skip the queue. Why not all injured workers?
There are also exemptions that allow RCMP officers to jump the line, federal prisoners and others who have been deemed better than the rest of us when it comes to timely care.
Nobody in government has acted against these clinics for a generation because they relieve the public system of tens of thousands of surgeries!
The accusations about “extra billing ” involve financial formulas, chameleon-like nomenclature and a lack of bureaucratic transparency.
Is “medically necessary” and “medically required” the same thing?
It’s the same with trying to figure out the actual length and effect of waiting lists — definitions vary, the numbers are like quicksilver, and some Oz-like wizard in Victoria controls all while reluctant to share, explain or even discuss the data.
Some enlightenment had been promised this week. Dr. Bassam Masri, head of Vancouver Coastal Health’s orthopedics department that will receive much of B.C.’s new $175 million hip-and-knee funding, is to testify.
He’s well aware of the harms of waiting lists. Yet the government has tried in advance to limit his testimony.
Given the developments last week, I can’t wait to hear what he has to say.