Chicken Little arrives at medicare trial

To listen to interveners in the Great Canadian medicare debate being waged in B.C. Supreme Court you’d think the sky was falling on public health care.

Private health clinics are not just a violation of the Medicare Protection Act, apparently they offend “the very notion of what it means to be a British Columbian and a Canadian.” The “queuejumping, the bait-and-switch tactics, the cream skimming of patients and the referral of patients with medical complications back to the purely public system,” the list of evils associated with these firms that have operated for 20 years is apparently lengthy. Describing them as audacious scofflaws, a lawyer for a group of patients intervening in the constitutional challenge of the act sounded as if she were on a crusade. “There is only one pot of money in B.C. to pay for health care,” Marjorie Brown maintained Wednesday delivering her opening at the groundbreaking trial. “Some of that money has been siphoned off for the illegal practices of Cambie and related clinics. That is, wealthy individuals who are able to pay user fees and extra billing charged by the clinics can jump the queue to see specialists (and thereby move up in the surgery queue) or jump the queue to surgery itself.”

You wouldn’t know from Brown’s creed-like assertion of equal access paramountcy in Canada that employees covered by workers’ compensation, Mounties, federal prisoners and others have privileged access to care. That’s because there is politics behind the scenes. The patients are backed by the B.C. Nurses’ Union, which started harassing the incoming Liberal provincial government in 2002 over private clinics breaking the act, which was passed by the NDP one decade earlier. The nurses, who were refused intervener status, caused such a fuss over the following half decade Victoria ordered an audit of the clinics and that prompted this litigation. Led by the pugnacious Dr. Brian Day, two clinics and a handful of patients claimed the government wasn’t delivering timely, medically necessary treatment and was violating the Constitution by simultaneously blocking people from accessing the care they needed. They want to end Medical Protection Act prohibitions against public doctors providing private services and patients having insurance to pay for privately delivered core health services. Dr. Day insists he has no interest in being the catalyst for a U.S.-style health care system but believes a more responsive, public-private hybrid similar to some European models would serve Canadians better without compromising accessibility. In keeping with the strident tenor of her opening, Brown scoffed that Day’s Cambie Surgeries Corporation and Specialist Referral Clinic Inc. are in it for the money — with a “large pecuniary interest” motivating the lawsuit. She accused them of “20 years of flagrantly unlawful profiteering” brought to public attention only by the BCNU.

“This case is really about advancing the self-interest of the plaintiff clinics at the expense of the continuation of the public health care system that by and large delivers the very best medical care to Canadians when they need it,” Brown insisted. Alison Latimer, lawyer for another intervener — a coalition of two doctors, two patients and two organizations, the B.C. Friends of Medicare Society and Canadian Doctors for Medicare — echoed those rhetorical concerns. Representing a range of medicare’s most-loyal faithful, Latimer conjured their fears that a successful challenge will end universal affordable care. She said the most vulnerable will face insurmountable health and income barriers to accessing privately financed health care. “They are critically concerned that if the protections the plaintiffs challenge are struck down, the resulting for-profit and parallel private system of health care would severely impact the ability of members of the medical profession to provide the very best care to patients according to need, not ability to pay,” Latimer added. Inequalities in access to care, accelerated cost increases, higher administration expenses, compromised care and repercussions within the North American Free Trade Agreement will follow — all very, very scary. Yet plenty of private firms legally profit from delivering health services (many of them doctors and dentists) and portraying Dr. Day and the plaintiffs as greedy carpetbaggers is cant. The real issue in this case is about data — are medical waiting lists so bad that people are dying or suffering physical and psychological damage to an extent that court intervention is required to stop harmful consequences of a fine-sounding government policy? Now that the opening statements are finished, for the rest of the week, uncontroversial agreed-upon evidence about the health care system is being entered. Justice John Steeves will begin hearing witnesses Monday.