A British Columbia doctor’s fight for private health care will be difficult and protracted, and it could pose a serious threat to Canada’s universal healthcare system, according to legal and medical experts.
Dr. Brian Day is challenging the province’s ban on the purchase of private insurance for medically necessary services that are already covered by the public system. His argument that the ban violates patients' constitutional rights by forcing them to wait for months and even years for medical procedures will be heard at a trial that began Tuesday and is expected to last months.
In opening remarks in a B.C. courthouse on Tuesday, lawyers argued that long waits for medical treatment in B.C. are causing “real and substantial harm†to patients’ physical and mental health. They also suggested that a private system would provide a “much-needed safety valve†and allow patients to pay for quicker care.
Opponents of Day suggest that his legal challenge, if successful, could spark a movement toward a U.S.-style health-care system that prioritizes money over equal access to health care.
“He is supported by U.S. insurance interests who are salivating at the possibility of moving into the Canadian market,†said Dr. Michael Klein, a pediatrician with Canadian Doctors for Medicare.
But even if Day’s constitutional challenge of the B.C. Medicare Protection Act is successful before the B.C. Supreme Court, the doctor will likely have to take his legal fight all the way to the Supreme Court of Canada, Â鶹´«Ã½ legal analyst Edward Prutschi said.
“It’s going to last an awfully long time,†Prutschi told Â鶹´«Ã½ Channel on Tuesday. “Even if he wins or loses, this is just phase 1. It’s destined for an appeal and he’s indicated his intentions to take it all the way to the Supreme Court of Canada.â€
Day originally filed his lawsuit against the B.C. government in January, 2009. His company, Cambie Surgeries Corp., along with five others, argued that the provincial Medicare Protection Act is unconstitutional because it prevents patients from receiving timely and reasonable access to health care.
Day has also said that allowing private insurance would ease pressure on the public health care system by reducing wait times and improving the quality of care for everyone.
But Day’s critics, such as the B.C. Health Coalition, say that privatization of health care services would be a “profound threat†to the medicare system in Canada.
“This is potentially a disaster for health care for Canadians. (It) potentially moves us over into a system in the American style where whoever pays the most gets the best service and everybody else waits a lot longer,†said Sean Meagher, executive director for Canadian Doctors for Medicare.
As a surgeon, Day stands to “benefit significantly†from privatized health care, Prutschi said.
“But I don’t think his arguments are entirely without merit.â€
Long waiting times ‘normalized’
Day is joined in the case by 20-year-old Walid Khalfallah, who waited more than two years for medical treatment while his spinal condition worsened.
Khalfallah was eventually treated in the U.S., but he is now partially paralyzed and moves around in a wheelchair.
“It’s not a good idea to wait for so long,†Khalfallah said.
His mother said it’s become commonplace for Canadians to simply accept lengthy wait times for important medical procedures.
“I was quite shocked how waiting in our health-care system has going to be, I’m going to say, normalized. It’s like, ‘Oh yeah, I had to wait, I have to wait, you have to wait. We’re all waiting,’†said mother Debbie Waitkus.
Philpott: Paying for treatment 'not a fair system'
Health Minister Jane Philpott told CTV’s Power Play on Tuesday that any system that allows some patients to pay to “get to the head of the line†is “not a fair system.â€
“The strong middle class is based on making sure that health care is there for them when they need it on the basis of that need, not on the basis of the ability to pay,†Philpott said. “And anything that will provide a barrier to accessing that care or will mean that people who have extra money get to the front of the line faster than others is not a fair system.â€
Philpott refused to comment on specifics of the B.C. case but said the federal government has sought intervenor status in the trial, which would allow the federal government to address the court.
She said Canada’s existing health care system is “excellent†and allows “high-quality care†to be delivered province by province. Philpott said the government “firmly believes†in the Canada Health Act.
“It has a number of really important principles, including, of course, accessibility, universality, public administration, et cetera. Not everything is covered in there that could be covered, but at this point the important thing to do is to make sure that we uphold that act as it is and that we make sure that Canadians are still able to get the care that they need,†she said.
'Cracks' in Canada’s system
The current Canadian system is not without “cracks,†Meagher said. He pointed to cases in Saskatchewan of patients paying for private MRIs and conversations in Quebec around allowing doctors to charge some patients an “accessory fee†for certain procedures at private clinics.
“But by and large our health care system is a system where everybody gets treated equally and we serve people based on their health-care needs, not on their ability to pay,†he said.
A group of protesters gathered outside the courthouse on Tuesday to rally against the case. An organizer of the protest called Day’s proposal “spurious†and said it has little to do with improving quality of care or cutting wait times.
“The crux of the issue is that it’s about funding and money, not about service and patients’ rights,†said Michael Butler, national health care campaigner for the Council of Canadians. “It’s no exaggeration to say that this is really the greatest threat that our medicare system has seen in a generation.â€
Debating 'two-tier' health care
Countries such as Australia have introduced hybrid health care systems that allow patients to choose between private and public medical treatments. Butler said these two-tier systems have helped “erode†public health care by allowing the most skilled doctors and nurses in the public system to be “poached†by private clinics.
Dr. Sacha Bhatia, director of the Women’s College Health Institute for Health System Solutions and Virtual Care, said universal health care is a “pretty significant Canadian value†and that steps to introduce private clinics could have major implications.
But he also suggested that a two-tier system could allow some patients to get elective procedures done sooner and provide doctors with another way to make money.
“It also means that physicians and other health providers will potentially be able to earn more money and obviously in an area of strict, stringent budgets, that’s something of interest for some groups,†Bhatia said.
However, Bhatia said a hybrid model would not address the sustainability of Canada’s health care system nor would it increase access of care.
Regardless of the outcome of the case before the B.C. Supreme Court, the only way to address this issue is through the Supreme Court of Canada, Prutschi said.
Any potential changes to the Canada Health Act as a result of Day’s lawsuit would be years down the road, he added.
With a report from CTV’s medical specialist Avis Favaro and producer Elizabeth St. Philip
