There has been a lot to worry about since the start of the COVID-19 pandemic. Thankfully, for the vast majority of Canadians, being able to afford essential medical care has not been one of those worries. But this week, a group of doctors and investors went to the B.C. Court of Appeal in an attempt to change that.
The Cambie Surgeries Corporation in Vancouver launched a constitutional challenge to B.C.’s public health care system back in 2009 after a government audit was triggered by patients who learned they had been billed for services otherwise covered under B.C.’s public plan.
This lengthy court case, which challenges key provisions of B.C.’s Medicare Protection Act (MPA) was heard at the B.C. Supreme Court from September 2016 to February 2020. Cambie Surgeries Corporation, on behalf of its CEO Dr. Brian Day, physician colleagues, and private investors asked the court to allow physicians to bill patients, private insurers, and the Medical Services Plan. They also want to charge patients higher fees than the public plan pays and allow patients to buy private insurance.
On September 10, 2020, the B.C. Supreme Court released a decisive 880-page rulingthat determined that Cambie’s vision “ … would create a second tier of preferential health care where access is contingent on a person’s ability to pay.” Despite the breadth of the verdict, Cambie Surgeries Corporation immediately appealed the decision. The appeal, heard this week in the B.C. Court of Appeal, is not focused on the health care evidence. Rather, Cambie is hoping to convince the Appeals Court that the Supreme Court made errors in the application of the law.
We are all eager for ways to reduce waiting times within our health care system. But allowing patients to pay more to jump the queue creates more problems than it solves because it takes resources away from our publicly funded system. Physicians and health professionals can only treat one patient at a time. If wealthy patients pay more for earlier or preferential treatment, physicians have less time and resources available to treat others on the public waiting list.
Simply put, more private payment in health care would increase waiting times for the majority of Canadians. This is demonstrated in Australia’s multi-payer system, where the median waiting times for cataract surgery, coronary bypass, hip replacement, and knee replacement surgeries are significantly longerthan those in Canada. Paying more for quicker treatment also widens the health gap between the rich and the poor in Canada, and particularly those with chronic or complex health conditions. It is an act of reverse Robin Hood — taking resources from the poor to treat the wealthy.
Fortunately, there are other evidence-based solutionsto reduce waiting times within our public health care system. Providing much-needed funding to extend operating room hours within our public hospitals is critical. Centralized intake (a single queue) for surgical referrals can triage patients appropriately and direct their care to the first available physician. Multidisciplinary, team-based care also helps to provide comprehensive treatment to patients on waiting lists.
The pandemic has proven the value of a publicly-funded health care system; unlike in the U.S., no Canadian has had to file for bankruptcy on account of hospital bills arising from COVID-19.
Yet many Canadians are unaware that health care is under attack in the B.C. Court of Appeal. We encourage everyone to learn about the case and to share your support for public health care with your friends, colleagues, and political representatives. Let’s send a clear message that Canadians do not want to sacrifice efficiency and equity for the sake of corporate profits. A glance south of the border is all we need to see how difficult it is to wrestle control from powerful private interests once they gain control of a health system. We have had more than enough to worry about throughout the past 15 months. Let’s not add whether we can afford medical bills to that list.
Edith MacHattie is an occupational therapist in Surrey and co-chair of the B.C. Health Coalition. Dr. Melanie Bechard is a Pediatric Emergency Physician in Ottawa and Chair of Canadian Doctors for Medicare. Both organizations are part of the Coalition Intervenors involved in the Cambie appeal.
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