At the heart of the case is whether patients have a constitutional right to pay for their medically necessary treatment in private surgery centres, thus bypassing long waits for many non-emergency operations in the public system.The trial before Justice John Steeves began September 6, 2016 and is scheduled to last at least four months with evidence from nearly 200 witnesses.
By Dr. Vanessa Brcic http://www.policynote.ca
September 8, 2016
The biggest constitutional trial “perhaps ever” in Canada is now in court. The future of our publicly funded health care system is at stake.
Putting Canadian Medicare on trial is complex, and vulnerable to the blatantly false and simplistic messaging that increasing “private care” will take the pressure off public wait lists, increase patient choice, and foster competition and innovation. Sounds nice, doesn’t it?
I want to break it down to a few key points so you can be equipped to follow these important legal proceedings, and more importantly, so you can build on this opportunity to speak up—loudly—for real health care reform. Now is the right time – we have a federal health minister and government that is carefully listening, and BC politicians vying for your vote next year.
Here’s what you need to know:
1. This case is not about patient choice. It’s about private profit.
Quite simply, this case is about the potential for doctors and health insurance companies to make a lot of money by charging patients for medically necessary hospital and physician care. The narrative of patient choice is a convenient smokescreen.
2. This case is not about improving health care service delivery at all. It is about expanding private, for-profit funding for health care.
Want to improve health care? Let’s talk about how we deliver health care services – let’s make them high quality, efficient, cost-effective, coordinated and patient-centred. This trial isn’t about that. It’s about how we pay for health care in Canada.
Dr. Day wants a constitutionally protected right to bill patients, health insurance companies and the government, and any combination thereof – whatever the market will bear. This will allow unrestricted profits for doctors and health insurance companies.
As a nation, do we want patients who can pay to get faster care than those who can’t? The Worker’s Compensation Board’s priority surgical access is an example of a two-tiered system that already exists (with its own big problems). Do we want more or less of this? In times of health crises, do we want more patients to have to choose whether they can afford to pay out of pocket for care, or insurance premiums that are unregulated and increasingly costly?
3. For-profit clinics are not illegal. This case is about expanding the market for these clinics by growing the profitable private health insurance sector.
In BC, doctors can unenroll from the public system and in many circumstances (including the Cambie Surgical Centre) charge patients however much they want for medical care. So why this court case if this is already legal?
Dr. Day has said that only about 10% of the patients at his for-profit surgical centre pay privately – it would be hard to expand this market given rising poverty and income inequality in Canada. However, 90% of the care at Cambie is funded through contracts, including with WCB (workers’ compensation) – this is the market that can be expanded upon, and where there is huge opportunity for profit.
Health care is not fully protected under the North American Free Trade Agreement (NAFTA), which allows foreign investors to sue the Canadian government if any policy denies them opportunity for investment or profit. US investors consider Canadian Medicare “the last great uncracked oyster in the North American marketplace.”
In Canada, private health insurance is unregulated, and for-profit insurance companies that pay for extended benefits like physiotherapy and medications have been increasingly reducing their payouts to plan holders. In the last twenty years, benefits paid to Canadians dropped from 92 cents for every dollar spent on premiums to 74 cents – below the legal “medical loss ratio” (the ratio of profit to paid benefits) in the US. Meanwhile, administrative costs for these companies have tripled. In 2011, Canadians paid $6.8 billion more in private health insurance premiums than they received in benefits.
Exorbitant profits in the health insurance sector in the US are the norm. The US spends 12% of its health budget on administration; Canada spends 1.2%. The US could save hundreds of billions of dollars annually if it moved to a single payer system like ours. It is simply not cost effective for us to move towards a payment system like theirs.
4. In a multi-tiered health care system, patients have less freedom, not more.
If Day wins, the vast majority of patients will have less freedom, not more – not only because they can’t afford the second tier of care, but because wait times will increase in the public system when doctors and nurses are busy working for patients who can pay for faster care.
Working in both publicly and privately funded health care tiers is an ethical slippery slope for doctors with a clear financial incentive to channel patients into a more profitable setting.
We know that American health insurance companies are in charge of what care their planholders can and can’t get reimbursed for. Private health insurance puts power in the hands of the insurance companies more than the patients.
5. Cherry-picking the most profitable elements of European health care systems won’t work.
For hospital and physician care, Canada has a 100% publicly funded (government pays), privately delivered (doctors work independently) system. That makes it hard to compare Canada to health systems that have public delivery systems (like the NHS in the UK). Looking at total health expenditures, many OECD countries also have a higher proportion of publicly funded care (and a higher proportion of spending on social services); many European countries fund pharmacare, home care, dental care, early childhood programs and more.
While private out-of-pocket health care spending in Canada has been increasing (due to pharmaceutical costs, insurance premiums and non-Medicare services), government spending has grown more slowly than inflation and population growth. No wonder Medicare has gaps.
If we want to look more like Europe and save money, we should spend more public dollars on currently uninsured health services like those listed above – we could save billions of dollars annually that could fund more public surgeries and chronic pain care.
6. This lawsuit is a distraction from the real work of health care reform being led by the federal government.
Let’s stop distracting ourselves and talk about efficiency and real care delivery solutions, now that we have a federal government on board and a provincial election next year.
If we truly have in common the desire to advocate for those with poor access, then let’s consider all of the patients who have inadequate access to needed health care services. There are aboriginal women who don’t have access to clean water, birthing care or cervical cancer screening, for example.
Regarding those “suffering and in pain”, access to surgery is distracting us from access to chronic pain care, which is more than surgery. Access to mental health services and non-surgical chronic pain services remain a huge gap in Canadian health care, despite being largely privately funded.
Dr. Day isn’t the only person listening to patient stories of long wait times and difficulty navigating services. But in contrast to doctors being paid privately at Cambie Surgery Centre, we are trying to improve the public system. Let’s stop wasting our time talking about expensive and inefficient funding models and advocate for what we really need: improvement in health care services in Canada.
This case is about how we pay for health care in Canada. What we need is to reform how we deliver care. That is how we will improve patient freedom.
Andrew Phillip Chernoff 