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Counterpoint: Let's fix medicare, instead of destroying it

National Post | June 21, 2014 12:01 AM ET
by: Monika Dutt, Maude Barlow and Rick Turner

Writing in the National Post, Marni Soupcoff called Brian Sinclair, an aboriginal man who died needlessly in a Winnipeg ER waiting room, a "martyr to medicare" ('A martyr to medicare,' June 11). She proceeded to use his tragic case to justify two-tier health care, as if vulnerable people, such as Mr. Sinclair, would benefit from a U.S.-style system where some people get to pay privately to jump the queue. The evidence from around the world suggests that this is not the case.

A constitutional challenge to medicare law in British Columbia, supported by Ms. Soupcoff's organization, the Canadian Constitution Foundation, threatens to do away with the universal public health-care system in our country. The case could lead to the end of Canadian public health care as we know it and leave us with a U.S.-style system, where some people get served and others are forced to wait.

The legal case is being driven by Dr. Brian Day, the owner of the Vancouver-based for-profit Cambie Surgery Centre, which unlawfully bills patients for health-care services. Dr. Day claims that the defining principle at the heart of Canadian medicare — that health care be provided according to patients' needs, not their ability to pay — is unconstitutional. He hopes to remove the rules that prevent a U.S.-style system from taking hold here in Canada. If Dr. Day wins in B.C., those laws will inevitably be struck down across Canada, which will undermine our entire universal public health-care system. A win for Dr. Day would be a loss for all Canadians.

Provinces protect fair and equal access to care by prohibiting doctors from charging for services already covered under provincial insurance plans. If you're sick, you get health care, and you don't get it any faster if you have more money. If Dr. Day wins, physicians will be permitted to charge patients any amount they like. The rich will get faster care than the rest of us.

Allowing some patients to pay for faster care does not take the pressure off the public system, as many have argued. Doctors can only take care of one patient at a time, and when they are serving rich private patients first, they are not available to serve the rest of us, even when our need is greater.

While the elite might get faster care, an abundance of evidence shows that for-profit hospitals reduce access to care for everyone else. Studies in Canada, Europe and the U.K. show that patients who can't pay, and whose doctors work in both the public and private systems, have the longest wait times. Australian research shows that private, for-profit clinics drain the limited supply of doctors and other health professionals from the rest of the health-care system, lengthening waiting times for all but those who can afford expensive private insurance.

There is no evidence that private, for-profit care results in better outcomes. None. Anywhere in the world. Canadian studies show that for-profit health care has worse health outcomes than not-for-profit care. Evidence from the U.S. shows the same. If all the evidence shows that Dr. Day's proposed changes will lengthen waits and create worse health outcomes, then what this case really comes down to is profit.

A provincial audit of Cambie Surgery Centre and the associated Specialist Referral Clinic found that patients were unlawfully billed an extra $491,654 in just 30 days. In one case, a Cambie patient was billed $7,215 for services that would only have cost $1,288.04 in B.C.'s public health-care system. Auditors also found over $66,000 in overlapping claims — evidence that suggests double dipping for the same services.

Although physicians at the Cambie Surgery Centre charge some patients nearly six times the actual cost of a procedure, Dr. Day is claiming that his constitutional challenge promotes human rights. Yet, encouraging rich Canadians to buy health care and jump the queue ahead of the rest of us does just the opposite.

We certainly need improvements to our system. Let's focus on those that benefit everyone, regardless of income. Across Canada, there are dozens of innovative projects that improve access, quality and cost-effectiveness, while protecting equitable access to care. The Alberta Bone and Joint Institute, for example, was able to reduce wait times from 11 months to 9 weeks for hip and knee surgery. Expanding public projects and efficiencies that have proven to reduce wait time, and continuing to innovate within medicare, represents the best future for the Canadian health-care system.

Canada does not need health reform through an end-run in the courts that's driven by for-profit clinic owners. What we need is evidence-based improvements to reduce wait times in emergency rooms and for elective surgeries. And that means we need government leaders who are committed to improving medicare. Poll after poll shows that Canadians favour investment and innovation in publicly funded health care to improve the system, not the expansion of a profit-driven system that benefits the few and harms the many.

Dr. Monika Dutt is chair of Canadian Doctors for Medicare and a public health and family physician in Cape Breton. Maude Barlow is the national chairperson of the Council of Canadians. Rick Turner is co-chair of the B.C. Health Coalition.


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