Vancouver orthopaedic surgeon Dr. Brian Day is challenging a law that prohibits doctors from working in both the public and private health care systems simultaneously and extra billing their patients while they do so.
Day did some boxing in his youth and now, bizarrely, he compares himself to the late Muhammad Ali as a kind of freedom fighter against injustice. He says he’s going to court not out of self-interest but rather on behalf of patients on waiting lists.
Opposes equal access
The basic tenets of medicare, which covers hospital stays and physicians’ services, are that it be tax-financed, publicly administered and equally available to everyone. Day is not impressed with equal access as a core value. He told the National Post: “We in Canada will give the same level of services to a wealthy person as to person who isn’t wealthy, and that doesn’t make sense.” Muhammad Ali he is not.
Extra bills patients
In fact, it seems that Day has been extra-billing patients for years. According to a B.C. Medical Services Commission audit initiated in 2008 and completed in 2012, Day’s clinic illegally charged patients hundreds of thousands of dollars more for services covered by medicare than is permitted by law. Day filed his legal challenge in 2009, after the audit had begun, claiming that the law preventing a doctor from extra billing patients is unconstitutional.
Wants it both ways
In Canada, the fee for physicians’ services is negotiated between the medical profession and agencies of a provincial government. There is nothing to stop a doctor from practicing entirely outside of the public system and billing his or her patients rather than the government. What Day wants, however, is the right to provide services in both the private and public systems, and also to charge more than the negotiated fees. Then-Health Minister Monique Begin made that illegal in 1983 because she believed it created a financial barrier for the poor and people of modest means.
Reform, but don’t privatize
Day’s critics say that his solution would mean reduced services for patients who don’t have the extra money to jump the queue. Former Saskatchewan Premier Roy Romanow, who led the Royal Commission on the Future of Health Care in Canada, concluded in 2002 that Canadians cherish their health-care system and see it as a right of citizenship. Most often it works well, but it’s also in need of improvement and innovation, which Romanow said demands thoughtful reform but not privatization.
Political door is closed . . .
Most Canadians and their doctors support medicare, too. But attacks upon it have been constant and led most notably by the Fraser Institute, a Vancouver-based lobby group that also dislikes unions and public schools, and challenges the science of climate change. Some politicians, including former premiers Ralph Klein and Mike Harris, also wanted to undermine medicare but citizens and voters wouldn’t stand for it. Interestingly, both Harris and Klein after retiring from politics became associated with the Fraser Institute, which receives at least part of its financing from groups in the U.S. linked to the Koch brothers and far-right organizations.
. . . so use the courts
In Canada, the political door has been closed to Day and his backers so they are now are trying to use the courts in their bid to to undercut public health care.
This article was published on the United Church Observer website on September 15, 2016.