Dr. Brian Day’s medicare challenge: he’s no freedom fighter

Dr. Brian Day, a Vancouver-based orthopaedic surgeon, is using the courts to attack medicare
Dr. Brian Day, undercutting medicare. (Day website photo)

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. 

 

Bill C-14, churches one voice among many in debate on assisted dying

Faith groups in Canada are one voice among many in assisted dying debate
Faith groups one voice among many in assisted dying debate

The current debate surrounding Bill C-14 — the legislation regarding medical assistance in dying — is a reminder of how Canada has become a more secular society in which organized religion plays a diminished role in public life.

My own parents, both in their 50s, died within 16 months of one another in the 1970s. During their ordeals in our rural Saskatchewan community, there was never any mention of assistance in dying and no possibility of their choosing such a path even if they had wished it so. We didn’t even have the language to describe it. There had, of course, been suicides in our predominantly Catholic community, and they were considered a grievous sin equivalent to murder. We were told that, ultimately, our lives didn’t belong to us but rather to God, and that it was God who chose when and how those lives would end.

Sue Rodriguez sought assisted suicide

Fifteen years later, such concepts were challenged by Sue Rodriguez, who believed that her life did, indeed, belong to her. She was diagnosed with Lou Gehrig’s disease and fought to have the legal right to assisted suicide. Her case then went to the Supreme Court, where she argued that a ban on assisted suicide was an infringement of her Charter rights to life, liberty and security of the person. Meanwhile, religious leaders — including the Canadian Conference of Catholic Bishops and the Evangelical Fellowship of Canada (EFC) — appeared as intervenors before the court in opposing Rodriguez. This marked the beginning of an informal alliance between bishops and evangelicals which has continued on other public issues, including legal opposition to same sex marriage.

Rodriguez eventually lost in a 5-4 judgment and, in 1994, she took her own life with the help of an anonymous physician. But fast forward to 2011, when the B.C. Civil Liberties Association went to the Supreme Court on behalf of two other gravely ill women, once again challenging the law against assistance in dying. That time, the court ruled that the Criminal Code prohibition was unconstitutional because it breached the same provision of the charter that Rodriguez had challenged more than 20 years earlier. In 2015, the court then instructed parliament to draft new legislation allowing medical assistance in dying in certain limited circumstances — something that’s now being debated.

Civil society on C-14 

The Canadian Medical Association (CMA), which represents 83,000 physicians, has come out in support of Bill C-14. The Canadian Psychiatric Association and the Canadian Association for Community Living were more cautious, although not opposed to the bill. The B.C. Civil Liberties Association, which launched the challenge at the Supreme Court, is keenly disappointed that the provisions for medically assisted death are, in its estimation, too restrictive.

Response from faith based organizations

And once more, the most vociferous opposition has come from the Catholic-Evangelical leadership and a number of allied groups. A news conference on Parliament Hill organized by the EFC and Catholic bishops also included representatives from the Canadian Council of Imams, the Salvation Army and a local rabbi.  Curiously, neither the United Church nor the Anglicans, Canada’s largest Protestant denominations, have released an official position on Bill C-14. The Anglicans have set up a task force and the United Church says it is developing a statement.

Religious leaders no longer talk, at least publicly, about our lives belonging to God. They do, however, talk about medical assistance in dying as “intentional killing,” and as being morally and ethically wrong. Catholic leaders warn that their many hospitals will not participate in any such procedures and will not make referrals to other physicians on behalf of terminally ill patients who request it. One wonders how they can do so when most of their funding comes from governments.

A diminished role

Indeed, times have changed. Religious leaders used to meet with the entire federal cabinet. Today, churches and religiously based organizations are merely a few among many mature and competent voices, such as the CMA, debating public policy. The contributions from faith-based organizations are valuable but no longer prescriptive.

This piece appeared in somewhat shorter form on my blog with the United Church Observer on April 28, 2016.

CMA’s Demand A Plan a winner in 2015 Canadian election

Canadian Medical Association (CMA) President Dr. Cindy Forbes. Photo courtesy CMA.
Canadian Medical Association (CMA) President Dr. Cindy Forbes. Photo courtesy CMA.

I belong to Ottawa’s Parliamentary Press Gallery and had access to a rich variety of information circulated during the 2015 federal election campaign. The most impressive advocacy that I saw was the Demand A Plan campaign, which was launched by the Canadian Medical Association (CMA) and several supporting groups. Now, that campaign has been shortlisted for an international prize in the annual Reed Awards, which will take place in Charleston, S.C. on Feb. 18.

Multi-media campaign

The Demand A Plan alliance last year waged a multi-media advocacy campaign, calling for a national seniors’ strategy. According to the CMA, more than 30,000 Canadians used the campaign’s website and sent roughly 25,000 letters to candidates across the country, asking where they stand on seniors’ issues. The campaign website also provided a “promise tracker” tool, which allowed visitors to compare the policy statements of different political parties.

Medicare must adapt

Although it was created more than 50 years ago, when the average age was much younger, medicare has not adapted well to serve the growing number of elderly Canadians. By 2036, people aged 65 and over will make up a quarter of the population and account for 62 percent of health costs.

The alliance says that it supports universal public health care but fears the system won’t survive unless seniors’ care is redesigned. For example, the group says that it takes nine months to get a hip replacement in Canada because hospital beds are crowded with seniors — many of them suffering from dementia and other chronic diseases without long-term care and home-care support. Interestingly, the group says that caring for someone in a hospital costs $1,000 a day, compared to $130 a day in long-term care and $55 a day at home.

Dr. Cindy Forbes: “momentum”

“We cannot lose momentum as we continue to push for federal leadership in the development of a national seniors’ strategy,” CMA President Dr. Cindy Forbes says, adding that the alliance has documented the Liberal Party’s election promises as they relate to seniors’ care (Those, too, are published on the website). They include negotiating a new Health Accord with the provinces and territories; investing $3 billion over the next four years to deliver more and better home-care services for all Canadians, including access to high-quality, in-home caregivers, financial support for family care, and, when necessary, palliative care; and investing in affordable housing and seniors’ facilities.

This spring, the CMA and its alliance partners want the Trudeau government to convene a meeting of provincial and territorial premiers to discuss seniors’ care. They also want to see a national seniors’ strategy in place by 2019.

No mention of pharmacare

Unfortunately, there is no mention in either in Demand A Plan or in the Liberal government’s promises, of a national pharmacare plan. Pharmaceuticals are the fastest growing component in health care costs and the need for such a plan is urgent.

They’ve come a long way

Still, there is no doubt that Canada’s doctors have come a long way since the CMA strenuously opposed the introduction of Medicare in Saskatchewan in 1962, and just as adamantly opposed recommendations for a similar national program by the Hall Commission in 1964.

A version of this piece ran in the United Church Observer on February 18, 2016.

Justin Trudeau’s ‘sunny ways’ and the challenges ahead

Justin Trudeau’s “sunny ways”. Photo by Wikimedia Commons, Alex Guibord
Justin Trudeau’s “sunny ways”. Photo by Wikimedia Commons, Alex Guibord

As Prime Minister-designate Justin Trudeau stood before an election night crowd in Montreal on October 19, he quoted former Prime Minister Sir Wilfrid Laurier, saying: “Sunny ways my friends, sunny ways.”  Referring to his Liberal party’s convincing upset victory in capturing 184 seats, well beyond the 99 for the Conservatives and 44 for the NDP, Trudeau said, “This is what positive politics can do.” Continue reading Justin Trudeau’s ‘sunny ways’ and the challenges ahead

Whither the Canada health accord?

Paul Martin negotiated health accord, Creative Commons photo
Paul Martin negotiated health accord, Creative Commons photo

The existing health care accord between Ottawa and the provinces and territories is set to expire on March 31, 2014 and the long term consequences are alarming. The issues are complex and the amount of money involved is in the many billions, but the key to understanding what is happening is this: Canada has a public, single payer health system for visits to the doctor and stays in hospital thanks to earlier political leaders, including Tommy Douglas, Woodrow Lloyd and Lester Pearson. Publicly-funded expenditures account for about 70% of all health care spending in Canada. The remaining 30% is private spending on items such as dental and vision care and pharmaceutical drugs. When publicly funded health care was first introduced in the 1960s, its costs were shared on a 50-50 basis by Ottawa and each of the provinces, which actually deliver most of that care. That cost-sharing arrangement has evolved greatly and will change even more dramatically in future, given a unilateral announcement made in 2011 by Jim Flaherty, who was Canada’s finance minister at the time.

Federal contribution dropping

According to a 2013 study by the Canadian Institute of Actuaries and Society of Actuaries, health care transfers from Ottawa to the provinces, which once accounted for 50% of all public expenditures, had fallen to 21% in 2012. The actuaries estimate that the federal contribution would drop to a mere 14.3% by 2037 under the revised formula announced by Flaherty. Continue reading Whither the Canada health accord?

Pulpit and Politics, best stories 2012

I worked for years in newsrooms and each December we would produce what we called Year Enders, which summarized the most significant stories that we had covered in the past 12 months. In that tradition, I have reviewed Pulpit and Politics for the year past and this is a brief summary of what I have found. Continue reading Pulpit and Politics, best stories 2012

U.S. Catholic bishops fight Obama’s Affordable Care Act

The U.S. Supreme Court has ruled that President Obama’s Affordable Care Act for health reform is constitutional but the country’s Catholic bishops remain staunchly opposed. When the president signed the ACA into law in 2010, the bishops claimed that it would force insurers to pay clients who received abortions and birth control services and advice. The president moved to assure the bishops that public money would not be used to provide for abortions, but that still left contraception. The president also made an exception there which, he says would exempt the employees of churches. The bishops say that doesn’t go far enough, and they want the exemption to apply to employees in all Catholic institutions, including hospitals and schools. In short, the bishops are prepared to scuttle health care reform for 300 million Americans because of its limited provision for contraception as an insured service. Continue reading U.S. Catholic bishops fight Obama’s Affordable Care Act

Medicare’s 50th anniversary, it’s biblical

Tommy Douglas, proposed medicare

We are approaching an important anniversary in Canada, which doesn’t appear to be getting the same amount of attention as are events to celebrate the War of 1812. It was on July 1, 1962 that publicly administered and financed medical care came into existence in Saskatchewan – it has since become known throughout as medicare. On the same day, Saskatchewan’s doctors went on strike, an action that caused controversy, fear, even hysteria in the province. There ensued a bitter 23-day standoff with doctors and the Canadian medical establishment, supported by the Liberal opposition and almost the entire Saskatchewan media, arraigned against the CCF government of Woodrow Lloyd and its allies in the labour and farm movements and citizens’ support groups. The strike ended on July 23 and the Saskatchewan Medical Care Insurance Act was passed during a special sitting of the legislature in August.

Justice Emmett Hall

By 1964, a federal Royal Commission led by Supreme Court Justice Emmett Hall had recommended the Saskatchewan model for all of Canada. In 1968, the Liberal government of Lester Pearson passed legislation enabling provinces to introduce publicly funded and administered health care. All provinces eventually did so.

Transcends politics

Roy Romanow, after he retired as Saskatchewan’s premier, led another Royal Commission into Health Care in 2001-02. Romanow was fond of saying that medicare transcended politics because eventually it won support from all political parties in Canada. It was conceived under a CCF government in Saskatchewan led by Tommy Douglas, and was later introduced and implemented by Woodrow Lloyd, who became premier in 1961 when Douglas left to lead the newly-created New Democratic Party. It was Progressive Conservative Prime Minister John Diefenbaker who appointed Judge Hall (who had previously been active as a Conservative) to the Royal Commission on Health Services. And it was a Liberal government led by Lester Pearson that implemented Hall’s recommendations.

Minority opinions

Romanow is right but there has always been a minority opinion that chafes under the reality that a good portion of health care in Canada is provided as a public good rather than a private commodity. Many Conservatives in the 1960s, including former Justice Minister Davie Fulton, were both surprised and unhappy with the recommendations of Justice Hall’s Royal Commission. Finance Minister Mitchell Sharp and other of Lester Pearson’s cabinet ministers in the 1960s attempted, unsuccessfully, to prevent the federal government from introducing the plan. Some premiers, including Alberta’s Ernest Manning, were unenthusiastic as well. But the federal government’s offer to share the costs of medicare on a 50-50 basis was too good a deal to refuse. The federal contribution accounts for a much lower percentage today.

There have always been politicians who would like to undercut the principles and features of medicare. They include former Premiers Mike Harris and Ralph Klein, the Reform Party in its early stages, and also a younger Stephen Harper. Has he changed his spots?  These points of view have had both research and propaganda arms in organizations such as the Fraser Institute.

It is the enduring support of medicare by ordinary Canadians that has prevented widespread experiments with privatization or the provision of parallel public services, where those who can pay can jump the queue.  I have, however, had a pollster try to convince me that it is not medicare as a concept that people support but rather the fact that they, as individuals, don’t have to pay out-of-pocket when they visit a doctor or are hospitalized. The same pollster said that Canadians vary little from Americans in their views on health care – they look at what is in it for them rather perceiving public health care as being in the interest of the common good.  I remain unconvinced of this analysis.

Serves us well

Our public health care system has served us well. I have experienced it close up during some encounters with pesky gall stones in the past month. The health care that I received was admirable other than a several hour wait in the hospital emergency room when I first went in. I am aware that there are longer waiting lists for conditions that are not acute. There are stories and statistics about long waits for procedures such as knee replacements and if you live in Ottawa, for example, it is a long wait to see a dermatologist. The system needs improvements but on balance we have good health care and it is available to everyone.

The costs

We are often told that we cannot afford public health care. Admittedly, there is a need to find new efficiencies and to spend more wisely. But let’s compare alternatives. In 2008, the United States spent an amount equivalent to 17% of its Gross Domestic Product on health care. In Canada, we spent 9.7% of GDP in the same year. In 2009, about 49 million Americans, or 16% of the population, did not have any health insurance. In Canada, everyone has coverage. 

Biblical

Janet Sommerville, a former chair of the Canadian Council of Churches, has written, “The principles guiding our health care system have an unmistakable affinity with the love of neighbour urged on us by God’s word in Scripture.”

Rubbing their toes

The federal government has plans this summer to spend $28 million commemorating the War of 1812, but no plans as far as I know to celebrate the 50th anniversary of the introduction of medicare. I’ll take a pass on the parades, the air force fly overs and the military re-enactments of border skirmishes between British forces and Canadian militia against the Americans.

I’ll go down to Parliament Hill where they have statues of former prime ministers. I’ll rub the toe on the shoes of Lester Pearson and John Diefenbaker and if the statue of Tommy Douglas were there, I would rub the toe on his shoe as well. Thanks guys.