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Undercutting health care

Most Canadians and their doctors support medicare. But attacks upon it have been constant.

By Dennis Gruending


Vancouver orthopedic surgeon Dr. Brian Day is challenging a law that prohibits doctors from working in both the public and private health-care systems simultaneously — and billing their patients extra while they do so.

Bizarrely, Day — who boxed in his youth — compares himself to the late Muhammad Ali. Like a kind of a freedom fighter, he says he’s going to court not out of self-interest, but rather on behalf of patients on waiting lists.

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, however, 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.

In fact, it seems that Day has been extra-billing patients for years. According to the 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. Claiming that the law preventing a doctor from extra-billing patients is unconstitutional, Day filed his challenge in 2009 once the audit began.

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, of course, extra-bill. In other words, he wants 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.

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.

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 undercut medicare, but citizens and voters wouldn’t stand for it. With the political door closed to them, Day and his backers are trying to use the courts for the very same purpose.


Author's photo
Dennis Gruending is an Ottawa-based author, blogger and a former Member of Parliament. His work will appear on the second and fourth Thursday of the month. His Pulpit and Politics blog can be found at www.dennisgruending.ca.
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