The B.C. Anesthesiologists' Society has asked B.C. Supreme Court for intervenor status in a lawsuit challenging B.C.'s ban on private health insurance. The anesthesiologists' application says they want to present the court with information on the state of health care in B.C., but they are not taking sides in the suit by Dr. Brian Day, who operates a private surgery clinic in Vancouver.
Two months ago, Day was cited by the B.C. Medical Services Commission for breaches of legislation governing private clinics.
Rather than comply with the commission's order to cease and desist, Day chose to sue the province. He claims the rules restricting private care are unconstitutional.
But does Day have a case? In one respect, he certainly does. For years, B.C. governments have turned a blind eye to private clinics. "Don't ask, don't tell," has been the motto. There is more than a touch of hypocrisy in this sudden attack of righteousness.
Moreover, Day and his colleagues claim an additional justification - the defence of necessity. Private clinics are required, they argue, because the public system has failed.
In particular, they point to elective surgeries, such as hip and knee replacements and cataract removal. The wait times for these are far too long, and growing worse by the year.
If public facilities cannot fix this problem, private clinics should be allowed to step in and do it for them.
This is certainly a powerful argument. But it has a sting in the tail for those who make it.
Wait times for elective surgeries have indeed lengthened across Canada, though only marginally.
At Royal Jubilee and Victoria General hospitals, the standard wait time for hip and knee replacements was 24.6 weeks five years ago; today, it's 26.9 weeks. Cataract wait times have actually decreased over the same period, from 15 weeks to 12.
These figures are comparable with results in other provinces. The longer delays for hip and knee surgery are due to the increased number of elderly and obese patients.
Nevertheless, wait times like these are without question an imposition. So is for-profit medicine the solution?
Here is the sting in the tail. Private health clinics are already perfectly legal in Canada.
There is nothing to stop surgeons or anesthetists from leaving the public system and striking out on their own.
But that is not what Day and his colleagues have done. According to the commission's audit, a large number of the physicians working at Day's clinic are still enrolled in the public system. In effect, they keep a foot in both camps.
This is problematic in a number of respects. For a start, it leads to queue-jumping. Suppose you are scheduled to see a physician at a public hospital in 10 weeks.
If that doctor says, "Come over to my private clinic and I'll see you tomorrow," you've jumped the queue. When he's seeing you tomorrow, he's not treating the patient next in line at the public hospital.
The audit also found "significant evidence" of "overlapping claims." This means that, in addition to charging the patient, the clinic may have billed the provincial health plan as well.
The auditors were unable to determine if this happened, therefore the presumption of innocence applies.
But what we do know is that it costs money to set up and run public hospitals. If private practitioners are allowed to keep a foot in that door, they gain an important element of financial security.
They also acquire expertise through doing a larger volume of operations and having access to a wider range of equipment.
This isn't really private medicine at all. It's a moneymaking scheme for a few, piggy-backed on a public health system we all pay for.
If this lawsuit goes to the Supreme Court, as many believe it will, let's hope the justices make this point clear. Private medicine is fine, just as long as it really is private.
