July 6, 2014
Michael Smyth, The Province
There's a nagging question that's been buzzing around in Brian Day's head for 20 years: Why shouldn't Canadians be allowed to spend their own money on their own health care?
It's a question the B.C. Supreme Court will answer this fall during one of the most anticipated health-care trials in Canadian history. Day, former president of the Canadian Medical Association, is a health-care iconoclast who's been challenging governments ever since he founded the Cambie Surgery Centre in the mid 1990s.
The B.C. government has tried to stop him from billing patients at his for-profit private hospital. The government says it's illegal for doctors to privately bill patients for publicly insured medical procedures, and doctors are not supposed to get around the law by charging "facility fees."
But that hasn't stopped Day from performing thousands of private surgeries at his stateof-the-art Vancouver facility.
"Only Canada has laws that say a citizen is not allowed to spend their own money on their own health," Day said in an interview.
"Throughout history, there have been many government laws that are violations of your rights, and this is one of those laws."
Day argues those rights are enshrined in section seven of Canada's Charter of Rights and Freedoms, which says "everyone has the right to life, liberty and security of the person."
Canadians forced to languish on waiting lists for surgery - often suffering from pain as their health deteriorates - are being deprived of those rights, he argues.
"Some people are actually waiting for serious heart and cancer issues. This doesn't happen anywhere else in the developed world," he said.
"And it's more than just patients waiting in pain. Twenty-six per cent of doctors in Canada have had a patient on a wait list die while on that list."
Day's constitutional challenge of the law - to begin Sept. 8 in a B.C. Supreme Court trial scheduled for 40 days - could be appealed all the way to the Supreme Court of Canada and set precedents for the entire country.
But now opponents of private health care are preparing for battle. The B.C. Health Coalition - backed by the health-care unions - is raising money to fight Day in court.
Opposition groups have won intervenor status in the case and will present evidence against private care.
"Brian Day's plan to bring U.S.-style health care to Canada would be disastrous for Canadians," said Dr. Rupinder Brar of Canadian Doctors for Medicare.
"If Dr. Day wins, physicians will be allowed to charge patients any amount they like for services, and patients who can pay will get faster care than the rest of us.
"A win for Dr. Day will mean skyrocketing costs and longer wait times in the public health system as it loses doctors to a parallel private system."
Day rejects all of that, of course. He says he wants a European-style system, not an American one.
"The countries that have a hybrid publicprivate system - like Switzerland, Germany, Holland, France and Belgium - everyone has rapid access to health care. If you need an MRI, you get it within a week in the public system.
"If you want to go to the private system in those countries, you can buy insurance. But you're not buying your insurance for more rapid access, you're buying it to choose a different hospital in a different region with a private room and different food.
"Access to health care is the same for rich or poor in those countries."
When Day gets to court he'll be able to cite many recent studies that back up his argument.
The Commonwealth Fund, a respected health care think tank, just released a report ranking Canada's health-care system 10th out of 11 industrialized countries, ahead of only the United States.
The study found countries with public-private hybrid systems delivered better-quality care for less money and shorter wait times.
The recent annual report card from the Wait Times Alliance, meanwhile, said wait times in Canada are up to three times longer than in other countries with universal systems.
"It is not right to force Canadians to wait," the report's authors said.
"In many other countries with universal health systems, it is indeed possible to have timely access to medical care - long waits are not an unavoidable price to pay, nor are they tolerated by their citizenry."
Day's opponents will cite other studies, like ones that show the devastating costs of private health care in the United States.
"Most bankruptcies in the U.S. are due to medical bills - we don't want to see a Canada where we risk losing our homes or go deep into debt when we get sick or injured," the B.C. Health Coalition says in its online fundraising appeal to fight Day in court.
The battle will be a fierce one. But Day hopes the case turns on the personal stories of individual plaintiffs who have joined his battle, including a Kelowna teenager whose spinal condition worsened while he waited more than two years for surgery. He is now a paraplegic.
The fight over private health care in Canada has raged for years. This crucial case could settle the argument once and for all.
Credit: Michael Smyth; The Province