Rupinder Brar, Adam Lynes-Ford speech to HEU

The Hospital Employees' Union -- the oldest health care union in British Columbia, representing 46,000 members -- invited CDM board member Dr. Rupinder Brar and our colleague Adam Lynes-Ford from the BC Health Coalition to speak at their annual convention about the Cambie Trial. We are grateful for the support of the HEU. Their members, who are often on the frontlines of patient care, understand the danger of Brian Day's legal challenge to dismantle Medicare.

The text of their speech follows.

Rupinder

I want to begin today by telling you a short story about one of my patients. I’ve changed names and some details to protect their privacy. This time last year, I joined a practice in Vancouver.

I saw a young woman who was pregnant with her first child – and although the pregnancy was unexpected my patient was overjoyed and felt her pregnancy was a blessing. This women had beaten all odds to be where she was – she had a history of a very traumatic childhood, which included numerous foster homes. She lost both her biological parents at a young age. She was coping with life but didn’t have stable housing among other things.

Once she found out she was pregnant she spent all her time finding work and suitable housing. And she succeeded. By the time she was seven-months pregnant, she was in recovery and living in a nice apartment in the heart of Vancouver. She told me she was determined to be there for her baby– unlike what she experienced growing up.

When her beautiful baby was born it was an uneventful delivery. She named her Jasmine.

But two days later Jasmine became very sick. After an extensive workup it was found the baby had suffered multiple strokes in a short period of time and had meningitis; her prognosis was not good.

Amazingly, the baby fought through -- just like her mother had.

Fast forward and here I was seeing mom and baby on their two-month well child visit. Jasmine was meeting all the expected milestones. She required up to three appointments a week, which her mother never missed -- from neurology, OT, cardiology and various other services. Everytime she leaves BC Children’s Hospital my patient is amazed by the care she received and always expresses her gratitude.

This beautiful child will require ongoing care with a multi-disciplinary team. She has been given the best chance possible because she was born in Canada. This is because we have a universal health care system that treats everyone based on need and not their ability to pay.

Thanks to Medicare, my patient can focus on the hard work of keeping housing, a job, and parenting her child without the worry, financial strain, and serious health risks that she would face if we did not have a universal system.

As a health care provider early in my career, I always imagined that Medicare would be the system -- with improvements of course -- that I would care for people within for the rest of my life. I’m here today with Adam because the system that my patient and her baby rely on, the system that you and your families rely on, is in serious danger.

That danger is the Cambie Surgeries lawsuit: the biggest, best funded legal attack against medicare in this country’s history. The case is at trial right now at BC Supreme Court, and both of our organizations are participating as intervenors. It started this September and will go until at least May next year.

The person behind this lawsuit is Dr. Brian Day. Some of you may have heard of him.

He’s the guy the media has dubbed “Dr. Profit” and the “Darth Vader” of health care, with good reason.

Brian Day owns two for-profit clinics in Vancouver. He has been the loudest cheerleader for privatizing health care in Canada for many years.

Day is also the one who says he is not insulted by being compared to Darth Vader because -- according to Dr. Day -- Darth Vader was actually a good guy... Along with rooting for the wrong side in the Star Wars battle, Brian Day is eager to be on the wrong side of health care history.

The goal of his lawsuit is to end universal Canadian public health care as we know it and replace it with American-style, two-tier health care.

Let’s be clear -- this is not just another incremental measure of privatization. Brian Day's legal challenge is an attack on the foundation of Medicare.

This lawsuit strikes at the Canadian principle that says access to health care should be based on need not our ability to pay.

Brian Day is arguing that this principle violates Canada’s Charter of Rights and Freedoms. Specifically, he is asking the court to change our health care laws in two fundamental ways.

Number one: He wants the court to allow all doctors to charge patients unlimited amounts for all procedures and services,  from routine check-ups to hip surgeries.

How would this be different from the way things work now?

Well, let’s say Adam came to me for some stitches on his arm which is covered by MSP. Under our current laws, there is a fee limit for that service and it is illegal for me to charge above that limit. I can then either bill MSP that amount or charge Adam and he can be reimbursed. This ensures that what we do as doctors is about evidence and the patient’s needs -- not our personal profit. And it ensures that Adam’s ability to get care doesn’t depend on whether he can afford my fees or not.

But Brian Day wants to change that.

The second thing Brian Day wants the courts to do is to allow parallel private health insurance. This would also represent a massive change to our system.

It would put private insurance companies in the position to deny patients coverage for medically necessary services like visits to the emergency room or cancer treatment.

Adam

If Brian Day succeeded in changing these laws, it would have a huge impact on Canadian life.

Under a two-tier system we would face longer wait times, poorer health, and skyrocketing health care costs, and not just for those of us in B.C.

As Rupi mentioned, the case is at trial right now in BC Supreme Court, but it has the potential to affect all provinces and territories because the case is almost certain to reach the Supreme Court of Canada where the decision will impact the entire country.

We already know that wait times for some services are a problem in BC and in other provinces. A two-tier system would only make this worse because health care professionals are a finite resource. When workers leave the public tier to treat patients in the private tier, that means fewer people left to care for patients in the public side. As a result, waits get longer for the majority of the population.

That is exactly what happened in Australia when they moved from a single-tier public system to two tiers. In the areas of the country that had more privately funded care, waits in the public system became longer. What’s worse, a privately funded tier provides incentive to make waits in the public longer.

A colleague from Canadian Doctors for Medicare told me that that there’s even a term for this in New Zealand; surgeons talk about “farming” in their practices. What they mean by that is the surgeons till the soil by keeping their public wait times long and then harvest the benefits of high-paying patients in their private practice.

Ironically, Brian Day claims that a two-tier system would shorten wait times in Canada. And in fact, he claims this is the goal of his case all together. But it’s clear that if long wait times is truly the illness that Brian Day wants to treat, his cure would be much worse than the disease.

In additional to longer waits, we’d also face higher costs, and a growing gap between those who can afford care and those who can’t. This really bothers me when I think about the growing income inequality that already exists in our country.

As Rupi mentioned earlier, health policy experts say that if we were to introduce a two-tier system in Canada, we’d end up with a system that closely resembles the US. One reason is that we share the longest and most open border in the world with the United States.

Right now, we have an exemption for health care under the North American Free Trade Agreement; however, if we eliminate our current medicare system, we would likely lose that exemption and our our health care “market” would be opened up to US health care giants.

In that sense, we wouldn’t just get American-style health care, we’d have an actual American health care system.

We only need to look to our neighbours to the south to see how well a two-tier system like this working. So many Americans are struggling with health care debt. In fact, it’s the number one reason individuals declare bankruptcy in the States.

Then there are the problems with insurance companies. A recent study found that health insurers (in states where they could access this data) deny between 11 and 24 per cent of all insurance claims. Eleven to 24 per cent of all claims are denied.

Some of these statistics really came to life for me when the trial began in September when people began phoning the BCHC office to share their stories. Many used to live in the US, that they had heard about the Cambie case, and they were really worried about what it could mean for them.

One woman told us that when she lived in the States and was pregnant with her first child, she started having serious bleeding. She knew that this meant that her baby’s life, and her life, could be at risk.

She went to one hospital but she was turned away because she had no health coverage. She went to another hospital -- they said no. Then another and another.

Finally, she found one that would admit her but only if she signed an agreement saying she would pay back the $10,000 cost of her visit. She was at college at the time and had to apply for social assistance to pay down the debt.

Then she told the story of her second child. Her husband has lost his health coverage through his job and the cost of a birth in the US starts at $16,000. So they went with a midwife because it was cheaper and put all the costs on a credit card.

But the story she most wanted to tell us was a recent one that happened here in BC where she and her family now live. 

Her nine-month old child was diagnosed with pneumonia while they are on vacation in Nanaimo. She said his health crashed really fast. They rushed to the hospital right away and they were able to get him stabilized. That’s the way the system should work, she told us.

She said, "If I was in the US I might have waited one more night before going to the hospital...and he might not have made it one more night..."

And then she told us  that she went to her car outside the hospital in Nanaimo and thought about that and just cried.

It’s so clear that a win for Brian Day would be a loss for Canadians.

Not only would it be a massive setback for everyone but the very wealthy, it would be disastrous for the labour movement. If we lose Medicare, thousands of union members who work in health care will be under an even bigger threat from increased privatization, which you know plenty about.

And all unions will be forced to bargain for the kind of comprehensive private medical insurance that workers in the US require. The cost of an “average” insurance plan in the US is about $16,000 per year for a family of four. And for all of us as public health care advocates, we’d face a grim future for our chances of winning a universal system back.

So if this case isn’t really about improving the system and shortening wait times, what is it about?

This case is about profit. Period. All you need to do it look at what led to this litigation, and that becomes very clear.

For years, patients have been complaining about being charged over the legal amount for services at Brian Day’s clinics.

In 2009 the province finally responded by notified several private clinics that they would be audited, including Brian Day’s Cambie Surgeries and Specialist Referral Centres. Now you’d expect a reasonable business person with nothing to hide would have opened their doors to a government audit. 

Instead, Brian Day responded by launching a lawsuit against the health care laws patients were accusing his clinics of breaking. And he fought all the way up to the BC Court of Appeal to try to stop the province from auditing his clinics.

After four years of fighting to get access to Cambie, the province released an audit report in 2012. What do you think they had to hide?

Well, the clinics made it very difficult to get information, but government was able to look at records from a period of about 30 days and  found many instances where patients were billed above the legal amount at the clinics. By many, I mean over 200 times in just one month where the clinic charged patients more than the legal amount. Sometimes up to six times the legal amount.

That extra-billing added up to just under a half a million dollars. In a month.

That wasn’t all. Auditors also found that sometimes the clinic billed the patients, but also billed the province, essentially double-dipping for the same service. These cases of “overlapping billing” added up to another $66,000 in revenue.

To top it off, they were requiring patients to sign forms promising they wouldn’t tell.

The audit makes clear Day’s clinics are charging vulnerable patients illegal sums of money. When the audit was released came out, the clinics didn’t pay the patients back, instead they have just doubled down on attacking health care law. And if Brian Day gets his way in court, he and many others will continue to take charge whatever they like with impunity.

Rupinder

This is why this attack on public health cannot go unanswered.

The BC Health Coalition and Canadian Doctors for Medicare are fighting the case in the trial as intervenors along with two individual patients and two individual doctors. One of the people in our intervenor group is Tom McGregor.

Tom lives here in Vancouver. Among the many ways he gives to his community, Tom volunteers as an advocate as his local church and advises Translink on how to best serve people with disabilities. He also has limb-girdle disease, a muscle wasting condition that affects the hips and shoulders.

If Canada had a private insurance system like the system that Day is proposing, Tom expects he would be uninsurable. He’s probably right. It is not profitable for insurance companies to cover people with pre-existing conditions and who regularly need health care -- like Tom. And probably like at least one close friend or family member in all of your lives. 

Like many Canadians, he would likely not be able to afford private insurance if he was insurable.

Our group is going to fight this case with Tom and on behalf of all of us who rely on a universal system to be there for us when we need it. Our group won the right to bring key expert evidence before the courts and we are working with a great team of lawyers.

But we can’t stop there.

We all know that although judges decide cases, major court cases like this are won and lost in the court of public opinion. Brian Day and for-profit advocates are trying to use this case to try to persuade the public that privatization is the solution to challenges in our system.

They’ve run radio and TV ads across the country and packed national newspapers with op eds. 

They have more money than us. But we have the vast majority of Canadians on our side.

In order to win in the court of public opinion, we need all hands on deck...

We’d like to thank HEU for it’s financial support and strong campaign support which were a big part of getting us this far. You are incredible allies.

You know, I got into medicine because I care about people. They come to me because they need help, and I feel honoured to be given their trust to care for them.

I can’t even imagine having to tell someone they can’t get care because they don’t have their private insurance provider won’t cover what they need, or to see people like baby Jasmine’s mom have to decide between housing and paying for her babies care.

The people won the fight to get medicare in the first place. We can win the fight to keep it. Our organizations are grateful to be working alongside allies like you to do just that.

Let’s win this case and get on with our work of strengthening a system that reflects our values, one that we can be proud of as an expression of how we care for one another.