On November 17, British Columbia’s provincial government proposed several new amendments to the Medicare Protection Act. According to the news release, the goal is to protect patients from “inadvertent billing errors and charges for insured services”. In fact, Bill 92 grossly jeopardizes the already limited rights British Columbian patients and physicians have to get diagnostic and surgical services outside the government monopoly.
A growing number of small diagnostic and surgical clinics operate in this province, primarily serving those who have the privilege of opting out of the appalling waiting lists for government-run hospitals. Most often, the bills of these privileged few are covered by ICBC or WCB.
However, some patients who need healthcare and cannot get it in a timely fashion in public hospitals have joined the ranks of WCB and ICBC cases going to private clinics. Since the current regulations only provide that you cannot pay for your own treatment, a third party payer, like your Uncle George, has been sufficient to clear the regulations. Because the physicians who do the surgery are working all the hours that the public hospitals will allow—surgeons have limits on operating time in the public system and have lots of excess capacity to do the private care—there is no loss to the public system. And, they are paid no more than when they operate in public facilities. The patient’s Uncle George pays the cost of the private facility, just like WCB does for its clients.
The current arrangements are a definite win-win – one of the very few in Canada’s crumbling health care apparatus.
In the aftermath of Bill 92 surgeons will have less operating room time in total, therefore fewer patients will be treated, and patients on the public waiting lists will wait longer - a lose-lose situation.
Bill 92 gives government the power to arbitrarily persecute doctors or private clinics who dare to reduce the province’s hospital waiting lists -- or even know about their colleagues doing it -- by levying hefty fines between $10,000 and $20,000. Bill 92 emphasizes this arbitrariness by prohibiting “the beneficiary being rendered the benefit (i.e. the procedure) in priority over other persons or being given preferential treatment in the scheduling or rendering of the benefit”. This is a meaningless clause because no individual patient has a legal claim to a position in the public queue for surgery.
Bill 92 also puts private diagnostic clinics out of business. This is disgraceful in a province where patients wait 12 weeks for an MRI scan or 6 weeks for a CT scan.
Bizarrely, the BC government tries to avoid responsibility for its action by claiming that the Canada Health Act, a two-decade-old law, forces the province to legislate against patient choice. Even more bizarre, the preceding NDP government had the wisdom to leave the private clinics alone, suggesting a different interpretation of the same decades old act. It is not clear that the Canada Health Act actually restricts private contracting for health services: it is a poorly written law.
This newly proposed legislation takes British Columbia a significant step backward. Common sense and international evidence indicate that increased private choice results in better health outcomes for less cost. Canada is unique in disallowing competition against the government-run health system – even Poland gave it up a few years ago.
Sweden, France, Australia, and Japan have universal access health care systems that cost less money than ours, after we account for Canada’s relatively young population, and provide better access to care and better health outcomes for the population. Each of these countries’ governments promises all citizens access to care regardless of ability to pay, yet none has followed Canada’s model of preventing individuals from deciding how they contract for medically necessary care.
The current BC government has shown little taste for serious health care reform. Although health spending has increased by $1.6 billion since the Liberals took power, waiting times for orthopaedic surgery have actually gone up 26 percent in the last two years. It now takes nearly 40.7 weeks from a British Columbian’s referral by his general practitioner until his treatment by an orthopaedic specialist.
If the government really wanted to reform health care to serve patients, it would open access to private surgical care for all who need it, rather than condemning most patients to long waiting times and sub-standard access to high-tech care with ever increasing costs.
It is time for the thousands of people who have had relief from their pain and disability in these private clinics to do a public service by coming forward and literally being counted in opposition to this new law that will harm British Columbians’ health. No law in Canada should deny consenting adults to seek out the care they need and restrict them to what the government sees fit to provide.