Re: A constitutional solution for an ailing health system?

We are writing in response to the recent editorial by Dr Brian Day, “A constitutional solution for an ailing health system?” We are concerned about the journal’s decision to publish a piece that did not declare a conflict of interest, makes erroneous claims, and lacks adequate references.

We are members of the Board of Canadian Doctors for Medicare (CDM), which has intervenor status in the Supreme Court of BC case involving Cambie Surgeries Corporation. However, unlike Dr Day, we have no financial interest in the outcome. Our involvement in the case rests solely on ensuring that a core tenet of the BC Medicare Protection Act and the Canada Health Act is upheld: that health care should be provided based on need, not on ability to pay.

There are a number of inaccuracies in Dr Day’s editorial.

Dr Day states that an expert witness put forward by the defendant “acknowledge[d] that his affidavit evidence was researched and edited by the Chair of Canadian Doctors for Medicare.” If this claim had been fact-checked by BCMJ, they would have learned that the physician referenced stepped down from the CDM Board in 2013, and was not the Chair of CDM. The witness in question simply consulted with his colleague, and he was unaware that CDM was an intervenor in the trial. Dr Day also chastises the witness for, in his view, being an advocate. Dr Day was also a witness and took the same oath to be a non-advocate, yet the advocacy in this editorial itself exposes Dr Day’s own lack of impartiality.

Dr Day chides groups opposing him in court who use private clinics in BC when, in fact, this has been quite common given that BC’s Medical Services Plan has, from time to time, contracted out services to private clinics, including Cambie Surgery Centre. All of that care was publicly funded. That is not unlawful. What is against the law is charging patients for care that’s already covered under MSP. That is what Cambie Surgery Corporation and the doctors who work there have been doing.

Dr Day conflates private delivery and private financing. The trial is not about private delivery, which occurs lawfully across the country. Rather, this case is about private financing, which is unlawful for hospital and physician services under both BC’s Medicare Protection Act and the Canada Health Act. What the plaintiffs in this case desire is the ability to extra bill patients more than what MSP pays, and to allow private duplicative insurance covering the same services as the public plan for those who want to jump the queue.

The editorial by Dr Day also fails to mention that physicians in BC have the right to opt out of MSP and not provide any publicly funded services, and instead charge patients directly as much as they want to charge for services provided in private clinics. Nonetheless, Dr Day and his colleagues have chosen to remain enrolled in MSP, while also extra billing patients in a manner that is inconsistent with BC law and the long-standing principles of medicare as reflected in the Canada Health Act.

With respect to the larger issues being debated about our health care system, we acknowledge that there are many aspects that need to be improved. However, this can all be done through a publicly funded system via changes to how we organize the delivery of care—not how we pay for it—to improve efficiencies and enable better access for everyone. We are also engaged in constructive public discussions about expanding the basket of services funded publicly to cover Pharmacare, other mental health care providers beyond physicians, home care, and virtual care.

We seek approaches that benefit all residents of Canada rather than only those who can afford to buy their way to the front of the line.

The stakes in this court case could not be higher. Evidence from the US, Australia, Germany, and other jurisdictions have shown that wait times would in fact increase for those who could not afford or qualify for private duplicative insurance, particularly those with more complex health needs or who have lower incomes. Should the plaintiffs win, and key provisions of the BC Medicare Protection Act be declared unconstitutional, it would forever change the fundamental basis of Canadian health care.

Given the importance of this case, we ask that, at the least, the BCMJ be more diligent in assessing pieces it publishes. An editorial that has a single reference written by the author 13 years ago, lacks fact-checking, and fails to disclose that the author has a financial stake in the case being discussed, seems at the least poor practice for a reputable medical journal, and at the most, a willingness to be complicit in sharing misinformation.

—Richard Klasa, MDCM
—Robert Woollard, MD, CCFP, FCFP, LM
—Monika Dutt, MD, CCFP, FRCPC, MBA, MFA
Sydney, NS
—Rupinder Brar, MD, CCFP(AM)
—Vanessa Brcic, MD, CCFP

Suggested reading

Duckett S, Nemet K. The history and purposes of private health insurance. Gratan Institute, 15 July 2019.

Heinrich N, et al. Waiting times for outpatient treatment in Germany: New experimental evidence from primary data. Jahrbücher für Nationalökonomie und Statistik Aug 2018;238(5).

Liddy C, et al. What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation. BMJ Open 2016;1-8.

SharedCare, Partners for Patients. GPs and Orthos Rocc’n Roll. 2018.

Wilson M, Mazowita G. Rapid access to consultative expertise: An innovative model of shared care. 2013.

This post has been peer reviewed by the BCMJ Editorial Board.

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