Private health insurance: The conversation continues

Issue: BCMJ, vol. 60, No. 8, October 2018, Page 386 Editorials

I have been involved in litigation on the constitutionality of Canada’s health system since well before the Chaoulli decision of 2005. The current action—in which the majority of plaintiffs are patients—was launched almost 10 years ago.

Government lawyers continue to block evidence while simultaneously making multiple illogical arguments. For example, a patient-witness taking large quantities of pain medications said they made her sick. Government argued that she was able to state how many pills she took, but the cause of the nausea required expert medical opinion. Objections were made to an ophthalmologist defining glaucoma and a colon surgeon explaining colonoscopy because they were not qualified as “experts.”

Government documents confirm that BC fails to meet its own maximum wait benchmarks—beyond which patients are harmed. Their lawyers argue pain and suffering while waiting are irrelevant. They are dismissive of patients lacking access to a GP, mental health services, cancer treatment, or those languishing on ER stretchers for days.

The 2018 Vancouver Coastal Health Authority report card reveals only 49% of surgical patients meet maximum medically accepted wait times. Government documents confirm that only 12% of patients with hip arthritis in “severe pain, unable to self-care, and at risk of serious harm” are treated within the maximum acceptable period. For lung cancer it’s 31% and for bladder cancer “with high risk of progression” only 13%. There are thousands of similar shameful examples.

Government lawyers have stated, “So the plaintiffs’ argument that evidence of harms . . . is somehow relevant . . . is simply wrong;” “Not all relevant evidence is admissible;” “Statements made by the premier or health minister cannot constitute admissions that can be relied on;” “Harms caused by current legislation are not relevant.”

They falsely accused BC clinics of “extra billing,” which the Canada Health Act specifies as billing in addition to payments from public health care insurance. Private clinics in BC don’t extra bill; public hospitals do.

Even tax-funded government experts have reported: “Parallel private insurance funding does add to the net resources available . . . and does provide some care that would otherwise be a charge on the public system.” Another discarded “expert” left the country after a judge ruled he caused an unnecessary enquiry costing over $10 million, and another wrote, “Medicare is being put on trial, and will likely be found wanting.”

Suspicious of the BC website data, I followed up with a surgeon whose profile showed very few patients waiting a very short time. In truth there were over 1200 waiting. A physician witness at trial described being ordered to stop seeing patients since it made surgical wait lists longer. The ministry ordered patients who were categorized as being in “moderate pain” to be reclassified as being in “mild pain” in order to (falsely) improve their statistics.

We’ve heard important evidence described as hearsay, irrelevant, opinion, and argument in order to have it excluded. To state one’s place and date of birth is inadmissible hearsay unless one personally remembers being born!

Our BC government volunteered to have $16 million deducted from their federal transfer payments. Other provinces that allow private MRIs and clinics suffer no penalties. Our current health minister stated, “The consequences of the failure of the previous [Liberal] government to enforce the law has cost patients millions of dollars.” He forgets that private clinics operated freely under the last NDP government and ignores the fact that private clinics save BC’s public system about $300 million a year.

Government recently announced fines up to $20 000 per patient undergoing private MRIs or surgery starting in October. Unless blocked by an injunction, wait lists will worsen dramatically. An underperforming monopoly cannot succeed unless competition and choice are eliminated.

A March 2018 Ipsos poll revealed 81% of BC residents support us. Government’s failure to consider public opinion is undemocratic.

I recently addressed a group of 25 visiting health executives from countries as diverse as New Zealand, Netherlands, UK, Switzerland, Germany, Zimbabwe, and Russia. They were shocked that private health insurance was illegal. The Russian delegate remarked, “This could not even happen in the former Soviet Union, where I was raised.”

Brian Day, MB. Private health insurance: The conversation continues. BCMJ, Vol. 60, No. 8, October, 2018, Page(s) 386 - Editorials.

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Luis A. Martine... says: reply

There is nothing resembling a 'conversation' there. Totally one-sided without a counter-argument. That is how Fake News become a wasteful time during any fair discussion. Shame on you (the editor and editorial board of the BCMJ)

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