On 8 September 2014 an 18-week trial, which is being called “the biggest legal case in Canadian history,” will finally begin before the Supreme Court of British Columbia (www.charterhealth.ca [10]). The outcome of this case will significantly impact the health system. At a time when access issues are severely impacting medical care, all should welcome the fact that we will have an objective, evidence-based decision that will end the monopolistic system that is harming Canadian patients.

Several groups are opposed to the case. In that six of the seven plaintiffs were patients suffering from the system’s failings (sadly, two plaintiffs have died during the almost 6-year delay in getting to trial), it is regrettable that a small doctors’ group has joined ranks of certain unions in opposing their right to timely access. One union recently announced a $50 000 donation to their efforts. Given that our clinic’s main users are unionized workers, and that it was built by union workers, this makes no sense. There are three defendants in our case. They are the Medical Services Commission, the Minister of Health, and the attorney general. Of course, since our action was launched, the individual defendants have changed many times over. In a Monty Pythonesque manner, one of the former attorneys general has had private surgery himself, another is now one of our lawyers, and the others have expressed strong support for our cause. The problem is that the tails (bureaucrats) are wagging the dogs (elected leaders). 

In an unprecedented action, the government has submitted 30 expert reports to support their arguments. The government has hired highly paid (with your tax funds) advocates of the status quo, some of whom—seemingly unknown to the bureaucrats who hired them—have already been discredited by judges in previous actions. I believe that these experts will, under cross-examination, actually help our cause. They will be supported by the four expert reports that we have submitted.

The attorney general’s office has used a ploy that is similar to that of a poker player who has unlimited chips but a poor hand. They have tried to push up the costs to a level that they hope will force us to abandon the effort. Their plan will not work, and we will see this case through.

Our current health system has all the features of the North Korean airline, rated the world’s worst. Air Koryo extracts funds; sets prices and dictates spending; owns and controls the facilities; decides where services will be located; trains, employs, regulates, and funds the workers; governs how, when, and where clients are served; determines the level and quality of services; self-regulates, self-evaluates, and outlaws competition. Canada’s “Koryocare” model is unique on this planet.

Every other country offers options for nongovernment care. Our current laws allow injured workers, RCMP, armed forces, not to mention foreigners and federal prisoners, such rights. We will plead with our judge that free Canadians should be granted the same rights as those in jail, and the same constitutional protection under the Charter of Rights and Freedoms that was granted to citizens of Quebec. Canadian patients must be emancipated from laws that force them to wait, suffer, and—in the words of the Supreme Court of Canada—sometimes die while they wait.

Sir William Beveridge, founder of the British National Health Service, declared: “The State, in organizing security, should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum for himself and his family.” In a free and democratic society, governments are elected to serve the people, not to dictate to them, limit their freedoms, and restrict basic human rights. Let’s hope that our justice system agrees. We believe that governments act unlawfully when they promise but fail to deliver timely care, and at the same time outlaw other options.

Justice J. Spencer of the BC Supreme Court has stated: “… if it comes to a choice between a physician’s responsibility to his or her individual patient and his or her responsibility to the medicare system overall, the former must take precedence.” Doctors who act otherwise are, in my opinion, guilty of unethical behavior and are complicit in the suffering of patients needing access to care. I hope, as the trial approaches, that our various professional associations will support our case. So far they have been quiet.

The medicare monopoly in Canada is simply a failed insurance scheme that is not serving the needs of the public. “Koryocare” is an apt description. Success in our case will enable the introduction of a system similar to European models of hybrid, universal, accessible, patient- (rather than government- or union-) focused care.

The suffering experienced by our six patient plaintiffs (and many more patients across Canada) would not have occurred in other developed countries. Here, the poor and the underprivileged suffer from the worst access and outcomes. That has to change. I believe that change is coming.
—BD