August 9, 2012

Dr. Day, owner of a private clinic in Vancouver, can't seem to decide what his priorities are. On one hand, he wants to reduce the time patients have to wait for surgery. On the other, he is determined to poke his finger in the eye of Canada's fabled health care system.

He says he is dedicated to public health care. "I will commit to a policy that all Canadians receive timely access to medically necessary services, regardless of their ability to pay," claims Dr. Day.

So why, given this lofty goal, has Dr. Day run afoul with the law?

It's not because of his privately-run Cambie Surgery Clinic. Privately-run doctors' offices and clinics are not prohibited; they are an integral part of Canada's health care system. It's not that most of Dr. Day's practice isn't perfectly legal. Ninety per cent of his work involves the treatment of soldiers, police and WCB patients who are insured outside the Canada Health Act.

Still, he insists on charging patients in contravention of B.C.'s Medicare Protection Act. A recent investigation by B.C.'s Medical Services Commission revealed what had been an open secret: Dr. Day has been routinely extra billing for years.

Dr. Day has been both cagey and outspoken about his lawless ways. He obstructs the commission's investigation by claiming that the extra billing is just a "facility fee." He openly defies the law and ridicules the commission's audit saying that their investigation was like determining: "if a car parked next to a no-parking sign is parked next to a no-parking sign. Our position is, the no-parking sign is illegal."

He's less glib in explaining how extra billing will achieve his desired goals of reducing wait-times and providing surgery regardless of patients' ability to pay. If he were so determined, he would charge less, not more. I'm sure Dr. Day understands the way a free-market economy works: patients will flock to surgeons who provide quality care for less. He could cover expenses through volume care. If he wanted to improve access to health care, he could make it more affordable.

Of course, that's not the way Canadian Health Care works. We don't have a market-driven system in which doctors compete through pricing. Ours is an insurance plan in which everyone contributes and everyone is covered. The beauty of our single-payer system is that it reduces the administrative overhead that competing health insurers suffer from, such as in the U.S.

Dr. Day doesn't address the obvious advantage of a single-payer system. When the government runs the insurance system and also makes investments to improve the health of everyone, the costs of insurance are reduced. In a single-payer system, a healthier population means lower health care costs. That's an investment that a private insurance company wouldn't make. Sure, if they invested in public health, improved wellness, and reduced disease, then insurance claims would be fewer and profits would be more for them. But so would profits for all their competitors. Why make such an investment?

Despite good intentions, Dr. Day seems determined to bring inefficiencies into health care. He has filed a B.C. version of the landmark Chaoulli case that opened the way for residents of Quebec to buy health insurance from competing private insurers. "If we win, it will be the best thing that ever happened to medicare, because medicare is going bankrupt," Dr. Day said.

The only way to improve health care is to tear it down, he seems to say. "The operation was a success but the patient died," goes the old saying.

David Charbonneau is the owner of Thompson Studio
He can be reached at dcharbonneau13@shaw.ca