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The Globe and Mail Wed Mar 4 2015

Here we go again. Courts are being asked: Should citizens be allowed to buy private insurance for essential medical services? Or should citizens be restricted by what public health care provides, and when? This central question at the heart of single-tier public medicine was supposed to be before the B.C. Supreme Court this week. Instead, the provincial government discovered overlooked documents about wait times and asked for extra time. The delay matters little. Sooner or later, the issue of private health insurance for essential services will be before the B.C. court and then, almost certainly, before the Supreme Court of Canada again.

Dr. Brian Day is a long-time advocate of private medicine and the owner of the Cambie Surgery Centre in Vancouver, which offers surgeries for patients who wish to pay. Dr. Day advertises his clinic outside the province, too, for those from elsewhere wishing to avail themselves of faster treatment than the public system can provide. Dr. Day has brought this case to court on behalf of patients whose health, he argues, has been imperilled by long wait times. As Dr. Day told The Globe and Mail, "This is a case about patients being able to provide for their own health when the government won't provide it." Dr. Day is wrong when he asserts that the government "won't provide" service. The issue is rather more about when.

National Post Mon Sep 14 2015

Letters

A dentist in Okotoks, Alberta, Dr. Allen was forced out of his profession while waiting for years for surgery to address his severe and debilitating back pain. What began in 2007 as a seemingly minor hockey injury gradually turned his life into a nightmare of around-the-clock pain. Normal tasks, like shovelling snow or tying shoelaces, became impossible. On one occasion, Dr. Allen watched helplessly as his one-yearold daughter, while crawling on a bed, lost her balance and fell off, and he could not move to catch her. Dr. Allen finally received a referral for surgery in early 2009, but no surgery could be performed

The Timmins Daily Press Wed Aug 24 2016

How did it ever come to this? How did supposedly intelligent men and women, given the responsibility for running our health-care system, allow things to deteriorate so badly? More importantly, how did we-the public-allow ourselves to be duped all these years by spineless, self-serving politicians?

Earlier this year, an Ontario teenager, Laura Hillier, died while waiting for a stem-cell transplant. She was only 18 years old, and had her whole life ahead of her. Unfortunately for Laura, she made the mistake of getting sick in Ontario, a province where-like most of the rest of Canada- we've had our heads buried in the sand for far too long when it comes to how we fund our health-care system. This young girl died, not because they couldn't find a donor-there actually was one-but because those in charge couldn't find a way to fund the procedure that would have saved her life.

By Medicine Hat News Opinon on April 11, 2014.

On April 2, Justice P. R. Jeffrey of Alberta’s Court of Queen’s Bench rejected the claim put forward by lawyer John Carpay on behalf of Darcy Allen that prohibition on private health insurance in Alberta infringes on Mr. Allen’s Charter Rights. Mr. Carpay based his court argument on the Supreme Court of Canada ruling in the Chaouilli case that a ban on private health insurance under Quebec law infringed Mr. Chaoulli’s Charter right to security of the person. This claim was not a rejection of access to health care but rather recognition that allowing private insurance to determine Albertans’ access to health care is not a solution to the problems in our public health care system. The Alberta Court found Chaoulli didn’t apply. That’s no surprise. The Supreme Court clearly stated Chaoulli applied only to the specifics of the Quebec case. This Alberta case was simply political grandstanding. We can’t build the health system we want through the courts. A small, angry minority of Albertans wants a two-tier health system where a few people get whatever they want while everyone else waits. The great majority of us want good health care based on need, not ability to pay. The minority just can’t seem to live with losing this argument. Or do Mr. Carpay et al believe in democracy and the rule of law only when they win?

CMAJ October 18, 2016 vol. 188 no. 15 First published September 19, 2016, doi: 10.1503/cmaj.109-5327

Steve Mertl

It was the British Columbia government’s turn Sept. 12 to rebut a Charter challenge barring doctors from operating both inside and outside the public health care system. However, anyone who came to the BC Supreme Court expecting an impassioned defence of medicare was disappointed. Instead, lawyer Jonathan Penner attacked the legal underpinnings of the case filed by Cambie Surgeries Corp., which operates a Vancouver private clinic, and its co-plaintiffs.

Simpson writes with a clear ideological bias. He favours increased privatization. With frequent criticisms of those he calls "unreconstructed defenders of medicare" and the Supreme Court justices who ruled on the landmark Chaoulli case and whom he calls "gifted health policy amateurs," he spares no rhetorical disdain. Unfortunately, Simpson practises much of the same behaviours he criticizes in others.

His superficial analyses of multiple complex systems that function within different geographical and demographic realities do not help us understand the Canadian system.

privatization of health care is his solution to medicare's problems

What did the court say? A slim majority of judges ruled that Quebec’s ban on private health insurance for publicly-insured services violated Quebec’s Charter of human rights and freedoms. The decision, based on selective and at times flimsy evidence, is not a blanket overturning of the ban.

Why are we allowed – sometimes even obliged – to buy private insurance for prescription drugs, eye care, dental care, home care, nursing-home care, etc. – but not for surgery and doctors’ visits?

The Province Sun Jun 14 2015

Dr. Patrick McGeer, a distinguished neurology researcher at the University of B.C. and a former Olympian, served as an MLA from 1962 to 1986, the last 10 years as a cabinet minister. mcgeerpl@mail.ubc.ca mcgeerandassociates.ca The B.C. government is wasting your tax money on a court battle that has now been going on for more than six years. Initially, the government accused the Cambie Surgery Centre of violating B.C.'s Medicare Protection Act. The clinic launched a counter suit, joined later by six patients, on the grounds that the B.C. legislation violated the Charter of Rights. A defeat for the provincial government seems to be a certainty. The Supreme Court of Canada has already ruled in Chaoulli v Quebec that patients are "suffering and dying on wait lists" and that "access to a wait list is not access to care."

The court decided that if you are a Quebecer, you are protected under the Charter of Rights and Freedoms. Their reasoning has certainly come true since in the B.C. case, two of the original four plaintiffs have already died and a third is paralyzed for life. The province is ignoring the Supreme Court of Canada, apparently hoping its ruling will only apply in Quebec. The issue is whether the constitution allows you to spend your own money on your own health care and whether private clinics should be allowed to provide that care. The B.C. government says, no, you must join a queue for treatment. Queues are a euphemism for rationing. Canada is the only country in the world that has ever imposed such a system.

Montreal Gazette Wed Jun 10 2015

Re: "Ten years after Chaoulli, we are still waiting" (Opinion, June 8) Economist Yanick Labrie argues that when a government cannot offer timely medical care there is "no justification" for its maintaining a monopoly on such care. Instead, Labrie advocates the general availability and use of private medical insurance as a solution.

However, the use of private insurance results in those who can afford it queuejumping in front of those who cannot, and this can increase the medical wait time and prolong the suffering of the latter. The only solution that will not increase anyone's suffering is to increase government health spending and to use universally accessible medical resources more efficiently. This way, everyone's wait time can be reduced to acceptable limits. Robert Hajaly Montreal

The Record (Sherbrooke) Mon Nov 16 2015

The people of Quebec will only benefit from a universal, free and comprehensive health-care system if there is strong and swift intervention by the federal government. Otherwise, Quebec will likely be the first province to slip out of the Canadian health care scheme. In fact, Quebec's current health care laws and practices do not respect the principles set out in the Canada Health Act. During the past decade, the core principle of health care - that medically necessary care should be universally covered and paid through public funds - has gradually eroded in Quebec. The process has been a slow but steady sum of small legislative changes that have benefited practitioners over patients. The result has been governmental tolerance for grey-zone billing practices and impressive fee-charging creativity from medical entrepreneurs.

The turning point was probably the Supreme Court of Canada Chaoulli ruling in 2005. The decision said that prohibiting private medical insurance was a violation of the Quebec Charter of Human Rights and Freedoms, particularly in light of long wait times for some health services. The ruling has fed steady development and acceptance of a two-tier health care system in Quebec. The expectation that medically necessary care will be free in Quebec is less and less warranted. Some specialists in public hospitals propose faster access to their patients - for a fee - or less invasive interventions through their for-profit clinics. In such clinics, doctors are still paid by Quebec's public health insurance, but patients are often billed for the rental of the surgery room, for local anesthetics or for access to more advanced technologies. hile officially illegal, such practices are widespread. Stories abound about W eye drops or anesthetics that cost the clinics cents being billed to patients for hundreds of dollars.

The pain became so disabling that Dr. Allen was forced to sell his dentistry practice in July 2009. In desperation, Dr. Allen underwent surgery at his own expense in December 2009. The surgery was successful, relieving his pain and signalling a return to health. The cost of the surgery was $77,000.

Dr. Allen argued that section 26(2) of the Alberta Health Care Insurance Act, RSA 2000, c A-20 prevented him from obtaining private health care insurance and covering the cost of his surgery. The section in question prohibits insurers from issuing private health care insurance for basic health care already covered under the Alberta Health Care Insurance Plan. It gives the public Plan a monopoly on health care insurance for basic health care services. Dr. Allen argued that this was unconstitutional, infringing his section 7 Charter rights

The chambers judge held that the unconstitutionality of section 26(2) was dependent on whether Dr. Allen could demonstrate that this particular restriction on private health insurance in this specific context offended section 7. In his view, the connection between state-caused effect and the harm suffered by Dr. Allen had not been satisfied. This was because there was no evidence indicating either that the prohibition caused Dr. Allen’s wait time in the Albertan health care system, or that private health care insurance would have been available for this type of surgery anyway.