Mr Justice Steeves’ decision in Cambie Surgeries Corporation v. British Columbia (Attorney General) reads like a Scott Turow novel, albeit at a slower pace.
It includes all the major elements of a legal thriller: a law suit with white hats and black hats, ordinary people desperately searching for ways to alleviate their pain, entrepreneurs seeking financial gain, a constitutional battle that may forever change Canada’s universal public healthcare system, all of which lands before a wise and thoughtful judge who meticulously considers the evidence presented in a trial lasting 194 days which included the oral and written testimony of 36 physicians, 17 patients, 40 experts and 75 witnesses, and delivers an 880 page decision in support of public healthcare.
The characters
The plaintiffs are Dr Brian Day, the Cambie Clinic, the Specialist Referral Clinic which provides assessments and referrals to Cambie, and some physicians and patients associated with those clinics.
Dr Day founded the Cambie clinic. He’s a staunch advocate for private healthcare and doesn’t come across as a sympathetic character.
Dr Day’s argues it’s unconstitutional to deny patients, who can afford to pay, the option of obtaining private healthcare in the face of lengthy waits for such care in the public system.
He is not advocating for reducing wait times or increasing funding in the public system. And he admits that allowing patients to pay for medical services at private clinics will not reduce public wait times.
The defendants are the BC government, the federal government, and doctors and other advocates who argue laws which preserve the universal public healthcare system and ensure that access to care is determined by need, not the ability to pay, are not unconstitutional.
They also argue that allowing a parallel private healthcare system to emerge would undermine the public healthcare system by increasing costs and reducing capacity, and would exacerbate the inequity of access.
Law prof Lorian Hardcastle posted an insightful blog on the constitutional aspects of the decision this morning.
For a quick Soapbox take on the case read on.
The business of private clinics
Private healthcare clinics are a lucrative business that chew up a lot of resources.
Dr Day testified that 100 surgeons are affiliated with the Cambie Clinic. They’re supported by a staff of 95 employees (nurses, front office staff, cleaners, etc).
The Cambie Clinic charges patients a facility fee that covers salaries, overhead and operating costs. The facility fee goes into general revenue, and a payment, similar to a dividend, is made to the doctors affiliated with the clinic. This payment is in addition to whatever the doctors receive from the BC government for their work in the public sector.
Doctors working at the Clinic and other private sector clinics earn two to four times more for procedures they perform in the private sector than for those same procedures in the public sector. One doctor said that in 2016/2017 he earned $240,000 in government billings compared to approximately $950,000 in private clinic billings.
Not surprisingly, some doctors say they’ve reduced their time in the public sector to spend more time in the private sector.
The details of how doctors’ work is tracked and how their payments are calculated remain a mystery. Dr Day, the man in charge of Cambie, was unable to provide an explanation or documentation showing how this was done.
Not all experts are the same
Justice Steeves noted that experts for both the plaintiff and the defendant strayed beyond their areas of expertise at times, however he highlighted a number of serious concerns with many of Dr Day’s experts that resulted in their opinions being given little or no weight.
Dr Day took it upon himself to communicate with four of his experts in a way Justice Steeves said amounted to “counselling them to ignore, if not violate, their primary duty” as experts (namely to assist the court and not be an advocate for either party). Dr Day’s communication with these experts “so tainted their evidence” that Justice Steeves gave their reports and testimony no weight.
Similarly Justice Steeves gave no weight to some of Dr Day’s healthcare economists because their reports were (1) simply commentary prepared for CD Howe, (2) consumer information prepared for the Frontier Institute or (3) reports prepared for the Fraser Institute by someone who was “minimally” qualified as an expert on health policy and whose work suggested a “very narrow philosophical interest.”
Interestingly, Justice Steeves noted that Dr Day himself was evasive and argumentative and rejected the doctor’s evidence where it was contradicted by other witnesses or documentation.
Suffering
While it is true that elective surgeries are not, by definition, treatment for life-threatening conditions, the challenge facing patients attempting to access diagnostic and surgical procedures is fraught with physical and mental distress and cannot be ignored.
The testimony of patients appearing for both the plaintiffs and the defendants was heartbreaking.
The longer we fail to address the issues caused by a lack of timely access to the public healthcare system, the more desperate people will become and the more willing they will be to latch on to a private healthcare solution.
The sequel
Dr Day says he’ll appeal Justice Steeves’ decision. And if he loses at the next level, he’ll likely appeal to the Supreme Court of Canada.
Everyone who supports Canada’s public health system should thank their lucky stars that the decision the Supreme Court of Canada will be reviewing will be the magnificent 880 page decision issued by Justice Steeves.
Susan on the Soapbox 
Susan: Thanks for another great blog. Private for profit health care is not the route we should be going on. We need to look no further than America is doing with their health care system. People are ending up flat broke because of it. The UCP merely wants to finish what Ralph Klein wanted to do, and put private for profit health care in Alberta. We must say no the this. In the U.K, they have a mix of public and private health care. It isn’t working out so well.
Dwayne, I agree with you. The UCP says the NDP and groups like the Friends of Medicare are scare mongering when they say the introduction of private healthcare in Alberta will lead to the mess we see in the US, but the evidence given in the Cambie case (and accepted by Justice Steeves) shows that (1) doctors in the private sector charge two to four times more for a procedure than they do in the public sector and (2) patients have to pay this additional cost out of their own pockets. It’s this latter point that opens the door to private health insurance which is the only way ordinary people can afford to pay for private healthcare. The snag with private health insurance is that it’s like private car insurance, the insurer determines who is eligible for coverage and what illnesses and accidents are covered. The sicker you are, the higher your premiums are (assuming you can get coverage at all). And just like car insurance, the insurance can deny your claim.
The people championing private healthcare should talk to some people in the US about how well it’s going for them.
Even Ralph never fought as hard as Lord Jason. Ralph’s heart never seemed to be in it, at least after the public rally that saved Edmonton’s Grey Nuns hospital from closure. Damaging public services is a classic US Republican strategy. It’s no surprise Lord Jason uses it.
That’s true Mike. And yet people continue to elect these guys. I can almost understand why Albertans would believe Ralph was one of them, but Kenney with his blue pick up truck camper tour? Not so much.
Dr Day is very selfish! Rich people can pay but the scum that allow this situation to pick private over public are missing the point.They can go to the states and see what a mess private health care has produced for the poor . And it makes the most vulnerable Die.I Do not want to see this in Canada! Thank god the Judge did not agree with Dr.Day.Public health care should be funded better and made a priority.That way everyone in society benefits much to the chagrin of the selfish souls who honour money over caring for those who cannot pay for health care.
Merci, mercy.
Leila and Laurent Jeff: Justice Steeves provides a very clear picture of Dr Day’s character. He said Day was evasive and argumentative. When Day was asked a simple question, to confirm Cambie’s address, he launched into a speech about why the clinic was important. Day admitted Cambie had provided illegal medical services. Day couldn’t provide documentation on how the doctors were compensated. He said the “dividend” was compensation for non-surgical duties like ordering equipment and acting as “orderlies” (which makes you wonder what the other 95 clinic staff were doing). Day’s interactions with key expert witnesses was problematic. He sent them a 31 page document trying to influence their expert opinions because he couldn’t testify as his own expert witness.He made “many inappropriate personal attacks” against government experts that the Judge says likely influenced Day’s experts.
It goes on and on.
I have to say that Dr. Day is nothing if not persistent. Reading the Globe article referenced in Prof. Hardcastle’s blog reinforces my belief that politicians like Gordon Campbell (and others) should have paid dearly for failing in their fiduciary duty to ensure that the law was enforced. Lessons learned. Let’s see how Qenny will fare
Wikipedia’s entry on Brian Day tells much the same story. Note the list of action items Day submitted to the Romanow Commission in 2001.
https://en.wikipedia.org/wiki/Brian_Day
Mike, thanks for the link to the Wikipedia entry. It’s interesting to note that Brian Day, like Jason Kenney, started out on the political left/centre and ended up firmly in the free market, privatize everything, right. We’ll never know why they flipped like that, but if they get into positions of power they can do tremendous harm.
Good point Edison. Day’s lawyers tried to argue that since the government failed to enforce the law preventing extra billing, it was okay for Day et al to continue to extra bill. Not surprisingly, Justice Steeves gave that argument short shrift.
The issue we’re going to have in Alberta is Kenney is unlikely to pass laws prohibiting doctors from providing private medical services and charging two to four times the rate they get paid in the public sector. If this happens we can expect the feds to cut Alberta’s health transfers dollar for dollar for every extra billing dollar the doctors collect.
Then Kenney can blame the feds for hurting Alberta, when in fact it would be Kenney’s fault, not Trudeau’s (again).
It is tragic that lives are on the line for profit. When we have Canadian trained doctors acting like american doctors strictly for the profit motive then its time to rethink the system. Obviously there has been a change in the doctoring of the past when our physician’s cared. Dr Day seems like a decent doctor but of awful character. Money is the new “God”. He can always go south…
Sidney, I’m glad you brought up the point about Canadian trained doctors. Justice Steeves said the investment in training new physicians in BC is substantial. In 2016 the start-up cost for each new space at the UBC med school was about $1 million; the annual operating costs for each new space was about $273,000. Med students pay between $18,000 to $25,000 in annual tuition and costs, that’s nowhere near enough to cover these costs which are borne by the government and school benefactors. Then add in the cost of building private diagnostic and surgical facilities (one doctor said his facility cost $1 million) which is often paid for by the government, and you can see why the public (also known as taxpayers who funded all these capital and operating costs) is not impressed when they’re asked to pay two to four times the rate the government pays the doctors in the public healthcare sector for the very same services.
I love this one!! Delicious legal thriller indeed! Glad it ended well for my favourite side. Keep up the great work.
Thanks artistdianne, I’ll be following this story for quite some time, I’m hopeful it will end well at the Supreme Court of Canada. Justice Steeves took great care to explain why he decided as he did. This makes the decision tougher to reverse on appeal.
Day & his supporters were trying to portray themselves as humanitarians, seeking only to relieve suffering. But in reality, what he is offering is a way for the rich to jump the queue and get faster access to health care, for no other reason than because they’re rich. Our public health system is — or should be — predicated on the principle that your priority for access to care is decided based on the medical urgency of your condition, not the thickness of your wallet.
I have read that among the most prolific users of their services, is the province’s Worker’s Compensation Board, which doesn’t want to pay people injured on the job to sit at home on the waiting list with the rest of BC’s patients. I’ll leave it to Ms Soapbox & other commenters to decide for themselves if this is equitable. Certainly other insurers, like private disability coverage carriers, don’t get that privileged access.
Jerrymacgp: you raise an interesting point. Justice Steeves touches on the relationship between public healthcare and workers compensation in his decision I think this is a historical anomaly. Workers comp had been in place for about 50 years when BC adopted its public health legislation and the government decided to make workers comp exempt from the public health legislation (I suspect for the reasons you set out, employers don’t want their employees out sick when they could be working). But it does point out the inequity built into the system. It reminds me of the Queue Jumping Inquiry where we learned that professional athletes and even young people with strong athletic potential were given preference to ordinary people because their injuries interfered with their livelihood or future prospects.
Justice Steeves reviews the history of public healthcare in Canada starting at paragraph [162]. It’s a remarkable story.
“The longer we fail to address the issues caused by a lack of timely access to the public healthcare system, the more desperate people will become and the more willing they will be to latch on to a private healthcare solution.”
Well that is quite apparently the MO of the UCP after all, especially for those pols holding positions of power with their spouses already ‘in the business’ of private medicine, so I am not certain what Albertan’s expected; just don’t ever get sick or injured in Sundre, I guess. Unless you can afford to, I mean.
GoinFawr: I take your point. One thing Justice Steeves’ decision makes crystal clear is that the issue of wait times is complex. There are many ways the government can (intentionally or unintentionally) make wait times even longer. This includes ticking off all the doctors (your Sundre example) so referrals from family doctors to specialists are delayed; and underpaying anesthesiologists and OR/ICU nurses so these professionals leave creating shortages which results in operating rooms shutting down.
From what I’ve seen of the UCP’s approach to public health so far, I’m surprised the exodus of our medical professionals hasn’t proceeded even more quickly.
Great exposition of the case, Susan. All thoughtful Americans point to Canada as an example of what their health system should be like. To emulate the U.S., the only developed country without universal medical care, would be folly.
In truth, one of the reasons behind the rise of Trump is the elitism of a health system accessible and affordable only by the (shrinking) middle class and above.
In 1993, while Ralph Klein was starting to dismantle Alberta’s public health care, a team of American health-care specialists was touring Canada. They were studying Medicare. I can’t cite chapter and verse, but the Americans’ message was, “We need this system in America, right now.” Ironically, King Ralph was saying to Albertans, “We need the American system here, right now.” (Paraphrased, of course. Ralph actually talked about “choice,” not “pay to be first.”) Almost 30 years, and the peons of Oiberduh haven’t learned a thing.
Mike in Edmonton: you’re right Ralph did try “the third way” which was supposed to be some kind of cross between the Canadian and US system and was offered under the banner of “choice.” I’ve noticed lately when a government is offering me “choice” it usually comes at a price. Which is fine I suppose for those who can afford to pay, but not so good for those who can’t and are still reliant on the public system which has been systematically undermined.
Thanks Mike Priaro. You make an excellent point when you connect the lack of accessible and affordable healthcare to the rise of Donald Trump.
I shudder to think what will happen to Americans as covid-19 continues to ravage the country. The pandemic is hurting the economy, more and more businesses are downsizing or shutting down. This means the employees who used to get health insurance for themselves and their families through their employers will be high and dry.
If by some miracle, these unemployed individuals find alternative employment, there’s no guarantee their new employers will provide the same health insurance benefits that their old employer provided.
Who in their right mind would agree to tie their access to decent healthcare to the financial well being of their employer and his insurance company?
I hope this decision will make Crooked Kenney pause in his efforts to dismantle the Public Health Care system in Alberta.
I’m sorry, Tina. I doubt anything will derail Lord Jason. He knows what’s best, and he’ll give it to us, like it or not. Best we can do is shout loud enough to distract him, survive the inevitable hissy fit–and then kick him out of office in 2023.
Tina, I think Mike is probably right and Kenney will be undeterred.
The law prof Lorian Hardcastle is going to post a second blog in which she applies the comparative health policy evidence of this case to privatization in Alberta. Regardless of what the lawyers say, I think Kenney will plow ahead with privatization, just as he’s plowed ahead with the $30M/year war room and the Public Inquiry into Anti-Alberta energy which is now at least 6 months overdue and $1M over its original budget, etc, etc.
Ideology drives this government more than any government that has gone before it.
Well, well. Brian Day is supposedly the premiere example of for-profit health care provider in Canada. I’d guess he’s modeled his business and his medical practice on US procedures.
This is interesting: “One doctor said that in 2016/2017 he earned $240,000 in government billings compared to approximately $950,000 in private clinic billings.” How can Day pay four times the rate of public service? Day was “unable to provide an explanation” for the huge difference. I wonder how much he charges for access to his private hospital? How well does he pay his non-union staff? If he can’t explain his time-costing practices, what does that say about his record-keeping? If he WON’T explain, what does that imply about his business practices?
Even more disturbing is the quality of Day’s “expert witnesses.” Four who were (apparently) coached by Day himself, and at least three ignored because they were writing for pro-business think tanks. Day himself was “argumentative.” Tell me, Ms Soapbox–how do judges respond when a plaintiff gets snarly in court?
Sure seems to me that Day’s argument could be summed up as, “I want to, so I will.” It might make a good business case, but not a good legal one.
Ms. Soapbox, you imply there are two remaining levels where Day can appeal his current loss. Can’t someone just pass this straight to the Supreme Court and save time and money for everyone?
Mike, from my understanding of the decision, private doctors get 2 to 4 times what the government pays them for the same services because private patients pay for everything–hundreds of dollars for the initial “consultation” fees, hundreds of dollars for the facility fees and equipment fees and any other fees the clinic decides to charge. The procedure is free in the public system and costs thousands of dollars in the private system. These fees are paid into general revenue, when all the costs are deducted, the clinic owners take their cut and whatever is left over is paid to the doctors. It beggars belief that Dr Day, a very successful businessman, had no idea how the calculations were made.
You asked how judges react to evasive and argumentative witnesses. Just like Justice Steeves, they give very little or no weight to the witnesses’ testimony. Here Dr Day hurt his case when the judge threw out his evidence wherever it was contradicted by other witnesses or documents.
With respect to jumping directly to the Supreme Court of Canada (SCC), that only happens in constitutional questions from the government (like when the Feds went to the SCC over Quebec’s separation referendum question). In this case Dr Day will file for leave to appeal to the Court of Appeal, the CA can hear the case or not, if it hears the case and Dr Day doesn’t like the result he can file for leave to appeal to the SCC who will decide to hear the case or not. If a higher court refuses to hear an appeal, that means the lower courts’ decision is the governing law. This is why Justice Steeves’ 880 decision is so important. It’s like the BC trial judge who wrote an extensive decision in the assisted dying case. Her legal reasoning was sound, there were fewer grounds for appeal and in the end, the SCC agreed with her and made assisted dying legal across the land.
Susan, thanks for the reply and explanation. I don’t see mention any provincial funding for Day’s clinic; we can at least hope it’s not subsidized by tax dollars (as I suspect most Alberta “extra-billing” clinics are). Let’s hope the CA will confirm Justice Steeves’ decision. Perhaps Day will be so cheesed off he’ll move south….
Wow. Thank you for this meticulously written and engrossing long read. It’s hard to fathom that anyone would want to move in the direction of the US healthcare “system”, and those scary quotes are like a pair of conceptual rubber gloves around the word to prevent ideological infection. Having two-tiered healthcare would start a snowball of privatization that would be the end of this country. I don’t know how the new agreement works, but the old NAFTA specifically stated that if any privatization occurred in the healthcare system, it would allow the US to offer privatized care in this country. All or nothing.
I don’t know what is meant by “delays” having never experienced, or felt that I experienced, delay in any of my treatment in over 60 years of accessing our system. I DO understand the concept of triage, and I suspect that some people merely feel entitled to immediate action when in fact their condition might not warrant that. I feel that this is one way we ration healthcare and reduce costs, usually a selling point to conservatives. In the US, they ration on ability to pay. I know which version I prefer.
On “rationing”, I’d like to suggest that we could certainly set up a health care system with virtually no wait times … but it would be enormously inefficient. It’s a bit like going into a grocery store with too many tills open — yes, that does happen on occasion lol — and a bunch of cashiers sitting around twiddling their thumbs, with no customers to keep the, busy. There would be so much excess capacity that the cost would be astronomical.
On the other hand, we all hate waiting in long lines, whether it’s at an understaffed grocery store with only two tills open in a bank of 10 or 12 — or for a CT scan, MRI or joint replacement. The optimum wait time — not so short that the system is severely under-utilized & inefficient, but not so long that people are left to suffer and maybe even die on the wait list — is a highly subjective and heavily politicized issue.
Wait times are also very complex. Hers a scenario: Let’s assume you decide your hips are sore and it’s getting harder to walk the dog. You make an appointment with your primary care provider — maybe you have to wait a couple or three weeks to get in, so there’s one wait time. Your PCP orders a set of X-rays; maybe you get in the next day, or wait a few weeks, it kind of depends: there’s another wait time. You make a follow-up appointment to get the results … oh, no, your PCP is on vacation, so you wait another two weeks to get your appointment. When you finally get in, your doctor or NP tells you the joint is wearing out, and you might need a hip replacement. But first, s/he decides to try more conservative management & sends you to physiotherapy, and says “come back & see me again in three months”.
So you go to PT, and at first it helps. So, at the 3-month follow-up, you and the Dr/NP decide to hold off. But, six months or a year later, things are worse than they’ve ever been, and you go back. Another wait to get in, another X-ray, another follow-up to get the results. This time, you’re told, ”I’m going to send you to an orthopod”, and s/he makes a referral to an orthopaedic surgeon. Then you wait for that consultation… a few weeks, a few months, maybe longer, depending on where you live & how many orthopods are practising in your area, and whether they each manage their own referrals or there’s a central pool. You finally get your consultation, and the surgeon says, “yup, you need a new hip”. He sends off an OR booking request to the hospital where he has privileges, and then you’re on yet another wait list … maybe 6 months, maybe 18, who knows?
So, how do we measure the wait time? From the first time you called your doctor for that initial appointment for the sore hips? Or from the time the orthopod sends the OR booking request?
Jerrymacgp: you’re exactly right when you say it’s difficult to measure wait time.
Justice Steeves spent a lot of time on this, pointing out as you did that many things can make wait times longer including patients refusing to be switched to a surgeon with a shorter wait list or wanting to delay surgery because they’re going on vacation.
Given that a key argument in Dr Day’s case is that patients’ constitutional rights are violated because public sector wait times are too long, it was critical for Justice Steeves nail this issue down. As you point out, there are many different ways to calculate wait times.
Steeves considered evidence from a number of different sources. He tossed out the federal benchmarks because they were too generalized. He tossed out the Fraser Institute expert whose analysis was based on a survey so flawed it didn’t even meet the Fraser Institute’s target response of 25% to 30% (I can’t figure out why Day’s lawyers submitted this “expert” in the first place) and he finally settled on the BC prioritization codes and corresponding wait time benchmarks.
The fact he engaged in a thorough analytical review will help his decision withstand appeal.
David great comment and especially your very last sentence.
I also know which version I prefer.
Carlos: that makes two of us!!
David, what an interesting point. I haven’t looked at NAFTA 2.0 (or whatever we’re calling it now) but your comment reminded me that the US is trying to negotiate a trade deal with the UK post Brexit and Trump caused a lot of controversy when he said when you’re talking about trade everything is on the table including the NHS. I’ve heard from my friends who are closer to the privatization issue in Canada, they tell me the American private health insurance companies are chomping at the bit to get their hands on our public healthcare system.
A ‘win’ for a publicly funded health care system is when a disease is effectively cured, the cheaper and more safely the better.
According to its own inherently amoral principles a completely market driven health ‘care’ delivery system naturally prefers illnesses remain incurable and chronic, with symptoms that can only be ~alleviated using expensive drugs. Cures don’t pay as well.
Just sayin’
Absolutely and we all know where we were even before the pandemic. The market driven, greed is good revolution of the last 30 years hit the wall for the same reason. It is a crazy, unsustainable profit driven process that is driving everything to collapse and it will end life on earth as we know it if we do not stop it in time. It is not just the health care system, it is a lot more than that.
Carlos, when I think about the impact of climate change on humanity (it’s becoming more obvious every day), I’m astounded by statements by politicians like Kenney who continue to pin “prosperity” on fossil fuels and tell us we have to convince the marketplace (which is who exactly?) to buy Alberta oil instead of “dictator-produced oil.”
The marketplace is driven by profit. It will buy the cheapest oil first. It has no heart, no soul and it doesn’t give a fig for Kenney’s dictator-produced (bad) oil vs Alberta-produced (good) oil distinction.
The irony is the marketplace has finally woken up to the impact of renewables and alternative energy on fossil fuel demand. Some companies and governments are changing gears. Others (like ours) still have their heads in the sand.
Here’s an interesting but disturbing link demonstrating the impact of climate change on population migration in North America. Spoiler alert: the Americans are coming.
https://projects.propublica.org/climate-migration/
GoinFawr: I think your argument works well in the case of pharmaceutical companies. What this case demonstrated was a major problem with a free market solution to healthcare is it can and does cherry-pick who gets treatment. The private clinics offer elective surgery, they do not accept patients with complex or life-threatening conditions which undermines the argument that preventing patients from accessing private services violates their charter rights of life and security of the person.
Furthermore, if a private patient develops a life threatening condition following surgery, s/he is bounced back into the public system.
All in all the Cambie case isn’t so much about alleviating pain and suffering as it is about allocating priority service to those who can afford to pay and allowing the surgeons who provide such services to make a lot of bucks doing so.
The only way ordinary people can afford to access this kind of care is if they obtain private health insurance and that would be disastrous to Canada’s universal public healthcare system.
Look at this
How can this people run anything other than the kids water parks and badly
https://www.cbc.ca/news/canada/calgary/foreign-funded-anti-alberta-energy-inquiry-1.5725780
talk about waste of money
talk about lunacy
talk about a complete group of idiots
Dr. Day seems a bit grasping to me. Doctors generally enjoy a financially comfortable life in the public system in Canada and in Alberta at least until recently. Well, perhaps not as financially comfortable as private clinic owners, but none the less reasonably good.
I don’t think he is doing this for the good of patients, as that arguement is very self serving. Those patients that can’t afford his clinic unfortunately get no treatment there. There is no waiting line, because those that can’t afford it can’t even get in the line.
I also don’t buy the arguement that private clinics like his take the pressure off the public system. There are only so many hours and so many doctors to go around. The more work is focused in private clinics takes away resources from the public system. In my mind there are only two positions – in and out. If a few doctors want to work solely in the private system without any government funding at all, I suppose they can choose to if the small number of patients who can afford to pay them is lucrative enough. However working in both systems will just lead to cherry picking and reduced time spent in the public system.
Hopefully this case will serve as a warning to the current Alberta government to back away from contemplating such privatization. However, I think they are quite ideologically rigid on this and will not be easily discouraged from heading in this direction. It will probably take a great deal of public pressure to stop them, in addition to court rulings such as this.
Dave, I agree with your points, especially where you said it’s either in or out. Not one of the doctors who testified in the Cambie case said they wanted to go out on their own. They wanted the best of both worlds, the ability to charge the government the going rate for their services and then top it up by charging the patient (or his/her insurer) hundreds of dollars more in return for getting to the front of the line.
In all the years I’ve been following this issue I’ve heard of only one doctor, a 60-something orthopedic surgeon here in Calgary who opted out of the public healthcare system and charges his patients the full price for his services.
As to whether this case will serve as a warning to the UCP government, I wouldn’t hold my breath. They’ll push ahead with everything they can until they’re stopped in court or thrown out of office.
Yes Susan these people all complain about lack of freedom to choose but they never really explain to the public what they are talking about.
The same apply to private schools. If people are so concerned about choice that is fine lets get the private schools but no public funding. That way there are real savings to the public budget. This idea of Freedom with other people’s money is just complete garbage. The UCP does not seem to understand what the difference is, To get extremely rich with public money is what they are doing with this neo-liberal propaganda. The selling of public assets like they have done around the world to their friends for peanuts is what they call investment. Well buying a public airport for 100 dollars and then get rich on it just because you have personal access to those who can do that is what they call creating jobs. This has been done all over the world especially in Russia where all the housing that governments owned was offered for nothing to Russian oligarchs and even allowed them to expel seniors to then sell them for millions. That is how Putin got a hold on the Russian establishment. This is all written in articles especially by the Atlantic magazine and it did not even get the attention of the media controlled by the same people. In Canada we still can not do it so obviously but it is getting there with Oil companies and others paying less taxes than people like you and me. For example ask CRA, if you are allowed, how much Amazon is paying in taxes in Canada versus their revenue, try it if you doubt what I am saying. You will be surprised. I on the other hand as a citizen cannot even ask for my taxes not to be taken out at the source. We have no choice. The freedom of choice is at a different level. We all have to pay to balance the ones that have a choice.
Justin Trudeau forgot one more very important foundation issue in his throne speech – total political revamp with direct involvement of the public. Trying the same over and over without change and expecting different results is the definition of idiot according to Einstein. I respect Einstein more than i do politicians, prime ministers or presidents.