A self-styled champion of privatized health care is bringing his fight to B.C. Supreme Court next week for the start of a months-long trial he says is about patients' access to affordable treatment, while his opponents accuse him of trying to gut the core of Canada's medical system.
Dr. Brian Day of Cambie Surgery Centre in Vancouver is challenging B.C.'s ban on the purchase of private insurance for medically necessary services that are already covered by the public system. He argues the restriction violates patients' constitutional rights by forcing them to endure gruelling wait times that often exacerbate their health problems.
"This is about making medicare better," said Day.
A statement from the B.C. Health Ministry, the defendant in the case, said its priority is to uphold the Medicare Protection Act and the benefits it safeguards. It declined further comment while the case is before the courts.
Hearing finally set to begin after six years
Day launched the lawsuit in 2010. There have been a number of delays, including a one-year postponement while the two sides unsuccessfully tried to reach an out-of-court settlement.
Canada's inefficient system is the product of a wasteful bureaucracy, a lack of competition and a misguided attachment to universal coverage, Day argues.
He said opening the door for private insurance would ease pressure on the public system, freeing up resources to cut wait times and boost the quality of care for everyone, whether publicly or privately insured.
It's widely agreed the lawsuit could have far-reaching ramifications for health care in Canada.
Adam Lynes-Ford of the B.C. Health Coalition, one of the interveners in the case, said making space for private health care flies in the face of the core Canadian value that people should have access to medical care based on need, not on ability to pay.
"This is such a profound threat to the health of everybody in Canada," Lynes-Ford said.
He said a win for Day would lead to a more U.S.-style medical system, meaning longer wait times for the average Canadian and skyrocketing costs as limits are lifted on what doctors can charge patients.
'Medicare is being put on trial'
Colleen Flood, a law professor at the University of Ottawa, described Day's lawsuit as one of the biggest constitutional cases "perhaps ever."
"Basically, medicare is being put on trial, and will likely be found wanting in many regards," she said.
"But the question is whether the cure for what ails medicare is more privatization. That's what Dr. Day is arguing," she added. "I don't think so myself and I think the weight of the evidence is against that."
Court battles over private health insurance aren't new to Canada. In 2005, the Supreme Court of Canada granted Quebecers access to private insurance when it ruled that excessive wait times infringed on patients' constitutional rights.
While that decision was argued under the Quebec charter and as a result didn't extend beyond that province's boundaries, a judgment in Day's case would make waves across the country.
Yanick Labrie, an economist affiliated with the Canadian Health Policy Institute and the Fraser Institute, said Day's case boils down to a patient's right to choose.
Greater choice among insurance providers would encourage more competition, which would boost efficiency and improve access, Labrie said.
"We should still expect to have a universal system, but in which you have some element of competition and choice for patients," he said, adding that a win for Day and the introduction of a hybrid health-care model would be a "revolution."
Problems with introducing regulation, professor argues
But Karen Palmer of Simon Fraser University's faculty of health sciences said attempts at introducing and enforcing a proper regulatory framework elsewhere in the world around a public-private system have been challenging.
"It's a bit like that game whack-a-mole," said Palmer, who is also affiliated with the Evidence Network of Canadian Health Policy. "Every time you make a regulation, somebody finds a way around it and it becomes a game."
She derided the suggestion that privatization would address the underlying challenges facing medicare, calling it a flawed attempt to fix the wrong problem.
"If their constitutional challenge is successful, the door will swing wide open in British Columbia and across Canada for insurers to sell what will amount to private queue-jumping insurance for those who can afford it, potentially harming the rest of us," Palmer said.
But even a victory for the province should serve as "a huge wake-up call to government decision-makers that we dodged a bullet" and urgently need to improve how care is delivered, she said.
The federal government has also applied to be an intervener in the case, arguing that any challenge to a principle so fundamental to the Canadian health-care system is of significant concern.
"Canadians overwhelmingly support universally accessible health care," government spokeswoman Rebecca Gilman wrote in an emailed statement.
Gilman reaffirmed the government's commitment to Canadians having reasonable access to medically necessary services based on need and not ability or willingness to pay.
Geordon Omand, The Canadian Press