Defenders of medicare — and that includes the overwhelming majority of Canadians — can unclench a bit following the long-awaited ruling by a British Columbia judge on the limits to private health care.
The stakes in the case were always blown out of proportion. Regardless of the way it went, the fight to safeguard and strengthen medicare would have continued.
But Justice John Steeves’ ruling this past week was unmistakeably a victory for medicare and the principle of an equitable health-care system.
The ruling will be appealed, probably all the way to the Supreme Court of Canada. But it’s obviously better to start with a judgment that affirms the basic values of our public system.
Justice Steeves did that by upholding three key provisions of B.C.’s Medicare Protection Act which were challenged by Dr. Brian Day, who operates one of six private surgical clinics in the province. Those provisions include bans on extra-billing, on selling insurance for “medically necessary care,” and on allowing doctors to practise in both the public and private systems at the same time.
Steeves’ judgment runs to a mammoth 880 pages, but his bottom line is that those prohibitions are reasonable. They “are not arbitrary, overbroad, or grossly disproportionate” to the legitimate goal of providing a universal public healthcare system and ensuring that access to medical services depends on need, not the ability to pay. And that, indeed, is the essence of Canadian medicare.
So far, so good. But it should be the beginning of the story, not the end.
Back in 2016, when Day began his case in the Supreme Court of B.C., we wrote that Day had “struck a nerve” by highlighting some of the more glaring shortcomings of public health care.
Most obviously, they included lengthy wait-times for some procedures and clear inequities in the system. The biggest clients of B.C.’s private clinics, it turns out, are public agencies like workers’ compensation, which have sent tens of thousands of patients for private treatment because it’s quicker and saves money. Yet others must wait many months for the same operation in a public hospital.
The public system can also be frustratingly slow to change, while private clinics are quick to innovate. No wonder British Columbia has no plans to do away with the private clinics that have operated there for more than two decades in close cooperation with the public system. They’re just too useful.
But the issue has always been how to improve medicare, not to stick a crowbar into the cracks and pry it apart. Why risk destroying a system that has served so many people so well over the years? There’s very little public support for going in that direction, and given Justice Steeves’ landmark ruling, no convincing legal case either.
The job that needs to be tackled now isn’t undermining medicare, but how to build it up. While Canadians sing the praises of public care, they actually spend close to a third of their health-care dollars in the private sector — on things like prescription drugs, dental care, vision care, physiotherapy and home care.
Things have moved on in the decade-plus since Dr. Day first launched his legal challenge. The job now isn’t just to protect medicare as it is against efforts to chip away at it, but to extend public coverage into other areas.
A comprehensive pharmacare program should top the list, and the COVID-19 pandemic has revealed other glaring shortcomings in long-term care and home care. It’s clearer than ever that the current medicare system doesn’t meet all our health-care needs, and there’s a lot more public support for addressing those gaps.
Defenders of medicare can savour a moment in the wake of Justice Steeve’s ruling. But the real job of fulfilling the promise of the system is just beginning.
https://www.thestar.com/opinion/editorials/2020/09/11/the-real-challenge-is-to-expand-medicare-not-just-save-it.html
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