SINGLE-PAYER HEALTH CARE IN CANADA
Single-Payer Health Care Isn’t Worth Waiting For
An orthopedic surgeon challenges Canada’s ban on most privately funded procedures.
When Brian Day opened the Cambie Surgery Centre in 1996, he had a simple goal. Dr. Day, an orthopedic surgeon from Vancouver, British Columbia, wanted to provide timely, state-of-the-art medical care to Canadians who were unwilling to wait months—even years—for surgery they needed. Canada’s single-payer health-care system, known as Medicare, is notoriously sluggish. But private clinics like Cambie are prohibited from charging most patients for operations that public hospitals provide free. Dr. Day is challenging that prohibition before the provincial Supreme Court. If it rules in his favor, it could alter the future of Canadian health care.
Most Canadian hospitals are privately owned and operated but have just one paying “client”—the provincial government. The federal government in Ottawa helps fund the system, but the provinces pay directly for care. Some Canadians have other options, however. Private clinics like Cambie initially sprang up to treat members of the armed forces, Royal Canadian Mounted Police officers, those covered by workers’ compensation and other protected classes exempt from the single-payer system.
People stuck on Medicare waiting lists can only dream of timely care. Last year, the median wait between referral from a general practitioner and treatment from a specialist was 21.2 weeks, or about five months—more than double the wait a quarter-century ago. Worse, the provincial governments lie about the extent of the problem. The official clock starts only when a surgeon books the patient, not when a general practitioner makes the referral. That adds months and sometimes much longer. In November an Ontario woman learned she’d have to wait 4½ years to see a neurologist.
Some patients would gladly go to a clinic like Cambie for expedited care, paying either directly with their own money or indirectly via private insurance. But Canadian law bans private coverage for “medically necessary care” the public system provides and effectively forbids clinics from charging patients directly for such services. The government views this behavior as paying doctors to cut in line. Doctors who accept such payments can be booted from the single-payer system.
Dr. Day’s lawsuit aims to overturn these provisions. It alleges that the government’s legal restrictions on private care are to blame for the needless “suffering and deaths of people on wait lists.” Dr. Day argues that the current system violates citizens’ rights to “life, liberty, and security of the person,” as guaranteed by the Canadian Charter of Rights and Freedoms, the equivalent of the U.S. Bill of Rights.
Moreover, Dr. Day claims the government has long tacitly approved of patients paying private clinics out of their own pockets. For decades, he argues, conservative and liberal politicians have offered him quiet praise and encouragement even as they publicly defend the single-payer system. It’s easy to understand why Canada’s leaders would talk out of both sides of their mouths. Private clinics perform more than 60,000 operations a year, saving the public treasury about $240 million.
British Columbia’s lawyers know that Dr. Day could embarrass Canada’s double-talking politicians by naming them at trial. This could explain the endless stream of seemingly deliberate delays that have kept the court proceedings moving at a snail’s pace. Dr. Day and his colleagues were supposed to testify in November but may not take the witness stand until February or March at the earliest.
Canadians have suffered long enough under single-payer waiting lists. There shouldn’t be a waiting list for justice, too.
Ms. Pipes is president and CEO of the Pacific Research Institute and author of “The False Promise of Single-Payer Health Care,” forthcoming from Encounter.
