Need, not privilege

Written by Brenda Schimke

It took nearly four years and an 880-page judgement for the B.C. Supreme Court to rule on whether patients could be allowed treatment based on their ability to pay instead of medical need.

Thankfully, medical need won the day.

The argument by the plaintiffs, led by Dr. Brian Day, chief executive of the for-profit Cambie Surgeries Corporation, was that patients’ constitutional rights were being violated when they did not have the right to access private surgeries and tests sooner if they deemed the public system wait times to be too long.

Day’s for-profit facility has been operating since 2003 providing both public and privately-funded surgeries in violation of the B.C. Medicare Protection Act. Had this challenge succeeded, Dr. Day would have inked a personal financial windfall, whereas now he owes thousands of dollars in outstanding fines.

In the written judgement, Justice John Steeves acknowledged that indeed some patients suffered terribly by having long wait times; however, the plaintiffs failed to show that patients’ constitutional rights were being violated.

The decision once again reaffirmed the cornerstone principle of Canada’s public health care system,’ access to necessary medical care is based on need and not on an individual’s ability to pay’.

Justice Steeves reiterated the preponderance of expert evidence that concludes under a private/public model, wait times increase and cause more inequity in the system.

Private surgeries siphon medical staff and resources from the public system and leave the most difficult, costly patients behind in the public system.

That doesn’t mean Dr. Day or Cambie Surgeries can’t exist in Canada, it’s just that they would have to step away from the public system—it’s one or the other. 

Co-mingling private and public under the same corporation is a gateway to abuse of public taxpayer dollars. It’s time the Dr. Day’s of this world become true businessmen and not count on taxpayers to be their financial backstop. 

It would be a sweet deal, indeed, were a surgeon just able to do enough public surgeries to pay expenses while focussing the majority of his efforts on private patients and personal wealth enhancement.

But there’s another side to this judgement that speaks directly to the federal and provincial governments and it should be a wakeup call. Shirking responsibility by unilaterally cutting health care budgets and turning public health care over to the private sector is no longer the easy ‘fix-of-choice’.

Changes are needed immediately.

The federal government, at a minimum, must restore health care transfers back to provinces.

The federal government once supported 50 per cent of provincial health budgets, but since the time of Finance Minister Paul Martin, and subsequent neo-liberal governments, it’s now dwindled to less than 23 per cent. 

The pandemic has shown how willfully inadequate and inefficient many aspects of our health care has become, including seniors’ care.

In turn, provincial governments need to start consulting ‘those in the know’, rather than ‘those in the old boys club’. 

History has proven the more politicians directly involve themselves in the health care file, the poorer the outcomes and the longer the wait-times.

Draconian budget cuts or political-expedient cash injections didn’t and couldn’t deliver long-term, sustainable efficiencies.

Efficiencies come when medical processes and delivery make sense and are predictable. 

Politicians, profit-seeking businessmen and politically-motivated academics have never understood enough to make sense of health care delivery or efficiencies. 

Everything must start with front-line medical professionals, supported by medical administrators and budgeting experts.

This significant court decision is instructive and important for all Canadians. It clearly re-affirms that Canada’s public health care system is about funding need, not privilege.

Schimke has spent more than 35 years researching and writing on private/public health care.


Brenda Schimke

ECA Review

About the author

Brenda Schimke

Schimke is a Graduate with Distinction from the University of Alberta with a BCom degree. She has lived and worked in Alberta, BC and Ontario.