The recent finding by the Medical Services Commission that two private clinics in B.C. have been extra-billing their patients should surprise no one, and the finding will have absolutely zero impact on the health care system itself - at least, for now.
But make no mistake - the Supreme Court of Canada may eventually have to rule on whether such extra-billing is legal or not, and that ruling could have a profound impact on the public health care system.
Dr. Brian Day, who runs the Cambie Surgery Centre in Vancouver, is adamant that any person should be able to purchase health services if they so choose. If a person is in pain and needs an operation, and if they have the financial resources necessary, they should be able to quickly alleviate that suffering rather than spend time on an often lengthy wait-list in the publicly-funded health care system, Day argues.
Presumably, there are a lot of people who agree with that point of view. But there are also many who don't, and they fear legalizing extra-billing will simply open the door for physicians to charge whatever they want for their services, and thus begin dismantling the access-for-all core philosophy at the heart of our publicly-funded system.
Of course, private clinics have been operating for years in this country and extra-billing has likely occurred since they opened their doors and started accepting patients. There is no compelling evidence they have inflicted harm on the public system.
Day has been fighting the government's attempt to rein in his clinic's activities for years. He wants to take the issue all the way to the highest court, if need be, to get government off his back and to enshrine in law a person's unfettered access to health care.
Of course, the court could rule against his argument, thus setting the stage for a confrontation between provincial regulatory agencies (like the Medical Services Commission) and private clinics, which may have to open their financial books to much greater scrutiny than they've been willing to provide so far.
But the case won't make its way to the highest court for some time yet (perhaps a year or two). In the meantime, it's unclear how the provincial government will deal with Day's clinic. The commission has said it will seek a court injunction if it detects any further evidence of extra-billing.
However, the financial penalties contained in the Medicare Protection Act (the provincial statute that specifically outlaws extra-billing) have yet to be proclaimed into law, and at $20,000 aren't terribly onerous.
It's likely this stand-off between the clinics and the provincial government will still be in place next year, which means Adrian Dix and the NDP would inherit this headache should they form government. Dix has said he would proclaim the penalties into law, and would vigorously oppose Day on philosophical grounds (he also favours returning to patients any money they paid through extra-billing).
Dix has also said he would enforce rules barring physicians from working in both the private side of health care and the public system. That may force doctors to choose sides, and the impact on private clinics when it came to retaining their physicians' services could be interesting.
Like any other service, human resources are a key component of any health care system, private or public. There are only so many doctors and nurses (and shortages exist in many areas of care) out there, and if too many work in the private side of health care, that could make wait times in the public side even longer.
So get ready to hear a lot from Day in the coming months. His fight has been going on a long time, but in many respects it's just getting started. And in Dix and the NDP, he may soon have a different and more aggressive adversary to deal with.
Keith Baldrey is chief political reporter for Global BC.
