An epic legal battle is raging in British Columbia's Supreme Court over Canada's public healthcare system, with one side arguing allowing private health care could solve chronic wait times while the other argues it could dismantle a national economic jewel.
The case revolves around crusader Dr. Brian Day's Cambie Surgery Centre, which charges patients for services.
B.C.'s Medical Services Commission, the provincial Health Ministry and the federal government, which is an intervenor in the case, say what the doctor is doing is illegal and are fighting to stop him from toppling Canada's equal access model.
For nine years the clinic's attempt to win for British Columbians the right to pay for health care — if they choose to — has plodded along, with a judge now set to decide whether B.C.'s Health Minister must testify.
- Whether to allow private insurers in B.C. to pay for services available under the public health system.
- Whether doctors can charge privately for services.
Any ruling in the case could set a precedent for the rest of the country.
Quebec 2005 ruling
The trial was the first challenge since a Quebec case ended in Canada's top court in 2005, ruling a private healthcare ban unconstitutional.
But that decision only dealt with allowing private insurance, not allowing doctors to bill market value for procedures offered by public healthcare.
Patients now get everything from hip replacements to mastectomies in private clinics, some covered by private insurance.
In B.C., doctors can currently charge legally for services — if they are elective services and the doctor has opted out of the public health billing system.
A 2012 audit of Cambie Surgery turned up a half-million dollars worth of illegal billing, as the centre charged both patients and the province.
So the fight began.
'Worst in the world'
The B.C. case has so far been before three judges.
Patrick McGeer, a neurologist and former Social Credit cabinet minister, took the witness stand this week to underline endemic problems with B.C. health services.
"It's insanity. There isn't a place in the world, except maybe North Korea, that has adopted the Canadian system. Why not? Because it's the worst in the world," said McGeer in an interview.
He is one of 107 witnesses being called to testify in the fight to allow the public to opt to pay for medical care.
McGeer wants the province to settle the case and let unlimited for-pay services in, as he's convinced case law has already been written in Quebec that guarantees British Columbians have the right to pay for healthcare — not just to a spot on a wait list.
Wait list purgatory
Despite increased operating room openings and surgeries, more British Columbians are on wait lists than ever — the total number increasing from 77,655 in March 2015 to 85,801 by the end of 2016.
The average wait time for an elective surgery — meaning a surgery not needed to save a patient's life — is now seven weeks.
McGeer blames chronic wait lists, idle surgeons and closed surgeries on hospital budget restrictions that force a top-heavy administration to ration services.
He's convinced introducing a two-level system would solve everything, pointing to Germany and other European countries that have "none of Canada's problems."
Crack where the light gets in?
But public healthcare — long considered the jewel in Canada's crown — is a divisive issue. Many fear allowing private pay options and private insurance would water down the public system and create a health services class system.
The B.C. Health Coalition consulted economist and former automotive union spokesman Jim Stanford as an expert in the trial.
He sees public healthcare as a major Canadian asset that both attracts business and ensures healthier people.
It saves automakers about $10,000 a year per employee, he said.
"There is no benefit whatsoever to dismantling a universal and relatively efficient system such as Canada has," he said.
Stanford believes the push for private comes from those who stand to make cash — private insurers and doctors.
A recent move to Sydney, Australia, gave Stanford proof that opening the door to private providers creates the feared two-tier system.
Private health providers cherry pick, marketing profitable services and leaving less profitable ones like emergency care to the public system, he says.
This results in an "expensive, inefficient hodgepodge."
But worse is the political dynamic.
"Well-off people who can have themselves covered through the private part of the system — they don't care about the public system anymore," Stanford said.
"Everything you are telling me is complete and utter nonsense. Completely ridiculous," he said. "That wouldn't happen here."
He insists the Canadian system is broken, although when asked about his own knee replacements he admits: "If you are a physician, you get special treatment."
So the current system, it turns out, already has a few tiers.