This trial could determine the future of public healthcare in Canada

Doctor Brian Day is taking Canada’s public healthcare system to court, and potentially paving the way for more for-profit clinics.

The operator of a Vancouver-based private surgery company, Day's case resumes on Monday as part of the long-running legal battle over whether patients can purchase private health insurance, and the role of for-profit clinics in Canadian medicare.

Public healthcare campaigners are arguing that Canada’s universal medicare system is on the line, while Day says the issue is about individual choice.

Medicare in Canada is administered by the provinces with cash transfers from the federal government and legislated under the Canada Health Act, legislation mandating that patients are not supposed to pay for care at the point of service. Day’s legal action involves both the province of B.C. and the federal government.

“Our system is inefficient because it is a government monopoly,” Doctor Day told VICE News. The former president of the Canadian Medical Association, Day said about 200,000 Canadians are languishing on waiting lists for medical procedures and allowing people to buy medical insurance to access private clinics like his would expedite treatments for sick people.

“Canada is the only country on earth where it’s unlawful to buy private health insurance,” he said as part of his Charter challenge.

James Hutt from the Canadian Health Coalition, an Ottawa-based lobby group, said Day’s court action “strikes at the heart of public healthcare.”

“We want a system that puts patients before profits,” Hutt told VICE News. “When people try to jump the queue by paying more it hurts the public system. “This isn’t about wait times or improving the public system, it is about profits; profit for doctors, private clinics and insurance companies.”

Representatives of both sides of the debate expect the case will end up at the Supreme Court.

CANADA VS US HEALTHCARE

Day said his clinic has been violating Canadian healthcare law for more than 20 years and he “doesn’t feel guilty” arguing that individuals should have the right to choose private facilities.

Hutt argues that Day’s legal action aims to transform Canada’s public healthcare system to something resembling the US privatized model, which is less efficient both in terms of costs and patient care, according to recent studies.

The US spends US$9,403 per capita on healthcare, or 17.8 percent of gross domestic product (GDP), according a study published in March in the Journal of the American Medical Association.

Canada, in contrast, spends US$4,641 per capita on health, or 10.3 percent of GDP, the study said.

“The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations,” the study concluded.

POLITICIANS GOING SOUTH

Day agrees the US model is inefficient, but said his aim is to align Canada’s system with European countries like Switzerland and Germany, which have universal healthcare and the option of private insurance for people who can afford it. Switzerland and Germany spend more per person on healthcare than Canada, according to data from the Organization for Economic Cooperation and Development (OECD).

Hutt said opening the system to more private clinics and private insurance will allow for-profit firms to “cherry pick” easier operations and other procedures as they could deny care to patients with complicated, expensive ailments.

This, coupled with doctors moving into private practice seeking more money, would hurt the public system, Hutt added.

While politicians champion the benefits of Canada’s public healthcare system, some government officials are happy to seek private treatment when they are put on waiting lists for care, Day said.

The late NDP leader Jack Layton, a staunch defender of public medicare, was treated for a hernia at a private clinic in Toronto (although he said he didn’t know the clinic was private at the time); former Newfoundland and Labrador premier Danny Williams travelled to the U.S. for heart surgery in 2010; and the late Ed Lawson, a senator and former president of Canada’s Teamsters Union went to the US for a quintuple bypass surgery.

Several politicians and union leaders who decry private healthcare have used Day’s Cambie Clinic, the surgeon said, refusing to provide specific names due to confidentiality.

While Day lambasted politicians for using private clinics while other Canadians are unable to do so, most Canadians support the public medicare system, according to polling data. And they’re willing to pay taxes to maintain it, which could undermine public backing for Day’s legal challenge.

Nearly 60 percent of Canadians said they would pay higher taxes if it meant the public healthcare system would finance in-home caregivers, palliative support for life-threatening ailments and financial support for families caring for ill loved ones, according to a 2017 Nanos Research survey carried out for The Globe and Mail. Less than 40 percent would oppose such tax increases, the poll said.