Monday, May 10, 2004

Penner shows health care better if you can pay

VICTORIA - Queue-jumping MLA Barry Penner deserves our thanks.
The Abbotsford Liberal pushed the issue of two-tier health care out in the open, by taking the dramatic step of paying for surgery at a private clinic to avoid health care wait lists.
Let me be clear. If was in Penner's situation, I would do the same thing. He's had a bad back for a couple of years, and injured it while exercising in mid-April. His doctor put him on a wait list for surgery to repair a damaged disc. It was elective, but it was pressing enough that the operation was scheduled within a couple of weeks.
Then the Hospital Employees' Union strike began, and the procedure wasn't urgent enough to be done under essential services.
Penner says his doctor disagreed. He was in pain, and worried - even scared, I'd say - about long-term damage. So he went to a private clinic and paid for the surgery.
I'd do the same, even knowing that the surgery was probably illegal. (And I, like Penner, would express regret about it.)
But that's not the way health care is supposed to work in Canada. The Canada Health Act requires equal access to care. Canadians have taken it as a principle that income shouldn't determine who gets needed treatment and who has to wait.
Governments have been working hard to ignore the reality that private treatment has already created a two-tier system.
Which is fine if you have money.
But what if you can't come up with the cash? (Penner won't say how much his operation cost, because the clinic swears clients to secrecy, a nice surreptitious touch.)
Then you wait. You risk the permanent damage Penner was worried about. If you don't have the same benefits as MLAs, you lose income. You suffer.
That is today's reality - a world in which there is one standard of health care for people with money, and another for those without. So far government's have decided to pretend it's not happening. Health Minister Colin Hansen introduced a bill last year that would have targeted the abuses. The Liberals passed it. But then Premier Gordon Campbell, under pressure from private clinics, said the law wouldn't go into effect.
The government is still trying to avoid the issue. Hansen struggled to explain why Penner's surgery - and thousands more like it - aren't a violation of the Canada Health Act's ban on paying to jump the queue for medically necessary procedures.
Penner didn't jump the queue, Hansen said, he just stepped out of it.
Anyway there's no clear definition of medically necessary, Hansen added, although surely Penner's surgery would qualify under anyone's definition.
And he noted correctly that Penner would have got his surgery in the public system if not for the strike.
But this isn't about the strike. Waiting lists have climbed steadily since the election, and private operations for people who don't want to wait are done every day.
At its base the issue isn't complex. Waiting lists are climbing because governments won't pay for the treatments people need. There are enough operating rooms, nurses and in most cases doctors. Governments don't believe treating people in a timely way is a spending priority. (Every year since 1997 about 2,600 British Columbians have been told they need hip replacements and put on a waiting list. But in every year but one 2,300 replacements have been performed. So waiting lists grow until it now takes an average four months to get an operation. A one-time $25-million investment would clear the backlog.)
Penner deserves our thanks. He has provided a high-profile demonstration that two-tier care exists.
Now all Canadians need to decide if we are ready to accept a health care system which lets people with money get speedy treatment, while others wait, and often, suffer.
Footnote: Hansen also noted that queue-jumping has already been sanctioned by the federal government in some cases. The WCB can pay for private treatment for claimants, and RCMP members and federal prisoners also are allowed to go private. When injuries and illness cost governments money, they find ways around the queue. In opposition, the Liberals opposed the practise; they have now changed their minds.

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