Friday, January 19, 2007

Big change on politics of two-tier care

VICTORIA - It feels like the political winds are shifting on health care. Governments' interest in private, two-tier care is fading and they're backing away - at least slightly - from the argument that we can't afford to care for sick people.
The Lower Mainland Medical and Laser Clinic was the latest to test the B.C. government's commitment to universal health care.
The doctors decided the Medical Service Plan payment rates aren't high enough. Their solution was to introduce reservation fees to push up revenues, a change announced in a letter to some 1,000 patients.
Patients could choose to pay an annual fee - $125 for families, $75 for singles - that would allow them the right to make doctors' appointments. Or they could pay a $30 fee each time they called to make an appointment with their doctors.
People who didn't want to pay wouldn't be turned away, the clinic said. They would just have to show up and wait in the office to see if their doctor could find time for them after the fee-paying customers had been treated.
The fees are a blatant violation of the Canada Health Act, B.C. legislation and the basic principles of medicare. Doctors simply aren't allowed to take payments from the public system and extra-bill patients at the same time.
With good reason. Those kinds of fees undermine the basic principle of equal access. They allow people with money to get faster, better access to care than their less affluent neighbours. People without the money to pay the fees suffer.
What's the big deal about an extra $30? Studies have shown that even small user fees deter people from seeking treatment. Sometimes that means one less unnecessary trip to the doctor's office or emergency ward.
But other times it means a cancer gains time to spread or a small infection, which could have been easily controlled, becomes a raging problem that requires a hospital stay.
And the user fees, of course, push up health-care costs.
That sounds obvious, but it seems lost on some of the advocates of more private, user-pay care who claim that it would somehow magically reduce health-care spending.
If you go to the doctor, the MSP fee for the basic visit is about $27. (Which explains why it might feel like you're being rushed in and out; that doesn't cover a lot of the doctor's time.)
But the reservation fee would double the cost for the exactly same service. Multiply that effect across the system and the amount of money being consumed by health care soars.
The U.S. experience has shown, user-pay health care costs much more. That's why California Governor Arnold Schwarzenegger is getting business support for a universal public health-care plan. Health care costs in the U.S. are consuming 14 per cent of GDP; in Canada, about 10 per cent. If our costs rose to the U.S. level, we would spend an extra $80 billion a year on health.
And that's why Alberta this month officially abandoned plans to develop a "third way" in health care that included user fees and two-tier care. The approach would do nothing to make the system stronger or mores sustainable, the government concluded.
Despite all that, B.C. - under both Liberal and NDP governments - has done little to stop the slow, steady spread of two-tier care, preferring to ignore the violations. Clinics routinely offer speedier surgery, tests and treatment to those who can pay extra while government looked the other way.
Until this time, when the government and College of Physicians and Surgeons moved quickly to press the clinic to abandon plans.
It t might be a blip. But equally, following closely on the shutdown of another clinic planning to offer premium emergency care to those who could pay a surcharge, it might mark a change.
Two-tier care is illegal, wrong and sends health-care costs soaring.
Most of the public knows that. Perhaps the government has been listening to you.
Footnote: The clinic's bold effort to introduce the fees shows how confident those in the industry have become that the government won't enforce the law. But the old response, a mix of willful blindness and then tough talk and no action, no longer seems to apply.


Dave Macmurchie said...

It may be that the Americans (the public, that is, not the political leadership) may be getting the message. Note this item from the Washington Post:

Gazetteer said...


I hope you are right about the legislators' 'change of heart'.

However, if one were a skeptic who views things like junkets to Europe to set up green-gowned photo-ops in P3 hospitals with vocal proponents of two-tiered care in tow you just might view the kind of thing that was done by Dr. Montgomery and the folks from the False Creek Clinics a sentinel node-like exercise in 'envelope pushing'.

Personally, in the absence of any concrete moves to halt this type of activity (ie. witness the provincial gov't's willingness to make 'deals' with the False Creek Urgent Care Ctr just last month) I am still in the latter camp.


(then again, given the subject of your recent front page piece in BC Business perhaps you are privvy to some inside info that we don't know about, re: the true intentions of the folks that are now influencing BC Gov't policy)