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.

Wednesday, January 17, 2007

Our squeamishness means more women die

VICTORIA - Up in Prince George, the city has just lost a legal fight to deny a business licence to a woman running an escort agency.
Down in Vancouver, the courtroom is being readied for the trial of Robert Pickton, charged with murdering 26 women, prostitutes working the city's dangerous streets.
Can you spot the connection?
The sex trade makes most of us deeply uncomfortable. We don't like the idea that men and women will perform sex acts with strangers for money. We don't like to think too much about the thousands of customers who keep the trade alive.
Our squeamishness is understandable. But it's also fatal.
Prostitution is legal in Canada. In part, that's in recognition that people have the right to decide what to do with their bodies. And in part we have acknowledged that the trade has flourished for more than 2,000 years and we're not likely to change that now.
But we don't like it. And our response is to push the sex trade into the shadows and out of sight.
So municipalities make life difficult for escort agencies and massage parlours - as Prince George did in illegally denying a licence renewal to the Black Orchid escort agency. (There are, as always, lots of points to argue about the case; the bottom line is that the B.C. Supreme Court found the city had no legal basis for its actions.)
Police, usually responding to public pressure, push the local stroll into the darkest, least-populated corners of the city or town.
Here in Victoria, it's an older industrial district on the far reaches of the downtown, deserted at night. No neighbours to be bothered by cruising cars and sex-trade workers on corners. But also no witnesses when things go wrong, few people to call for help. The 80 to 100 people working the streets are alone.
It is a gift to predators.
Sometimes the authorities go farther. Last month Lower Mainland police pooled their resources and dozens of officers swooped down on 18 massage parlours in one night.
The goal, police said, was to protect the women working in them and fight the risk of human trafficking.
But the 78 women police "helped" were led away in handcuffs. Police found all were at least 21 and in the country legally. While their workplaces were shutdown and they were cuffed, not one was charged.
In fact the while exercise did not result in one charge. Most of the businesses have re-opened.
It's not even any sort of accomplishment if a few have closed. Those women might well now be working the streets, in much greater danger than before the police launched their pointless raids. (At least pointless in terms of any actual measurable outcome.)
That's not to criticize police, or Prince George's city staff, for that matter. They are simply responding to our discomfort by attempting to push prostitution somewhere out of sight.
Police generally acknowledge that reality. When Prince George RCMP launched a program aimed at arresting johns in 2004, they were clear about the reason for trying to reduce the number of clients.
"If there is no longer persons buying the sex trade services then those sex trade workers may feel the need to move away from this community and to pursue their activities elsewhere," the police said.
The women wouldn't stop working. They would just go somewhere - anywhere - else.
Usually, somewhere more dangerous.
The message to sex-trade workers is also clear: We don't want to see you, hear from you or deal with your problems.
And that too makes them easier prey. Former Prince George provincial court judge David Ramsey attacked young girls, most working as prostitutes, over nine years before he was arrested.
Our determination to push them into the shadows helped make that happen.
Most of us don't like the idea of prostitution.
But it is here. Our unwillingness to accept reality and help people find safer ways to work doesn't change that.
It just means that more women will die.
Footnote: Most out-of-touch quote on the topic goes to Solicitor General John Les who described the Lower Mainland raids as "a huge shot across the bow" for anyone considering going into the sex trade. How? No one was charged; most were back at work within days. The effect of the raids was, more or less, nothing.