Americans are tying themselves in knots about the sweeping changes promised in U.S. President Barack Obama's new health-care law this week, with ferocious political opposition remaining over a measure expected to extend medical coverage to more than 30 million people who are now uninsured.
Canada's leading champion of private health care, Brian Day, can only look wistfully south of the border at the opportunities such a law would offer here.
"If you look at [the Obama]plan, it would be considered way to the right of any Canadian politician," he said. "It's based on private insurance and private delivery of health."
Dr. Day, as president of Cambie Surgeries Corp., is in court fighting for the right to allow British Columbians to use their own resources to jump to the front of the queue for medical treatment.
While a step toward universal health care has the Republicans crying the end is nigh, in B.C. the battle is over a shift in the other direction.
Two-tier on trial
Four months ago, the B.C. Supreme Court ordered Dr. Day's clinics to open their books to auditors for the Medical Services Commission to determine if they are breaking the law by collecting cash from B.C. patients for medically necessary treatment. The auditors were supposed to conduct their work this month, but the private clinics have appealed the ruling.
Dr. Day, a past president of the Canadian Medical Association, readily admits his private clinics are violating the Medicare Protection Act by extra-billing patients. But he said an audit will just delay the constitutional battle he wants heard over whether the law should be tossed out.
"Our whole premise is that the law that prevents people from using their own resources to bypass a wait[ing]list is unconstitutional," he said.
The case has been dragging through the courts for five years and could easily carry on another five. The original action was launched by the BC Nurses Union, which challenged the provincial government to enforce its own law and stop private clinics from treading on public-health turf.
The B.C. case began the same year that the Supreme Court of Canada, in what is known as the Chaoulli decision, struck down Quebec's ban on buying private insurance for medical services, saying it contradicted the provincial Charter of Rights. Dr. Day has argued this case is Chaoulli for the rest of Canada.
As the trial has developed, he finds himself opposed in court by B.C. Health Minister Kevin Falcon. In court documents tabled on behalf of the Health Minister, the tactics employed by Dr. Day's medical clinics to protect their business are described as "unconscionable, oppressive, illegal and inconsistent with public policy."
Today, as the B.C. government seeks to rein in health-care costs, Mr. Falcon is floating the idea of surgical tourism - inviting people from outside B.C. to circumvent waiting lists for medical treatment.
While there are British Columbians on waiting lists for non-urgent surgery of every kind, spending limits mean there are idle surgeons and empty operating rooms.
"We ration care on a lot of our surgical procedures," Mr. Falcon said. "Given that we have underutilized capacity, what surgeons and doctors are pitching to me is we could use that as a potential revenue generator. We're not going to say no to that … I'm open to having that discussion."
New Democratic Party health critic Adrian Dix argued that Mr. Falcon is undermining his own side in the court battle by flirting with medical tourism. "We have a Minister of Health who essentially says that kind of American-style health-care system, where you can buy your way to better access, is a good thing," he said. "It's clearly undermining the Medicare Protection Act and the Canada Health Act."
Medical tourism might inch B.C. closer to the system that Dr. Day wants to see, but it highlights a contradiction: Mr. Falcon is keen to allow visitors to buy their way to the front of the line at the same time that he is fighting to prevent British Columbians from doing the same.
How does he square that? His answer implies he would do both if he could, but for a flawed federal law that prevents Canadians from investing dollars in their own health care.
"I have no ability to do that," Mr. Falcon said. "The federal government would have to do that by amending the Canada Health Act and I'm not anticipating they are going to do that. So I have to work within the rules that are in place, I'm going to focus on where there may be opportunities, and medical tourism may be an opportunity."
Mr. Falcon notes that if the Canada Health Act is meant to prevent two-tier health care, it does a poor job of it. Canadians - even premiers - go to the U.S. for medical treatment.
And the bulk of Dr. Day's patients are drawn from the many groups in B.C. who are exempted from the waiting lists built into the public system: ICBC and Worksafe BC claimants, RCMP officers, Canadian Armed Forces members and federal prisoners.
To Dr. Day, the Health Minister's different positions on queue-jumping reflect another parallel to the political debate over Obamacare. "We've just seen with the Obama thing, how politics can distort logic here," he said.
As a minister of the Crown, Kevin Falcon is a defender of Canada's public health-care system. As a politician, he's less convincing.