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Good morning. Wendy Cox in Vancouver here.

Ten years after Vancouver’s Dr. Brian Day asked the courts to toss out a law that is a foundation of Canada’s health-care system, a B.C. court judge will start hearing closing arguments next week.

At the heart of the case, as Globe health reporter Kelly Grant writes, is Dr. Day’s contention that Canada’s ban on allowing patients to pay for necessary medical care violates patients’ rights to life, liberty and personal security.

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But Canada’s medicare system is organized on the principle that health care should be doled out first to those who need it most, not to those who can afford to pay for it.

Kelly spoke to Vancouver’s Dr. Rupinder Brar, a member of the board of Canadian Doctors for Medicare, who told her the case could “absolutely” set a precedent in the rest of Canada.

"It’s in the very fabric of who we are as a nation that we provide care for one another when we need it,” Dr. Brar said.

Dr. Day, 72, an orthopedic surgeon, said his goal has never been to dismantle public health care. Instead, he said, it’s always been about adding private options to the public system. Many European countries do this, providing faster access and spending less per capita on health care, he argues.

His clinic, the Cambie Surgical Centre, has been at odds with the B.C. government since before it opened: An archive photo shows Dr. Day posing with a sign in front of his clinic’s construction site. The sign notes “B.C. Residents Are Prohibited From Access to this Facility.” Still, for two decades, the B.C. government looked away while the clinic did a brisk – and perfectly legal – business operating on patients exempt from the law, mainly injured workers whose care was paid for by the workers’ compensation system.

The private clinics also treated regular patients who paid out of pocket for swifter diagnostic testing, specialists’ assessments and surgeries, violating a law that Gordon Campbell, B.C.'s Liberal premier from 2001 to 2011, said in an affidavit his government chose not to enforce – just like its NDP predecessors.

A Globe investigation by reporter Kathy Tomlinson in 2017 indicated the business has been a lucrative one for Cambie Surgery doctors, who at the time were able to double-dip. The doctors were billing patients directly as well as the public health-care system. The BC NDP government outlawed the practice after Kathy’s story.

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Kathy examined billing records for 16 surgeries, including knee replacements and a hernia repair, done at the Cambie Surgical Centre. The records show that patients were charged as much as $17,000 each for their procedures. By contrast, health authorities pay somewhere between $1,500 and $7,600 for the publicly funded surgeries that they sometimes contract out to those clinics; the provincial agency WorkSafeBC, pays clinics a maximum of $5,000 per surgery for workers injured on the job.

Dr. Day told Kelly the one good thing to come from the long-running trial was the chance to take the matter out of the hands of politicians and into the hands of a judge who can determine the law.

Whatever B.C. Supreme Court Justice John Steeves decides, the case will most certainly land at the Supreme Court of Canada.

This is the weekly Western Canada newsletter written by B.C. Editor Wendy Cox and Alberta Bureau Chief James Keller. If you’re reading this on the web, or it was forwarded to you from someone else, you can sign up for it and all Globe newsletters here. This is a new project and we’ll be experimenting as we go, so let us know what you think.

Around the West:

JASON KENNEY’S FAIR DEAL: Alberta Premier Jason Kenney has appointed a panel to examine a range of ideas to reshape what he says is the province’s unfair relationship with the rest of Canada. The proposals include a separate pension plan, a provincial police force and an Alberta revenue agency to collect taxes.

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VANCOUVER’S COMMERCIAL REAL ESTATE: The official picture of Vancouver’s office-tower scene is blindingly bright: almost zero vacancy, more companies clamouring for space, and buzz over the city’s transformation from a resources-only town to a rapidly growing tech centre. But there are some bad omens, ranging from the possible impact of global trade wars to the precariousness of WeWork, a company going through some high-profile struggles that was involved in the biggest downtown lease deal this year.

REGIONAL DIVIDES: A newly released survey suggests Canada’s regional divisions are widening, with people in Alberta taking the most pessimistic view of the province’s economy and their place in the country. The survey found respondents in Alberta were far more likely to say they’re concerned about job security and the economy, and less likely to see climate change as the most important issue facing the country.

MOE MEETS TRUDEAU: Saskatchewan Premier Scott Moe said he was disappointed after a meeting with Prime Minister Justin Trudeau, where he said Ottawa declined his request to withdraw a federal carbon tax on his province.

CONSCIENCE RIGHTS: A private member’s bill in Alberta has reopened the debate about how to balance the conscience rights of doctors with the needs of patients to access contentious procedures such as abortion and assisted dying. Legal experts predict a legal battle is ahead, arguing that the bill would likely run counter to an Ontario Court of Appeal decision earlier this year that said doctors must provide meaningful referrals in such cases.

DERELICT HOTELS: The City of Vancouver will get some help from the B.C. government as it grapples with the decision of whether to tear down two historic but crumbling hotels that have housed some of the city’s poorest residents, or whether to renovate the structures.

ALBERTA OIL: Imperial Oil Ltd. says it’s increasing its rail shipments, though it’s not interested in picking up oil-by-rail contracts that the Alberta government is attempting to offload onto the private sector.

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TODDLER TRIP: A 20-month-old Edmonton toddler playing with his dad’s phone inadvertently entered his parents into a contest. His parents were disbelieving when assured by their cable company that they had, in fact, won a trip for two to Tokyo. The boy, though, is staying at home. Said his mom: “I am not sitting on a plane for 14 hours with him and I don’t want to do that to anyone else."


Kelly Cryderman on ambivalence in the rest of Canada: “It’s hard to see how a focus on comeuppance makes for good public policy. It doesn’t really move the country forward to lambaste Albertans as they express legitimate frustration about policies that will make it difficult to build any new pipelines in the years ahead. Simply saying that prairie provinces should stop complaining in the face of unemployment or rising mortgage arrears isn’t helpful.”

Gary Mason on Jason Kenney’s power play: “Mr. Kenney knows reconciling his energy needs with the country’s climate-change prerogatives is a complex, if not impossible, task. Maybe that’s why he wants no part of that discussion. It’s easier to foment dissent. To lead what Alberta NDP Leader Rachel Notley has called a “dangerous” conversation.”

The Globe and Mail on the (tiny) divide between Kenney and Trudeau: “It turns out that Alberta and Ottawa have common ground, and in fact rather a lot of it. Both sides need to be adult enough to acknowledge that. Mr. Kenney’s UCP should embrace the fact that a big part of its emissions-reduction plan is built of the same material as the hated Liberal plan – a carbon tax. The Trudeau government, for its part, should be able to declare that Alberta’s industrial carbon tax either meets the federal standard, or comes close.”

Campbell Clark on Scott Moe’s threats: “If Mr. Kenney and Mr. Moe are serious about provincial autonomy, they’ll find an ally in Quebec Premier François Legault. Maybe that’s a satisfying thought for frustrated Westerners. It just won’t provide a satisfying solution. It won’t lead to pipelines or investment. The demands for an immediate revamp of equalization aren’t likely to produce satisfaction, either.”

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