Skip to main content
The Globe and Mail
Support Quality Journalism.
The Globe and Mail
First Access to Latest
Investment News
Collection of curated
e-books and guides
Inform your decisions via
Globe Investor Tools
per week
for first 24 weeks

Enjoy unlimited digital access
Cancel Anytime
Enjoy Unlimited Digital Access
Get full access to
Just $1.99per week for the first 24weeks
Just $1.99per week for the first 24weeks
var select={root:".js-sub-pencil",control:".js-sub-pencil-control",open:"o-sub-pencil--open",closed:"o-sub-pencil--closed"},dom={},allowExpand=!0;function pencilInit(o){var e=arguments.length>1&&void 0!==arguments[1]&&arguments[1];select.root=o,dom.root=document.querySelector(select.root),dom.root&&(dom.control=document.querySelector(select.control),dom.control.addEventListener("click",onToggleClicked),setPanelState(e),window.addEventListener("scroll",onWindowScroll),dom.root.removeAttribute("hidden"))}function isPanelOpen(){return dom.root.classList.contains(}function setPanelState(o){dom.root.classList[o?"add":"remove"](,dom.root.classList[o?"remove":"add"](select.closed),dom.control.setAttribute("aria-expanded",o)}function onToggleClicked(){var l=!isPanelOpen();setPanelState(l)}function onWindowScroll(){window.requestAnimationFrame(function() {var l=isPanelOpen(),n=0===(document.body.scrollTop||document.documentElement.scrollTop);n||l||!allowExpand?n&&l&&(allowExpand=!0,setPanelState(!1)):(allowExpand=!1,setPanelState(!0))});}pencilInit(".js-sub-pencil",!1); // via darwin-bg var slideIndex = 0; carousel(); function carousel() { var i; var x = document.getElementsByClassName("subs_valueprop"); for (i = 0; i < x.length; i++) { x[i].style.display = "none"; } slideIndex++; if (slideIndex> x.length) { slideIndex = 1; } x[slideIndex - 1].style.display = "block"; setTimeout(carousel, 2500); } //

The legal action launched more than a decade ago by Brian Day wrapped up in B.C. Supreme Court on Friday, ending the same way it began, with some overheated rhetoric. We are hearing that the future of medicare is in peril and that Canada is the only country on earth that bans private health insurance, neither of which is true.

The lawsuit aims to strike down key provisions of the B.C. Medicare Protection Act, arguing that restricting access to private health care is causing deadly waits for care that violate Canadians’ constitutional right to life, liberty and security.

Those opposing the action – including the federal and provincial governments – claim that a “two-tier system” would result in the end of medicare as we know it, throwing open the door to U.S.-style health care and wouldn’t make waits any shorter, except for the wealthy.

Story continues below advertisement

At the end of the day, Justice John Steeves needs to answer a seemingly simple question: should patients be able to pay for care in private clinics if they can’t get timely care in the public system? (Or, conversely, should government be able to restrict access to private care because it believes doing so serves the greater public good?)

Dr. Brian Day, medical director of the Cambie Surgery Centre, is seen in his office in Vancouver, in an Aug. 31, 2016, file photo.

Darryl Dyck/The Canadian Press

Regardless of what the court rules, it is unclear what impact it would have on the larger health system, or on access to timely care.

The only certainty is that, no matter which side prevails, the ruling will be appealed to the Supreme Court of Canada – meaning a final decision is a few years away.

The B.C. Medicare Act prohibits physicians from working in both the public and private systems, it does not allow physicians to charge extra for services covered by medicare, and it bans the sale of private insurance for “medically necessary” care (most hospital and physician care).

No province allows extra billing. Most provinces outlaw dual public-private practice, but some allow physicians to opt-out of the public system entirely. Five provinces ban the sale of private health insurance for procedures done in the public system.

So the rules are all over the map, and enforcement even more so. Even B.C. tolerated private clinics like Dr. Day’s Cambie Surgeries Corp. for more than two decades after it opened in 1996.

Paradoxically (or perhaps hypocritically is more precise), the best customers of private surgical clinics are essentially in the public sector – WorkSafeBC, the Canadian Armed Forces, the RCMP, Indigenous and Northern Affairs and Correctional Service of Canada.

Story continues below advertisement

The notion that private clinics are a threat to medicare is scant at best.

Similarly, the idea that not getting swift access to care is some grave injustice is dubious at best.

Sure, there are waits in Canada that are far too long and frustrating, but is waiting really killing people? And, even if it is, would allowing people with means to pay for faster care actually correct these injustices?

If we’re going to say that Canadians can buy care when waits are unreasonable, what is the threshold going to be? Will it be medically maximum wait times set by physicians or institutions, or will it be an individual feeling?

There is no question Canada needs to deal with the problem of lengthy surgical wait times. But quicker isn’t always better. And is having to wait your turn really unconstitutional?

If so, allowing private surgical clinics to cherry-pick profitable procedures to offer to the public is hardly a solution.

Story continues below advertisement

But neither is an outright ban. Most countries with universal health care have a mix of public and private provision and payment of care. What these countries do is regulate rather than outlaw private operators.

One of the great ironies of the case is that Canada actually has more private spending and a greater dependence on private insurance than virtually every other country with universal health care.

Canadians are enormously dependent on private insurance for prescription drugs, dental care, vision care, hearing aids, home care, long-term care and much more. Surely many of these services are “medically necessary,” but public access and funding is greatly lacking.

Ultimately, we need to decide what is covered by medicare and what isn’t.

It’s never going to be easy to draw those lines in the sand, but it’s essential.

What the limits of medicare are, or should be is also a policy issue that needs to reflect our culture, our values and our expectations of government.

Story continues below advertisement

It’s certainly not something we should be leaving to the courts – especially when the courts are going to take a generation to decide if waiting violates our rights.

Your Globe

Build your personal news feed

  1. Follow topics and authors relevant to your reading interests.
  2. Check your Following feed daily, and never miss an article. Access your Following feed from your account menu at the top right corner of every page.

Follow the author of this article:

Follow topics related to this article:

View more suggestions in Following Read more about following topics and authors
Report an error Editorial code of conduct
Due to technical reasons, we have temporarily removed commenting from our articles. We hope to have this fixed soon. Thank you for your patience. If you are looking to give feedback on our new site, please send it along to If you want to write a letter to the editor, please forward to

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff.

We aim to create a safe and valuable space for discussion and debate. That means:

  • Treat others as you wish to be treated
  • Criticize ideas, not people
  • Stay on topic
  • Avoid the use of toxic and offensive language
  • Flag bad behaviour

If you do not see your comment posted immediately, it is being reviewed by the moderation team and may appear shortly, generally within an hour.

We aim to have all comments reviewed in a timely manner.

Comments that violate our community guidelines will not be posted.

UPDATED: Read our community guidelines here

Discussion loading ...

To view this site properly, enable cookies in your browser. Read our privacy policy to learn more.
How to enable cookies