It's telling that, when federal Health Minister Jane Philpott was asked what she intends to do about double-dipping Canadian doctors who exploit desperate patients for financial gain, all she could say was that she will do… something.
Dr. Philpott declared herself to be "determined to find ways to make it very clear that we expect the law to be upheld." The only thing made clear by her response is that the Health Minister doesn't have an effective means of preventing double-dipping, a practice she must surely have been aware existed before The Globe and Mail reported extensively on it last week.
And that is the crux of the matter. Even though double-dipping is illegal under Canadian law, is a morally dubious act no matter which way its practitioners spin it, and everyone knows it's going on, it is far too complex a problem for Dr. Philpott to fix by insisting that the law be upheld.
Double-dipping exists for two reasons: Public health care in Canada is an expensive and messy business that is not run as cost-effectively or efficiently as it could be, resulting in some of the worst wait times in the developed world; and because Ottawa and the provinces have refused to acknowledge that desperate patients are turning to doctors willing to treat them outside the public sphere in exchange for large sums of money.
If double-dipping is "disturbing," as Dr. Philpott put it, then she has things she can actively do to fix it. She will not have to look very hard.
For one, she can call out the provincial and territorial medical associations that have long averted their eyes while a growing portion of their members simultaneously practise both inside and outside the public system – the illegal double-dipping in question.
Dr. Philpott has a moral cudgel she can wield, because let's face it: A Canadian doctor telling a desperate patient in chronic pain that they can wait months for taxpayer-supported public treatment, or get it quickly by slipping him or her thousands of dollars at the private clinic he or she just happens to own or work at, is downright sleazy.
As the Globe has reported, this actually happens in Canada. Not in every doctor's office, but in more than enough.
Canadian physicians in the public system should be frantically looking for legal solutions for someone in relentless pain, not throwing up their hands in defeat, and then holding them out for a quick payoff.
Why aren't the 12 medical associations that regulate doctors in the provinces and territories reining in this exploitative behaviour? And what about the people who are ultimately responsible for the health care system: the governments of the provinces and territories. Why aren't they doing anything about it?
Defenders of double-dipping call it a necessary evil, because the public system is so overloaded that specialists can't get access to hospital operating rooms and other critical facilities. While they have a point, they are ignoring the fact that double-dippers charge enormous sums that are governed by greed, not by a sense of duty to a desperate patient. A private surgery centre in B.C. that charges the government a maximum of $7,600 for a procedure done on contract will charge a patient more than twice as much, the Globe found. It's gouging, pure and simple.
But the fact that there are indeed many public ORs that routinely go unused because of limits on staffing and other resources is something Dr. Philpott and her provincial counterparts should look into. What is needed to get them running full-time? Are there funds that could be redirected? How can Ottawa help?
Dr. Philpott should also come clean and admit that private clinics are, like it or not, a reality in Canada's current health-care landscape. Instead of ignoring their existence until a journalistic investigation makes it impossible to look away, Ottawa and the provinces should at least regulate the fees charged by private clinics. Among other benefits, that might enable private insurers to step into the game and relieve some of the financial burden on patients who opt to pay out-of-pocket for treatment.
For many, the idea of officially sanctioned two-tier health care is downright unCanadian. But it is also not very Canadian to force desperate people into the hands of doctors who are working both sides of the street, charging unregulated prices, and exploiting pain for financial gain.
Unless Ottawa and the provinces are willing and able to take concrete steps to reduce Canada's infamous hospital wait times, they should acknowledge that private clinics can have a role to play, and regulate them accordingly.
But let's please end this charade in which Canadian health officials are shocked to discover double-dipping goes on, and then pretend that an unenforceable federal law that ignores reality must somehow be respected. It's time for solutions, not platitudes.