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Why Nurses Care About the Charter Challenge: Standing Up Against the Threat to our Publicly Funded Health Care System

by Sally Thorne, RN


BC nurses have been closely watching the case of Dr. Brian Day, CEO of the for-profit Cambie Surgeries Corporation, who has been challenging the constitutionality certain key provisions within our BC Medicare Protections Act, the Act that protects our health care system. His attempt to remove the bans on extra-billing and on private insurance to cover hospital and physician services already covered by the public system are seen as a threat to the fundamental values of access to health care based on need rather than the ability to pay. And as such, the charter challenge by Day and the group of plaintiffs he leads aims directly at the backbone of BC's publicly funded health care system.

As a recent poll confirms, 90% of British Columbian endorse the core principle of a universally accessible publicly funded health care system. And the rest of Canada is closely watching, as a dismantling of the foundational principles of our public health care system will most certainly lead to legal challenges in other provinces.

As a recent report in the Tyee noted, the origin of this case goes back to 2007, when the BC Medical Services Commission attempted to audit Day's for-profit clinics due to reports of improper billing. Day successfully blocked the audit for several years with a charter challenge, but when it was finally completed and released in 2012, it found evidence of extra billing and overlapping claims to the BC Medical Services Plan. Day's position is that physicians ought to have the legal right to both bill patients directly and also be funded by the public purse. The BC Health Coalition, which has intervenor status in this charter challenge case, is an organization of many individuals and organizations who believe that the fairness and equity that underpin our publicly funded system must be preserved, and that the changes Day is making would inevitably mean that ability to pay privately allows patients to jump the queue. And that, based on extensive international evidence, would create the kind of two –tiered health care system that is fundamentally counter to what Canadians stand for.

Over a 17-month period, courts have heard extensive evidence from the BC government, the BC Health Coalition, the Attorney General of Canada, Canadian Doctors for Medicare, and expert witnesses about the dangers of privately financed health care where there are no controls on what doctors, for-profit clinics and insurance companies could charge patients. Day's lawyers are attempting to prove that the public health care system we now have is unable to deliver timely care and therefore depriving patients of their right to medical procedures. The closing arguments, which were to have been heard early in December, have been rescheduled to the new year.

In a recent op ed in the Vancouver Sun, BC physicians Mei-ling Wiedmeyer, Lynn Farrales and Srinivas Murthy wrote: "As doctors, we find it extremely troubling that patients and wait times are being used as cover for what this case is really about: increasing doctors’ incomes and corporate profits. We are grateful to work in Canada, where we can provide ethical care to people when they need it, and our patients don’t have to take out loans or go bankrupt. Many communities already struggle accessing basic care - whether due to income, geography, discrimination or otherwise - and undermining our public system is not the solution. We are very well paid for our work as doctors in B.C. At a time of growing inequality that threatens the health of many British Columbians, doctors do not need new income sources from extra-billing patients." They reminded us that any physician in BC can already opt out of the publicly funded system and bill privately. What Day and his colleagues are seeking is the right to charge extra fees for care that is already covered.

Canadian nurses have watched their colleagues in other countries, most especially the USA, struggle with a health care system that seemingly privileges some and penalizes others. This is NOT the kind of health care system I want to be part of, and I think most of my nursing colleagues would agree. Of course, there is a great deal we can do to improve wait times and better organize the care we do provide. For example, better deployment of nurses of all designations within expanded roles is a major component of building a more sensible and effective health care system, and NNPBC will be fighting that good fight on behalf of us all. As Canadian Nurses Association made clear in its 2013 report Registered Nurses: Stepping Up to Transform Health Care, harnessing the full capacity of nurses in nurse-led clinics, interventions and models of care could save the health care system plenty and ensure that many more patients receive the timely care they require.

In the immediate, it is my belief that we need to be loudly championing the value of the principled and fair system we believe in. We must also make sure that nursing voices are heard as we move toward the conclusion of this particular chapter in the challenge to public health care.

I encourage all of you to make your voices heard through all forms of communication and social media. Follow the BC Health Coalition @BCHC, Canadian Health Coalition, @HealthCoalition, Save Medicare, and use: #CambieCase, #NoToDay, #BChealth, #Stand4Medicare when talking about this issue.

Let's demonstrate our collective nursing leadership by showing the world that nursing, the most trusted profession, fully stands behind fairness and equity for all in our publicly funded health care system.

About Sally Thorne

Sally Thorne, RN, PhD, is Professor at the University of British Columbia School of Nursing and a Board Director of Nurses and Nurse Practitioners of BC. She currently serves as President of the RN Council for NNPBC. Thorne was a founding member of the BC RN Network and the Association of Registered Nurses of BC, for which she served on the Board for most of its existence. She has been actively involved in many nursing organizations, including Canadian Association of Nurses in Oncology, Canadian Nurses Association, the American Academy of Nursing, and the International Academy of Nursing Editors.

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