This week we host Dr. Monika Dutt, Board member of Canadian Doctors for Medicare and a public health and family physician in Nova Scotia. She fills us in on the historic legal challenge to the Medicare program that was just decided by the Supreme Court of British Columbia. The plaintiff, a for-profit surgery clinic, sought to allow patients to pay more for quicker treatment; it would have opened the door to a two-tiered health care system that would draw resources away from the public system and disproportionately affect the most vulnerable patients. Dr. Dutt talks about the ramifications of this victory for Canada’s single payer system and what’s next in the fight for a better Medicare.

Show Notes

Canadian Doctors for Medicare, which Dr. Dutt sits on the Board of, was founded about 10 years ago to defend Canada's single-payer healthcare system, and also to improve and expand upon it. It may be confusing for some in the United States, but "Medicare" in Canada refers to their entire universal healthcare system, whereas here in the U.S. "Medicare" is a healthcare program only for seniors age 65 and older.

Although the entire system in Canada is referred to as "Medicare," in reality each province and territory runs their own single-payer health insurance plan. They all have to meet the requirements of the Canada Health Act, though, which outlines the core principles of Medicare, including universality.

While you can buy private health insurance in Canada for services not covered by the public single-payer system (like dental care, some medications, and other specialty services depending on the province), private insurers are not allowed to compete with Medicare by covering the same care that Medicare already covers.

This principle, and what happens when you allow a "two-tier" system of public insurance competing with private insurance, is exactly what was at stake in a major lawsuit that was just ruled on - Cambie Surgeries vs. British Columbia. This case started in 2016, when Cambie Surgeries sued British Columbia's single-payer system, trying to win the right to do three things:

"Extra billing" (called "balance billing" in the United States), or allowing providers to charge their patients above and beyond the rates they receive from Medicare, which would open the door to preferential treatment for patients able to pay more;The ability to bill private insurers for basic healthcare that is covered by Canada's Medicare program, which would allow the creation of a two-tier system where people willing to pay more for private insurance could gain access to better and faster care; andAllow providers to be reimbursed by both private and public insurance. Providers in BC who participate in Medicare currently cannot accept private duplicative insurance or be paid out-of-pocket for any services covered by Medicare. BC physicians are free to not enroll in Medicare, in which case they can bill patients out-of-pocket, but they cannot also bill the public plan.

If the lawsuit was successful, it would have allowed those who are healthier and wealthier to buy preferential treatment, and to get treated first - exactly as they are allowed to in the United States. However, just this past week British Columbia's Supreme Court ruled against Cambie Surgeries, relying on a mountain of evidence submitted by experts around the globe showing that allowing two-tier systems undermines care in the public system and... does not improve wait times. (More on this shortly!)

Expert witnesses were brought in from Canada and other countries with single-payer healthcare systems. The Judge's final ruling, which considered all of that testimony, is 880 pages long (!!), but Canadian Doctors for Medicare has helpfully compiled a 40 page summary of the ruling. The Judge found that, if the court ruled in favor of the plaintiffs, it would make Canada's healthcare system more inequitable, and would likely increase waiting times instead of...