VANCOUVER - Advocates on both sides of a legal debate over the future of public health care in Canada are offering opposing diagnoses on how to rejuvenate what many consider an overburdened medical system.
Jonathan Penner, a lawyer for the British Columbia government, told B.C. Supreme Court on Monday that a lawsuit proposing to revamp the rules around how medicare operates may undermine the principle of equal medical access for all, to the detriment of the majority of residents in the province.
Cambie Surgery Centre, a private clinic in Vancouver, is suing the B.C. government for using the Medicare Protection Act to prevent doctors from providing medically necessary treatment in both the public and private systems and to forbid private insurance for core medical services.
Penner said in his opening remarks Monday that upcoming evidence from proponents will probably show that some British Columbians wait longer for surgery than they would like or than what would be considered ideal.
"The evidence will show, however, that overall the quality of care that British Columbians receive is among the best in the world and that when urgent or emergency care is needed it is almost invariably provided without delay," he added.
"In terms of the overall provision of health care in British Columbia, the patients who are waiting too long are the exception and not the rule."
Last week, a lawyer for Cambie Surgery Centre argued that a public-private system would help B.C. curb skyrocketing health-care costs by reducing pressure from the public system, freeing resources and shortening wait times.
Penner countered by saying privatization "would create perverse incentives for physicians and would introduce a private system that would depend on abandonment of present efforts to reduce wait times in the public system."
"The health-care system is highly complex and the repercussions to various components of that system of striking down those prohibitions are uncertain and problematic," he said.
Along with the Cambie Surgery Centre, plaintiffs include several patients who argue that forcing people onto wait lists for medically necessary procedures violates Canadians' charter rights.
Penner made repeated references to the Chaoulli case, a lawsuit decided in 2005 at the Supreme Court of Canada in favour of allowing some private health-care coverage in Quebec.
While that ruling was based on Quebec's Charter of Human Rights and Freedoms and thus applied only in that province, privatization proponents in B.C.'s lawsuit point to a conclusion included in the court's written decision that "Access to a waiting list is not access to health care."
Penner dismissed the suggestion that the Chaoulli case applied to the B.C. situation, arguing that circumstances in the two provinces are different.
For instance, he argued that the article referenced in the Chaoulli case is defined more broadly than the section being referenced in the B.C. suit.
"The evidence before this court will not be the same and will tell a very, very different story," Penner said.
Federal government lawyers are expected to provide input in the trial that is scheduled to run through to February.