Tuesday, April 17, 2007

False responses

The story didn't make the headlines out of yesterday's Question Period. But it's worth highlighting that Tony Clement has explicitly taken the side of the False Creek patient-funded clinic in claiming (with little basis) that it doesn't violate the Canada Health Act:
Ms. Penny Priddy (Surrey North, NDP):
Mr. Speaker, the False Creek Urgent Care Centre in B.C. is back in business, charging patients hundreds of dollars for basic medical services that should be free. This American style clinic is the exact opposite of what Canadians expect from our health care system. It should be illegal, but the clinic has found a loophole that allows it to stay in business.

Every Canadian has the right to free, universal health care when they need it most, regardless of whether or not they are carrying their chequebooks. Will the Conservatives take action today and put an end to clinics that charge patients for medically necessary urgent care services?

Hon. Tony Clement (Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario, CPC):
Mr. Speaker, nothing could be further from the truth. Indeed, we are reviewing the situation of this clinic, but upon first blush by the minister of health of British Columbia, it is violating no laws in British Columbia, violating no principles of the Canada Health Act...I see no double standard in that.
So let's see what the Canada Health Act actually has to say. First, let's look at the definition of "insured health services", whose importance will become clear shortly:
“insured health services” means hospital services, physician services and surgical-dental services provided to insured persons, but does not include any health services that a person is entitled to and eligible for under any other Act of Parliament or under any Act of the legislature of a province that relates to workers' or workmen’s compensation;
In effect, any and every medically-necessary service rendered to an "insured person" (i.e. resident of the province) is included within the definition, except where payment is provided for under other legislation.

Which is important on a look at one of the Canada Health Act's five core principles, being that of comprehensiveness:
9. In order to satisfy the criterion respecting comprehensiveness, the health care insurance plan of a province must insure all insured health services provided by hospitals, medical practitioners or dentists, and where the law of the province so permits, similar or additional services rendered by other health care practitioners.
The emergency services provided by the False Creek clinic are plainly "insured health services" provided by medical practitioners, and equally plainly not covered by B.C.'s health insurance plan. Which would seem to make for a glaring violation of section 9 of the Canada Health Act.

And the apparent violations don't stop there. Here's the first part of the accessibility principle:
12. (1) In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province

(a) must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons;

(b) must provide for payment for insured health services in accordance with a tariff or system of payment authorized by the law of the province;
It should be apparent that the False Creek billing system both isn't on uniform terms and conditions to those applied elsewhere, and isn't one "authorized by the law of the province".

So we have two sections of the Canada Health Act apparently violated - and that's dealing solely with the "principles" part of the act (which Clement appears to have deliberately referred to) rather than the sections which specifically deal with extra-billing and user charges. For added fun, the prohibition against user charges is violated even more clearly:
“user charge” means any charge for an insured health service that is authorized or permitted by a provincial health care insurance plan that is not payable, directly or indirectly, by a provincial health care insurance plan, but does not include any charge imposed by extra-billing.

19. (1) In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, user charges must not be permitted by the province for that fiscal year under the health care insurance plan of the province.
Of course, Clement himself holds the only available means of holding B.C. accountable for the current Canada Health Act violations going on within the province. And Clement has left no doubt that in addition to having prejudged the outcome when it comes to the False Creek clinic, he has zero interest in allowing his department to do its job by holding violators accountable.

That said, the fact that there may be no formal means to force Clement and his department to carry out much-needed enforcement doesn't end the matter. Yesterday's response offers just one more example of the Cons being entirely happy to take the side of privatized health care even while claiming to support the Canada Health Act. And if Canadians are informed of just how dishonest the Cons are being on the health file among others, that can only help the chances of preventing them from holding office for long.


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