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How private clinics lengthen wait times for all of us

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Photo: Nellies Beemster-Klaucke/flickr

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Have you ever asked yourself or been asked, isn't a two-tiered health-care system a good thing if it shortens wait times? If the rich want to pay out-of-pocket for their health care and free up space in the wait line for public care, shouldn't we let them? It sounds logical, right? It isn't.

I'm going to try and explain how private clinics lengthen wait times for the 99 per cent of us and I'm going to do that by using the example of the grocery store.  

We've all probably been in line at the grocery store when the place is packed and only two cash registers are open. Let's name the lanes 1 and 2. The for-profit clinics argue that if you opened a third lane (number 3) and you make it an express line -- eight items or less -- you'll shorten the other two lines. I should explain why lane 3 is an express lane. Private, for-profit clinics are just that, for-profit. Their goal is to make money for themselves and their investors. In order to make money in health care, you need to perform profit-making surgeries with profitable patients. This means patients are cherry-picked by age and care required. If you're young, healthy and rich, you've got a good chance of seeing a doctor at the private clinic. If you're elderly, if you have a chronic condition, or if you can't afford private care, you will be promptly sent back to public health care -- you're not profitable enough.  

Additionally, if anything goes wrong with your surgery at the for-profit clinic, or if you require follow-up care, you're often referred to the public system. Complications are expensive and for-profit clinics won't make money off of them. They want healthy, young, rich patients with straightforward surgical needs. Eight items or less.

Still with me?

If a grocery store has an extra staff person on hand, this works really well. People with eight items or less move over to lane 3 and lanes 1 and 2 shorten.

Here's the problem when we try to apply this third express-line analogy to health care -- where are the extra health-care professionals to staff lane 3? Where's the extra surgeon, radiologist, nurse practitioner that can be taken away from the tasks they're doing now? Removing medical professionals from the public health-care system means one less person to see patients.

The true picture of an express lane means that the cashier at lane 2 abandons their post and moves over to lane 3 (express lane). Now the people at lane 2 need to merge with lane 1. Lane 1 has become a much longer line. Lane 3 is now open -- but only to people who have eight items or less (healthy, wealthy, young). Also, people in the express lane are going to need to pay 100 times more for their groceries than people in lane 1. So lane 3 is looking pretty empty with a cashier just waiting for the occasional shopper with eight items or less who is willing to pay extra for their groceries. If you can go to lane 3, you'll certainly not add yourself to the line in lane 1. But let's be honest, by removing the lane 2 cashier who could serve any customer in the store and putting them in an express line with strict requirements for service, you certainly haven't reduced the wait time for the 99 per cent of shoppers -- in fact, you've significantly lengthened it.

A two-tiered health-care system means longer wait times for just about everyone. It also means a lot more; it changes the ethics of health care in Canada. Instead of pooling our health-care resources, triaging our residents and ensuring everyone gets the care they need when they need it, a two-tiered system says that Canada thinks the healthy, young and really wealthy deserve care before others.

While the idea of blogging about health care using the analogy of a grocery store may be silly, understanding the injustice inherent in a two-tiered health-care system is essential, especially now. There is a court case making its way to trial very soon in B.C. (likely September, 2014) on two-tiered health care. Dr. Brian Day of the Cambie Surgical Clinic was found during a provincial audit to have illegally billed both the clinic's patients and the public health-care system $566,000 in only 30 days! The B.C. government was taking Dr. Day to court when he launched his own lawsuit. He is suing the B.C. government for "the right" to make a profit off sick patients and the province. Dr. Day is challenging Canada's medicare laws and if he is to win, we would lose single-tiered health care in Canada.

The Council of Canadians is supporting the work of our allies the British Columbia Health Coalition and Canadian Doctors for Medicare who have intervener status in the case.  On December 3, the Council of Canadians ran a fundraiser to help raise funds for the legal intervention. The Canadian Federation of Nurses' Union generously matched all the funds raised. Thank you to everyone that participated and donated. Please continue to donate if you can and please talk to your friends, neighbours, colleagues and community about what a two-tiered health-care system would mean for Canada. We need your help to get the message out that Canada believes in a single-tiered public health-care system that ensures everyone has access to care regardless of their ability to pay. No eight-items-or less requirements for care and no lengthening wait times for the 99 per cent.

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Photo: Nellies Beemster-Klaucke/flickr

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