VANCOUVER - Nobody should be surprised the province's politicians are skirting the issue of public-private health care during the election campaign, says a professor from the University of British Columbia.
Premier Christy Clark and New Democratic Party health critic Mike Farnworth were pressed by reporters Tuesday on a constitutional challenge by Vancouver Dr. Brian Day who's fighting a provincial law that prohibits him from billing patients for services covered by the public health-care system.
When asked about the case, Clark initially avoided the question, before answering she doesn't "anticipate any change in course," because of the lawsuit. Farnworth didn't answer the query.
Craig Mitton, a professor of health economics at UBC, said he's not surprised with Clark's or Farnworth's answers because of the "sheer politics" of an issue that has divided the electorate.
"What's a politician to do? They're stuck," he said. "Either way, from the political perspective, they're going to be in tough with half the population."
Regardless, Mitton said he expects the government to show leadership and either change or enforce the law.
At the centre of the issue is Day, the operator of the Cambie Surgery Centre and the Specialist Referral Clinic.
In July 2012, his lawyer filed an amended statement of claim tied to a lawsuit originally launched in 2009 that argues Canadians have a right to timely health care that's not being provided in the public system.
That same month, the province's Medical Services Commission released an audit that found his clinics have been illegally billing patients for procedures that should be covered by the public system.
In August 2012, the provincial government applied for an injunction to stop the billing.
"I should note that those private clinics were operating under the NDP as well," said Clark, when asked about the issue.
"I am committed to our publicly funded health-care system and making sure that people have access to our publicly funded health-care system."
Farnworth said the lawsuit will work its way through the system and won't be solved any time soon.
"The government will be standing up in defence of, you know, public health care," he added. "Governments face these kinds issues all the time, and they deal with the outcomes and they advance their case and that's what we will have to do."
Far more outspoken on the issue, though, has been NDP Leader Adrian Dix who frequently blasted the Liberals over public-private health care in the legislature.
"This is a government that refuses to learn about extra-billing in this province, refuses to go out and enforce the very act that we're talking about today," Dix said April 28, 2008.
One month later, on May 27, 2008, Dix attacked for-profit care and privatization.
"Enough of the drive to privatization," he said in the legislature. "Enough of the drive of rewarding for-profit supporters of the government.
"Back to a time when we made the investments necessary to ensure that everybody was in the same health-care boat getting high-quality public health care services. That's what the public wants."
Mitton said the public is split on the issue, with about 50 per cent of the population wanting private, out-of-pocket health care and the other 50 per cent wanting a fully public service.
The current system, he added, is neither.
For the past decade about 70 per cent of B.C.'s health-care system has been focused publicly, with the remaining 30 per cent going to private care.
Included in the private system are services like out-of-hospital medications, chiropractors, physiotherapists, eye doctors and even MRIs, he said.
In fact, Mitton said only a "very small proportion" of people pay out of their own pockets for publicly insured services.
Shutting down private clinics like Day's would have little impact on the public system, he added, because the clinics deal with a such a "minuscule" volume.
He said the federal government could also claw back funding under the Canada Health Act if the province doesn't crack down on private clinics, but that mechanism lacks teeth because provinces receive a limited amount of funding from the federal government.
"Over 80 per cent of health care is funded by the province," he said.
Ultimately, the public-private debate comes down to ideology, said Mitton.
"It's a values-based argument."
Ideologically, an individual may want to chose how they spend their own money, he said, noting more private health care doesn't actually save the public system money.
But the biggest health-care issue facing British Columbians, the "elephant in the room," said Mitton, is instead the need to move resources out of the acute system into primary care, the community and public health, allowing people to receive services like home support.
"You know what? Those aren't the sexy things, right? That's not the topic that gets the headlines, but that's what we need to do."
Mitton also said British Columbians shouldn't be spending any more money on health care, either, because social determinants, like poverty reduction, affordable housing, early childhood education, have a far greater impact on people's health.
"That is the issue," he added.