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OPINION: Future of Canadian health care on the line

Let's say you are on a wait list for the type of surgery that will play a huge role in your life, perhaps the kind that restores full mobility or removes chronic pain or simply provides a level of comfort you haven't felt for some time.

Let's say you are on a wait list for the type of surgery that will play a huge role in your life, perhaps the kind that restores full mobility or removes chronic pain or simply provides a level of comfort you haven't felt for some time.

And let's say you've been on that wait list for months, and it's still unclear exactly when you're going under the knife.

Do you have the right to pay for that surgery in a private health-care clinic, bypassing the more clogged publicly funded system in favor of quicker treatment?

That question is at the core of a court case beginning this week in B.C. Supreme Court. The implications of the case are potentially huge and stand a good chance of turning our cherished public health-care system on its head.

The case itself is almost eight years old but has been delayed for various reasons. It involves a private health-care clinic run by Dr. Brian Day (along with some of its patients) suing the B.C. government because it won't allow people to buy private insurance for medically necessary services that are covered in the public system.

The case is expected to last months and will likely extend well beyond that because, whatever the verdict, the losing side will undoubtedly appeal the judgment all the way to the Supreme Court of Canada.

A couple of important principles are in play here: should everyone have the same access to health care no matter how much money someone has, or do individuals have a constitutional right to purchase health care if they think it is necessary?

The Supreme Court of Canada has already weighed in on this matter, sort of. It ruled residents of Quebec could indeed purchase private health insurance, but the ruling was confined to Quebec only.

Many observers think the case will push our health-care system to resemble ones more common in Europe, the so-called "hybrid" model that combines both the public and private side. The theory is that a blended model would allow for competition and increased efficiencies in the health-care system (a theory challenged by pure public system advocates).

But even if that does occur, it's far from certain how sweeping any changes will be. Nothing dramatic has changed in Quebec, for example, despite that high court ruling back in 2005.

A key factor here is that no matter what the outcome of the B.C. case, there are only so many doctors and nurses in the system who can treat people. Even if the clinic were to win outright,  it's far from clear whether a high percentage of health-care providers would defect entirely to the private side.

Indeed, the B.C. government argues any growth in private clinic business would drain the public side of physicians, thus increasing existing wait times. However, that remains simply an argument, not a statement of fact.

B.C. has about two dozen private clinics that perform elective surgeries, and cosmetic work and surgeries sent their way via WorkSafe B.C.,  the RCMP and the Armed Forces comprise the bulk of their work.

Keep in mind those private health clinics exist only if they make money. If not enough patients (there are currently about 80,000 British Columbians on some kind of medical wait list) opt to pay (presumably) thousands of dollars to get off that list and have their surgery, the clinics will not be in a position to hire more doctors and nurses and therefore make huge inroads on the public system.

Presumably, some kind of business model for private clinics would evolve should Day win his case, but the public system would presumably still dominate (the public system does about 10 times the number of surgeries done in the private system, and it's hard to see high-end services for cardiac and cancer patients ever shifting en masse to the private side).

Nevertheless, the impact of this case is going to be felt one way or another. How big an impact won't be known for a couple of years yet, but I suspect provincial governments (which largely fund our health-care system) are watching this one nervously.

Keith Baldrey is chief political reporter for Global B.C.