In British Columbia you can buy your way to the front of the line for cataract surgery. Health Minister Colin Hansen chose to ignore that in legislative "debate" over the Medicare Protection Act.

Hansen is nobody's fool. He frequently demonstrates a detailed knowledge of his ministry; a true liberal, he may be cursed by some for the hard nosed stance he has taken in reorganizing health care delivery, but he is recognized as being very competent. Credentials like that make his performance in legislative debate in defense of the "Bill 92 (Medicare Protection Act)" more than disappointing. Have the Campbell Liberals adopted a new standard of deception? Having been exposed for breaking their promise on the sale of BC Rail, are they willing to give up any pretense of telling the truth?

One of my favorite political columnists, Paul Willcocks, wrote a column that opened with the question, "Who would have thought the Liberals would be the ones to battle doctors over extra-billing and private health care?" Willcocks went on to criticize the former government for not bringing physicians to their knees over violations of the Canada Health Act, and to praise the Campbell government for taking on the doctors. In defense of Willcocks, anyone could have been mislead before hearing the committee stage debate on Bill 92.

A succession of government backbenchers put questions to Hansen during committee stage, clause by clause, debate on Bill 92. The general tone of the questions reflected concerns that the Bill would stop queue jumping. Berry Penner (MLA for Chilliwack-Kent and a favorite for a promotion in a cabinet shuffle) said:

"I've got a question, as well, on section 5 of the bill. Just to follow up on a question the member for Saanich South asked a little bit earlier, I'm seeking some clarification around the impact this legislation will have on people currently providing cataract surgery in what are commonly referred to as private clinics. Will this amendment contained in this legislation essentially restrict or outlaw the provision of private cataract surgery in the province?"

The exchange then continued:

Hon. C. Hansen: "There's nothing in this bill that changes whether or not cataract surgery is or is not covered under the Canada Health Act. All this bill says - which is the same after this bill is in force as it was previously - is that cataract surgery is considered a medically necessary procedure by Health Canada, and we therefore have to ensure that it is reflected in practices in British Columbia. So if a practitioner is enrolled in the Medical Services Plan, all this says is that they cannot extra-bill over and above what MSP would provide for."

"There is certainly the opportunity for the public system to contract with some of these private clinics for the provision of cataract surgery. We saw an example of that over the last number of years with the service that was being provided in North Vancouver, where the health authority had contracted out for cataract services to a private clinic. But if the physicians involved are enrolled in MSP, then Health Canada expects us to ensure that there is not extra-billing that is being charged to the patient."

B. Penner: "I thank the minister for this answer. I think this may be my last question, then, on this topic."

"In the Fraser Valley - actually, located in Abbotsford - there is a cataract eye centre. My understanding of their practice is that the physicians will bill the Medical Services Plan for their service in terms of providing cataract eye surgery, and then the clinic itself turns around and sends a separate invoice to the private patient who has elected, rather than wait six to nine months on a waiting list for the public system to deliver the cataract surgery, to avail themselves of this service at the clinic in Abbotsford."

"Will this legislation impede or prohibit the practice of the clinic sending a separate invoice directly to the patient, where the physician that comes into perform the service is billing separately to the Medical Services Plan?"

Hon. C. Hansen: "I want to make it clear: this bill does nothing to change whether a procedure is or is not covered under the Canada Health Act. All this bill does is ensure that we have the ability to follow up on patient complaints, because we, as provinces, have the obligation to ensure compliance. Now, whether a clinic is or is not compliant with the Canada Health Act does not change as a result of this legislation."

"In the case of the example the member used, if the bill that is sent to the patient directly for the patient to pay…. If that is in relation to an enhanced service such as the specialty lens that we were talking about earlier, then it is appropriate. If they are sending a bill to the patient for fees in relation to the actual cataract surgery, then it is not appropriate. It was not appropriate last month and will not be appropriate once this bill is brought into force."

Throughout the debate Hansen made it clear that the only purpose for Bill 92 is to satisfy the federal government with respect to its demands; he also made it clear that any violations of the Canada Health Act are complaint driven, in other words, if you pay to jump the queue and don't complain, they will also look the other way.

Hansen should know that a common practice for jumping the queue for cataract operations is to charge for correcting an astigmatism, a condition that most people have to at least some mild degree. Correcting the astigmatism is not covered under Medicare (not medically necessary under the Canada Health Act), but it is convenient to also perform the cataract operation while correcting the astigmatism. The government gets billed for the cataract operation, the patient gets billed for correcting the astigmatism (queue jumping) and no one complains. In addition to defining an eye condition, a second definition of "astigmatism" is "the state of being unable or of refusing to accept or believe what is true or right". The Campbell government appears to suffer from astigmatism.