Out of Order on Health Fees

The wimpish reaction of the Campbell government to the Copeman Health Care Centre has sent a message that any physician can ask patients to pay an annual fee to guarantee access to "uninsured services"; the trick lies in defining precisely what is insured and what is not. With a wink and a nod that loophole is being used to sell preferential access to Medicare's benefits. Questions were asked in the BC Legislature this week, not only about the Copeland Clinic but about copycats. On the North Shore a physician sent letters to patients asking for an annual fee to cover "uninsured services". When asked about that letter, Health Minister George Abbott said:

Isn't it strange that the Minister would ask the college to interpret legislation! The Canada Health Act allows the federal government to penalize provinces, it doesn't control physicians or clinics. The Medicare Protection Act is a provincial statute. The Health Minister should go to the Attorney General for an interpretation, not to the College of Physicians and Surgeons (which frequently is confused with the doctors' union, the BCMA).

In Calgary a medical practice is asking $3,600 per year for patients to assure 24 hour access to their services. That makes the fee of $240 asked by a North Shore physician for "uninsured" services look paltry. Once the horse is out of the barn on ways around restrictions on extra-billing; copycats will quickly proliferate. It doesn't help that BC's doctors are in contract negotiations with the same March 31st deadline on the $1 billion dangle as all other public sector workers.

Part 4 of the Medicare Protection Act is subtitled "General Limits on Direct or Extra Billing". In anything but plain language, the Act essentially says that a doctor cannot bill a patient for a service that is covered by Medicare unless the physician opts out and directly bills all patients.

Perhaps Premier Campbell can report on what he learned about extra-billing in France since dépassements" appear to be common. The Canada Health Act was adopted in 1983 in order to force provinces to end extra-billing and hospital user fees; at the time, extra-billing was becoming a problem in Ontario and Alberta, and BC had daily fees for the use of hospitals. It is strange to hear references to the Act that appear to be 20 years out of context, as if all provisions of Medicare were governed by the Canada Health Act. The Act set out the principles of universality, accessibility, comprehensiveness, portability and public administration and provided that the federal government could withhold $1 in transfer payments for every $1 that was charged by way of extra-billing or user fees. Alberta and Ontario settled with their physicians and ended extra-billing, and BC ended its practice of charging hospital user fees. In theory the Act could be applied to other circumstances but successive federal governments have demonstrated that they are more interested in negotiating with the provinces rather than imposing penalties.

The practice of charging annual fees in order to gain preferential access to a physician, in the name of charging for uninsured services, needs to be dealt with by the province by penalizing the offending physicians. With Bill 92 (2003), Medicare Protection Amendment Act, the Campbell government took the legislative step necessary to increase its power to deal with extra-billing physicians; however, it has not proclaimed that Act. In question period on March 2nd, 2006, Jenny Kwan asked the Minister of Health: "Will the minister admit that the problem here is the government's lack of action in enacting Bill 92, the Medicare Protection Amendment Act? My question to the minister is: when will the minister do the right thing and enact Bill 92?" The Minister, George Abbott, is one of the best performers in the BC legislature. He's not the sort of guy that needs the government house leader to protect him, but Mike de Jong jumped to his feet and said: "Mr. Speaker, the member is a seasoned veteran of this chamber and knows that that question is out of order."

When Social Credit ruled BC it was common practice for Ministers to refuse to answer questions by saying they were out of order, and there were plenty of reasons for finding questions out of order, including that they anticipated future policy. Technically de Jong was correct but it has been many years since government hid behind those rules. It was an insult to Abbott, and the public, for de Jong to jump into the exchange. Perhaps it suggests that the government caucus or cabinet have had some heated go-rounds on this topic. By his knee jerk reaction, de Jong demonstrated that the opposition hit a nerve.