The Defendants in the Cambie lawsuit are B.C.'s Minister of Health, the Attorney General, and the BC Medical Services Commission.
The Defendants will argue that B.C.'s health care laws are constitutional, and will make numerous arguments defending B.C.’s public health care law, some of which are summarized here:
The province will rely on national and international evidence that shows publicly funded universal health care systems are the fairest and most cost-efficient way to provide patients with access to services – without the financial barriers that plague patients who live in countries like the United States.
They will argue that evidence shows striking down our current laws will create a health care system where medical care is provided preferentially to the few who are able to pay for it, and where waitlists are likely to grow longer for most people.
The Defendants will draw on evidence from countries with two-tier health care systems that shows where parallel public and private health care systems exist, people who cannot afford, or do not qualify for, private insurance have more limited access to coverage and medical care than people with more money.
They will also point to evidence showing that wait times in the public health care system tend to increase when doctors are allowed to work in both the public and private systems. Higher pay in the private system means that doctors tend to prefer private practice rather than practicing in the public system. When physicians work in both the public and private systems, there’s an incentive, and a tendency, for doctors to delay surgery in the public system so that patients are attracted or forced into the private system.
The Defendants will highlight a problem known as ‘cream-skimming’, where private, for-profit clinics restrict their practices to less complicated cases, leaving public hospitals with a more complex and expensive case mix. Private clinics like Cambie and Specialist Referral clinics only offer elective surgery, provide only a limited range of services, and do not provide care for urgent medical conditions or complex surgeries.
Finally, the province will draw attention to the ethical concerns that can occur when doctors have ownership interests in the private clinics to which they refer privately-insured patients.
The Defendants have also launched several counter claims against Cambie Surgeries Corporation.
The province is seeking damages from the clinics, pointing to the economic losses faced by the province in instances where federal transfer payments were withheld from B.C. as a result of the clinics’ extra-billing practices.
The province is also asking the court for a declaration that the “acknowledgement forms” used by the clinics are void and unenforceable, and that the clinics can no longer require patients to sign them. These forms require clinic patients to pledge that they will not seek reimbursement from B.C.’s public health insurance plan for the cost of their surgery, nor give the province any information about the surgery they received. If a patient does disclose, the waiver requires the patients to indemnify the clinics for any damages and costs that arises as a result.
The province is seeking a warrant authorizing an inspector to enter the clinics. They are also seeking a declaration that there is reason to believe Cambie and the Specialist Referral Clinic have contravened the Medicare Protection Act, and an order restraining the clinics from contravening the Act.