Tuesday, May 31, 2011

The Attorney in 12A

As I sat down in 12C on my flight from Vancouver, my seatmate looked up from the flight magazine and gave me a friendly, “Hi!” By the time we were in the air, he had revealed he was a personal injury attorney traveling down to LA with his buddies to spend a long weekend at The Peninsula, the chief objectives of the trip being dinner at the Belvedere, Spago, and Melisse. Guess business in the personal injury field is doing all right in British Columbia. Before we moved on to more important subjects like my list of hidden restaurant treasures in LA, Mr. P.I. Attorney seemed happy to give me his take on the BC health care system as a patient, as an employer who provides extended health insurance (see Definitions) to his employees, and as a personal injury attorney.

As an individual, Mr. P.I. says his health care has all been good. When he had to have an ankle ligament tightened after an injury, he waited two days to see his family doctor and two months to have the surgery to repair it.

Interestingly, the main reason his wife works 25 hours per week is because her employer pays the premiums for their private extended health insurance as well as their Medical Services Plan (MSP) premium. This got me wondering how much the premiums are for the private, as well as the public insurance. Searching the Internet for extended health insurance coverage quotes, I found a pretty comprehensive policy for a 40something couple with 2 kids for about $320 per month and the MSP monthly premium for families earning more than $30,000 per year is $121. A savings of $441 dollars per month will certainly buy a few dinners at Spago.

Mr. P.I.’s law firm provides some help to their employees for purchasing extended coverage. Similar to the way employers in the US can choose whether to provide any level of health care coverage for their employees and can choose how much of the premium to cover, employers in British Columbia may provide different levels of extended coverage benefits. And some employers do not provide any extended health benefits at all. Also, different policies have different covered benefits, for example, medications, vision care, dental care, chiropractic care, physical therapy, private hospital rooms, and travel health insurance.

As in the US, more large employers provide health benefits than small employers. In Canada it also seems there is some correlation between higher paying jobs and employer-provided extended health insurance coverage. In Vancouver I’ve spoken to employees in clothing stores, the car rental agency, and the nail salon that don’t receive extended health care from their employers.

So it is commendable that Mr. P.I.’s rather small firm pays about half of the premium cost for their employees. Mr. P.I. raised another interesting point: When an employer covers these benefits in Canada, they are taxable. This has been a point of contention in the US health care debate.

Since Mr. P.I. is, well, a personal injury attorney and deals with clients needing health care, I decided to ask him about his cases. As it turns out, basic auto insurance is obtained through a government plan, ICBC, which all BC drivers are required to obtain. So Mr. P.I. ends up bringing cases against the ICBC to get health care costs covered.

This led me to ask whether the Medical Services Plan ever gets sued for not covering services or because a delay in receiving services results in a bad outcome. I’m not talking about personal injury cases, but you know, the way HMOs and PPOs in the US get sued? He said he hadn’t heard about any individual suing the MSP for delayed treatment but he had heard about a case involving the MSP denying coverage for a course of treatment for autism. Seems to be uncommon, though.

He did say there are medical malpractice lawsuits. I guess since doctors are reimbursed to provide all medically necessary care, if someone doesn’t get the care they need, it’s not because of a government insurance plan’s decision. It’s the result of a doctor’s decision so the doctor is to blame.

When I was just about done with my questions, I asked Mr. P.I., “ If you got to vote on it, would you vote to have more privatization in the health care system?” I figured, this guy makes good money, if spending money on private health insurance could eliminate wait times for his family, wouldn’t he be in favor of that? He looked out the window and said with some hesitation, “Yeah, maybe I would…” Then he looked back at me, “But only if physicians were very limited on the amount of time they could spend practicing in private clinics vs. the time they spent in the public system.” In a follow-up email he wrote to me, “Our system is far from perfect, but I do think that it is pretty good, and is a good model for other similar countries to follow in principle.”

These Canucks are darned proud of their health care, eh?