Opinion | Pay for optional health care extras? We do that already, and it’s not extra-billing

Here’s the supposed peril from Doug Ford’s plan to expand independent medical clinics:

“Upselling.”

Beware doctors who make money off unsuspecting patients — peddling costly “extras,” promoting unneeded upgrades, pushing optional add-ons.

That’s why some are bombarding the premier with questions about the menace to medicare as we know it. Or medicare as we think we know it.

To make their case, the doomsayers keep pointing to Exhibit A — a cautionary tale that goes something like this:

If you get cataract surgery in an independent clinic today, you’ll encounter a menu of pricier possibilities.

OHIP only covers a basic corneal procedure allowing you to see clearly. If you also want to see even more sharply by ditching your glasses, sorry, but you’ll have to pay far more for specialized optics and special measurements (to correct myopia, astigmatism and so on).

The choice is yours. Fix your cataracts free but keep wearing glasses; or pay out of pocket for a glasses-free look, albeit not at taxpayers’ expense.

According to opposition politicians and dissident doctors, the above scenario should give us all pause. But wait a minute — wasn’t all this happening at independent clinics long before Ford’s Tories took power, under the nose of the last Liberal government?

In truth, upselling has been around forever — in medicine and in life (not to mention death … at funeral homes with costlier caskets). Some may find it distasteful, but let’s not mix up upselling with extra-billing.

Or pretend it amounts to two-tier medicine. Upselling is about choice — which should surely be informed not uninformed, honest not dishonest.

Patients have every right to demand transparency and honesty from medical practitioners with professional and ethical obligations. That’s why we need rules and regulators, to protect people from deceptive or predatory practices.

The bottom line, however, is that upselling is a consumer protection issue for wronged patients. It’s not a valid reason to create new roadblocks for future reform that could benefit all patients in need.

A wiser government might have buttressed its rollout of expanded private surgery clinics by doubling down on regulation and inspection at the same time. There’s still time for extra vigilance going forward, but let’s not rewrite history in the process.

OHIP today guarantees a single-payer (government) system within a multi-player (health providers) framework that is universal and accessible, without privileged access for rich folks who jump the queue. Upselling doesn’t change that equation.

Allowing a 70-year-old pensioner to ditch her glasses after upgraded cataract surgery is not two-tier medicine. In fact, it’s little different than allowing anyone to spend big money at the optometrist on progressive glasses with sleek UV coatings — instead of condemning her to trifocals, bifocals or reading glasses.

To be sure, some providers can prey on people’s ignorance or exploit their indifference. Sometimes you have to look awfully hard to find full disclosure at some of the not-for-profit clinics offering cataract surgery, while other for-profit operators are more transparent.

All clinics should post clear price lists for all to see, whether for basic OHIP procedures or so-called “upselling.” Any transgressions are questions of professional ethics and regulatory compliance.

That said, all clinics are emphatic that upselling isn’t queue-jumping.

Despite my own personal bias in favour of public ownership, I can’t muster credible arguments (other than ideological and nostalgic) against experimenting with more privately run clinics to do basic surgeries burdened by massive wait-lists. Let’s not hold future reforms hostage to the problems of the past.

Just because the previous Liberal government looked the other way at lack of disclosure by not-for-profit operators doesn’t mean we should demand closure of them all. Nor should that foreclose the future expansion of for-profit clinics at a time of growing shortages.

Yet some are dismissive of plans to reduce wait times for cataract surgery and hip or knee replacements, arguing that these are a side show. Tell that to the older people whose muscles will atrophy while waiting to walk again, or who won’t read until they can see clearly again (see also: Rosie DiManno’s personal and persuasive column on cataracts).

It’s easy to see why people don’t trust this government to keep its word. It’s hard to see why patients should suffer for it.

“I get that people are skeptical,” Windsor Regional Hospital CEO David Musyj told the Star’s Rob Ferguson in a fascinating story about a new private clinic that serves as a model for the province. “But it’s worked in Windsor.”

Oddly, while critics falsely claim that private clinics will let people jump to the front of the line, those waiting lists might ultimately be cut for everyone if we can innovate a more efficient model for the most streamlined surgical procedures. That’s the lowdown on upselling.

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