Friday, August 8, 2008

Aborted Logic

Over at Blue Like You, Joanne (having some time ago completed her "Journey"), is plenty miffed about Dr. Henry Morgantaler's challenge to abortion funding restrictions in New Brunswick. You see, in every province but New Brunswick, elective abortions are publicly funded procedures. Strange, since a full 70% of the 33 respondents to Joanne's recent Poll of Polls favour "some kind of abortion law".

Stranger still, since a recent poll of 4 of my friends showed 100% of respondents in favour of closing the books on the abortion debate. Math is hard.

Anyways, regardless of your views on the choice vs life debate, you have to marvel at the complete absence of intellect by Joanne's commenter "Ed the Hun" who wonders:

Of course the irony to me is that the left (who so FULLY supports Morgentaler) are contradicting their own stance regarding NO PRIVATE HEALTHCARE.

Isn’t Morgentaler’s clinic ‘private’ (as in not part of the publickly [sic] owned) and isn’t what he is asking no different than if someone were to open a clinic in Alberta where you might go to get a hernia repaired for example and the bill is paid by the Alberta Government?

To which Joanne dutifully replies: "Good question, Ed".

Good question?? Is she joking?? Sadly, probably not. Ed and Joanne, I know it's tough, but try to follow here. Morgantaler is fighting for public funding for abortions in NB. Currently, women who wish elective abortions must pay out-of-pocket, which he believes represents an unwarranted barrier to access. Those who support Morgantaler support his challenge against private-pay abortions. So no contradiction exists, despite the tortured logic you invoke to try to make it so. Clear? Good.


wilson said...

''You see, in every province but New Brunswick, elective abortions are publicly funded procedures.''

Abortions are publicly funded in NB, up to 12 weeks, and procedure done in a hospital.
If by elective you mean ON DEMAND abortions, done in a private facility, are not publicly funded.

No doctors on Prince Edward Island will perform abortions.

Wasn't there just a court case, where a Quebec man won the right to PAY a private clinic, when the public system wait lists were too long?
So women do have a choice in NB, go early or pay your own way.

wilson said...

ps. early preg tests can tell you you if you are pregnant within a day of your first missed cycle. The wait times in the NB hospital is 1-2 weeks. So, lots of time to decide and proceed within the 12 week period.

Red Canuck said...

No Wilson, according to the article, abortions are only funded in NB if done in hospital up to 12 weeks, and if 2 doctors certify that it is medically necessary.

This last clause leads me to believe that elective abortions are not covered at any stage in NB. By the letter of the law, abortions would only be covered if a continuation of the pregnancy would pose a medical risk to the mother, thus necessitating an abortion for medical reasons.

herringchoker said...

Elective abortions are funded in NB when performed in a hospital. The New Brunswick Health Services Act treats abortion like any other specialist medical procedure. In NB all specialist procedures require a referral from a GP. This is the "two doctor rule" that Red was referring to. Bear in mind that the second doctor is the abortionist, so there isn't a high likelihood of the patient being turned down.

Harbord Henry's biggest problem in NB is that he did lousy market research. His Fredericton clinic is only a kilometer away from the largest abortion provider in the province, the Chalmers Hospital. Abortions there are covered under medicare, just like most other procedures and are, to the patient, seen as being free. Meanwhile Henry insists on charging $700 per to use his facility. You can see why he has trouble drumming up business.

For about a decade now Henry has been trying to get NB to pay for abortions at his clinic. He has even offered to sell the clinic to the province. Unsurprisingly, he hasn't been taken up on the offer. If Henry was truly interested in serving New Brunswick women in need of his services, he would have been better off locating in Moncton, or Bathurst, or another community where there are no doctors who will perform abortions. (Abortions ceased in Moncton about four years ago). In that case, he could make a plausible argument about providing a needed medical service in an unserviced area. But he's never done that. Strange that. Of course, his Fredericton clinic is near the UNB campus, the largest university in the province. That couldn't have anything to do with it, could it?

Red Canuck said...

Herringchoker - Thanks for the details. Presumably a portion of Morgantaler's fee goes into paying his overhead. What I don't understand is why the province would have any objection to allowing Morgentaler to bill the Provincial health plan the same amount as any physician would bill for providing the same service in a hospital (eg Chalmers). One has to believe that the province's intransigence on this issue has more to do with its "moral" stance on abortion than with anything else.

herringchoker said...

Hey Red,

You're free to draw your own conclusions of course, but the same rules would apply if the clinic was for cataract surgery or performing MRIs. If they are not performed in a hospital, they won't be covered. (There are exceptions for emergency treatment performed outside the province, but within NB the in-hospital rule applies.)

The larger issue, from the province's perspective, is cost control. The Dept of Health controls the budgets for the hospitals. It maintains that control by severely limiting the number of outside service providers (like Henry M). So far, no court has ever ruled that a province cannot set rules for controlling costs, provided that they provide the service. That is what's happening in Fredericton (see above).

If the gov't changes this policy, as the Minister of Health has been alluding to for the past two years, Henry will be the first in line looking for payment. As for his legal case, well good luck. But I should point out, he's not spending his own money pursuing this matter. That makes litigation so much easier.

Red Canuck said...

HC - I guess I'm influenced by living in BC, where "private" surgical clinics and MRI centres are sprouting up. But fundamentally, I'm concerned about both fair and timely access, but also about people not having to pay out of pocket for procedures covered under provincial health plans.

If Henry wants to offer his services in his own clinic, I feel he should be able to bill the province the same amount (but no more) than his gyne colleagues in the hospital bill the province for providing the same procedure.

It would be interesting to see whether patients wanting an abortion through the publicly funded system are actually able to get this service in a timely manner, given that the 12 week clock is running and that, as you said, only one hospital in the province is offering the service.

herringchoker said...

Well two points,

Henry doesn't actually perform any abortions in Fredericton, he has local stringers. In fact, it wouldn't be surprising to discover that the same OB/GYNs who do the procedures at the DEC do the procedures at his clinic. After all, most physicians are private operators, even under medicare. All they need is a billing number.

The other issue is that there doesn't seem to be any shortage of services, at least not any that can be determined from outside sources. There are approximately 1,000 abortions performed in NB (give or take) in any given year, going back a decade or more. This is despite having an aging and declining population.

Another issue that may (or may not) be relevant is that Henry can still bill other provincial health-care plans for any abortions done for out-of-province patients (remember, his clinic is located a skip-and-a-jump from the UNB main campus). PEI, two decades after Henry's big win in the SCC, still has no abortion providers on the Island. That province does, however, pay for procedures done in neighbouring jurisdictions (like the VG in Halifax, or Henry's clinic in Fredericton). This may constitute the bulk of the Fredericton clinic's patients in any event.

Which brings me back to my original question. If Henry won't follow the provinces rules, and can't make a go of it on the free market, why should he get a public subsidy for his "private" health care venture?

herringchoker said...

Oh, BTW. There are at least two (and sometimes three) hospitals that perform abortions in the province. The DEC in Fredericton, the Saint John Regional Hospital, and the Woodstock hospital depending on the year (the hospital in Woodstock never provided very many, and its only an bit over an hour to drive to the DEC).

Both hospitals in Moncton used to provide the service but stopped, not because of local pressure, but because "no shows" were using up too ER time, with everyone but the patient showing up. Given that Moncton is the second-largest population centre in the province, I've always wondered Henry didn't just set up shop there, instead of trying to compete against the DEC. At least there he could argue that he was providing a needed medical service.