Voters in tomorrow’s Vancouver-Fairview provincial by-election face a choice between a pair of front-runners with very different takes on the current state of B.C.’s health care.

NDP candidate Jenn McGinn has spoken of a “continual deterioration of our public health care system” while BC Liberal Margaret MacDiarmid claimed studies show B.C. to have “the best health care outcomes of any province.”

Both claims should be taken with a grain of salt, said Robert Evans, an economist with UBC’s Centre for Health Services and Policy Research.

“I do worry about this ‘the system is falling apart’ rhetoric,” Evans said, explaining it’s a line that belongs more in the hospital budget-slashing 1990s than the present and tends to come from people who haven’t been in the system.

“When you ask patients what they’re experience has been, it’s not universally positive but it’s a remarkably high level of positive,” he said.

While waiting lists continue to be a political problem, Evans said their stubborn refusal to go away has a lot to do with the changing criteria doctors use when deciding surgery is necessary. Given that both the number of procedures and those awaiting them have increased, the severity of the ailments of the people on the lists may be more important than their actual numbers.

On the other hand, Evans said it’s hard to know to what extent British Columbians’ excellent mortality rates, heart disease and obesity levels are actually attributable to the health care system.

Evans said he worries about the “continual chipping away” of public health services in favour of private facilities.

“I think private delivery leads inevitably towards some level of private payment,” Evans said. “It doesn’t do so right away but the economic incentives are just too strong to try to tap the patient’s wallet when you’re running a private for-profit facility.”

MacDiarmid, a physician for more than two decades, was at the centre of the public-private controversy during her presidency of the B.C. Medical Association when that body nominated private-services enthusiast Brian Day to head the Canadian Medical Association.

She said people shouldn’t read too much into her public support of Day, which she attributed to her duty to accept the democratic decision of her caucus.

“I’m a strong supporter of our publicly funded health care system,” she said. “People shouldn’t be refused access due to a lack of funds.”

At the same time, she said there is a place for publicly funded, privately delivered services in certain instances if they can be more cost-effective or reduce waiting lists. The important thing, she said, is the outcome for patients.

Evans said the distinction between “for-profit privatization” and “publicly-funded private services” is not purely one of ideological framing.

“If you could get the private clinics hooked into the system, not going after the patient’s wallet and just doing the stuff cheaper and getting paid at a rate that corresponds to their lower costs, great!”

The problem, he said, is the temptation for “cherry-picking” – attending to the “cheap and cheerful patients” in the clinics and sending the more difficult cases through the public system, thereby giving the impression that private care is cheaper – and making a little more cash by charging for something extra.

Rob Annandale reports for The Hook.