Dr. Brian Day @DrBrianDay Twitter

  • Past President Canadian Medical Association
  • Past President Arthroscopy Association of North America
  • Honourary Associate Professor University of British Columbia
  • 2014 Doctors of BC Don Rix Leadership Award

Hybrid fix looms for health-care ills

Aug 25, 2007

National Post
Ageing population making reform even more urgent

William Hanley

A close friend in Ottawa suffering great discomfort with a swollen knee is told he can either hobble around for nine months waiting for an MRI or head over to Quebec and get one performed almost immediately for $750. He's a Boomer getting ready to retire, but not a wealthy one. So. like countless Canadians confronted by unpalatable health-care options, he's weighing options that only add insult to injury.

Across the country in Alberta, one of the richest jurisdictions on Earth, health authorities are faced with a bill for $215,000 after having to send a woman to Montana to give birth to her quadruplet daughters because of a domestic shortfall of neonatal intensive care beds.

From the cradle to the grave, it seems, Canada is falling short of many expectations in health care, further exasperating a population looking for a solution -- almost any solution -- to what has emerged as the policy puzzle of the early 21st century: What is the best way to provide health care, especially in a rapidly ageing society that will require more resources with each passing year?

Stepping into this policy minefield as new president of the Canadian Medical Association is Brian Day, a B.C. orthopedic surgeon who wants to see some reconstructive surgery performed on our health-care system. Day, known by his detractors as "Dr. Profit" because of the private Cambie Surgery Centre he operates in Vancouver, has been on a waiting list of sorts himself, having been elected to the CMA's top post all of 18 months ago. Now that he's finally in the job, he's expected to become a strong advocate for reform and will be closely monitored by those who fear he will try to dismantle medicare.

But as Tom Blackwell reported in the National Post this week, Day says he is not advocating the privatization of Canadian health care. "To privatize the medicare system in Canada would be an impossible task, even if you wanted to," he was quoted as saying. "But there's no reason to. I think the public system can benefit from exposure to some of the principles that operate in the marketplace."

Those words, as carefully scalpeled as they are, will be fighting ones to the fierce defenders of medicare.

They believe that further creeping privatization of the system, as represented by Day's clinic, which exploits loopholes in public health rules, will eventually erode medicare and relegate

it and most Canadian patients to second-class status. Both sides of this epic argument have plenty of evidence--and lots of rhetoric -- to prove their points.

Pro-public-only system advocates need only point to the United States and its expensive and chaotic insurance company-run system to underline the evils of private health care.

Go see the Michael Moore documentary Sicko, they say, to get a picture of a U.S. system where tens of millions have no health insurance and tens of millions more are inadequately insured.

Private-care advocates need only point to the seemingly endless waiting lists for procedures in Canada, to the more successful public/private systems in many countries, including Britain, Australia, France and Germany, where consumers have a choice to buy services out of their own pockets while still paying taxes to support viable public health systems.

I'm no expert on public health policy (and I can hear the "amens" to that). Not even close. I'm an interested observer with a large stake in the outcome of a debate that can be life or death one.

In the best of all possible worlds, the one I would like us to inhabit, we wouldn't be having a public/private debate. Canada -- a rich country by any standard -- has the resources, both financial and human, to provide adequate publicly funded health care. But I fear that getting all the various -- and often competing -- interests together to keep the system public and make it fully functional is as impossible as Brian Day says it would be to privatize said system.

Indeed, many an MRI has been done on the system and there are myriad diagnoses and recommendations of treatment. As a result, some kind of hybrid system of public/private health care is inevitable.

Better then that it be an organized move to such a system than the current chipping away at the Health Care Act through loopholes and court challenges and rulings.

With such a new compromise system must come guarantees -- absolute ones -- that the public system cannot be eroded at the expense of those of us it has served -- and, yes, sometimes disserved -- all our lives. I have no doubt that by the time the last Boomers turn 60 in the early 2020s, our health-care system will be restructured.

The question will be whether it will limp along to that status -- like my friend in Ottawa with the gimpy knee--or be rehabilitated in an orderly, timely fashion.

In fact, here's a footnote -- or, rather, a kneenote -- to my friend's MRI story that serves to underline the frustrating shortcomings of our health system: Soon after being told about the nine-month wait or the $750 MRI solution by his doctor's receptionist/ assistant, he ran into a friend who said that if he was available any hour of any day, he might be able to get the MRI. He phoned the clinic directly and was told that was a possibility. In the event, the very next week he went to the MRI clinic at 2 a.m. on a Tuesday morning, got his MRI and is awaiting the results. Of course, if he needs an operation, the wait time might be nine months. Or will it?

whanley @ nationalpost.com
© National Post 2007