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

Public sector unions should push for more private involvement

Nov 17, 2009

Vancouver Sun

By Brian Day

Let's be clear about what medicare is: The word has nothing to do with universal access. Medicare is simply the name of a method of paying for health care. No more, no less. There are other schemes that provide better care and coverage, to more people, at a lower cost in many countries around the world. If you count Taiwan, Kosovo and Vatican City, there are 195 countries in the world. Predictably, none have modelled their health systems on Canada's.

This is not surprising when one considers that last year, alongside 29 other countries with universal care, Canada ranked last in value for money. Politicization and prejudices have led to an impasse that has prevented necessary reforms in Canada. Debates and discussions have tended to degenerate into unhelpful confrontations between supporters of a near exclusively tax funded and government delivered care (for physician and hospital services) and others supporting options and choice.

Is there a way to break the deadlock that often degenerates into ideological arguments on the role of the private versus public sectors? Often we find the political left -- including most trade unions -- arguing against private-sector participation. Trade unions themselves are a mixed group but seem united on this issue. The paradox is that their attitudes and philosophies are reducing job opportunities for their members.

It is an undeniable fact that Canada's health system is in a serious fiscal crisis. Health spending is increasing at many times the rate of inflation. As patients suffer on waiting lists, more and more money (90 per cent of new spending) is channeled into health care, with minimal evidence of improved productivity or performance. At the same time, governments have returned to positions of debt and deficits.

Unions face reduced membership, influence, and even relevance. In the past, especially in the late 19th and early 20th century, they had to defend the rights of their members against industrial bullies, but nowadays many of those rights are protected by law. It is still their role to negotiate higher wages and benefits for their members. However, in sectors where there is a shortage of labour -- such as in the health professions -- the restriction of market influences hurts their members. I saw this in the 1990s, when our Cambie Surgery Centre opened. We introduced a 25-per-cent higher starting wage scale for nurses, and the unions used that figure to leverage public sector wages. As our health system adapts to modern times, so must unions revisit some of their traditional beliefs and prejudices.

Rationing is forcing the exodus of doctors (especially in my specialty) and nurses. In a Canadian study, 79 per cent of new graduating nurses wanted full time work, yet less than half were employed. The private sector will expand capacity, create more jobs with better wages, and lead to improved benefits. While private sector unions have always had to understand and support the importance of productivity and performance in their industry, public sector unions have sometimes perceived that they are shielded and protected from economic forces. Neither the unions nor any political party can hide from the reality that medicine is subject to the laws of economics.

One of the largest private health corporations in Canada (Interhealth Canada) has pioneered private-sector health care abroad. It has been involved in recruiting Canadian health workers to leave Canada. Its founding CEO is a former NDP provincial cabinet minister and founding shareholders included several NDP governments, as well as the largest provincial nursing association in Canada. The benefit packages enjoyed by most unionized workers in Canada include private (I call it "two-tier") insurance and the biggest beneficiaries of expedited care and medical queue jumping in B.C. are unionized workers.

Many consider education to be an even more important social program than health care. Education has taught us that a hybrid system can work in Canada, as parents with children in private schools continue to support and fund the public system through taxation. The added resources boost the education system as a whole. Experience in countries with better universal health systems than ours (such as Switzerland, Austria, Belgium, Germany, France and Holland) illustrate that the same hybrid model will work for health care. It's time for all trade unions and all political parties to openly endorse such reform.

Dr. Brian Day is a Vancouver-based orthopedic surgeon, who served as president of the Canadian Medical Association, 2007-2008.

He is the founder and medical director of the Cambie Surgery Centre.
Page: A11, Section: Issues & Ideas