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

Health system, you're fired

Nov 12, 2005

The Globe and Mail

The fatal sickness of a broken system
As public health care grows increasingly unsustainable,
we should look at private and hybrid alternatives, Gary Mason writes


Saturday, November 12, 2005
Page A3

VANCOUVER -- Brian Day has operated on the knees of many a famous athlete, so sports analogies come easily to him.

"Okay," says Dr. Day, one of North America's leading orthopedic surgeons. "Imagine you're a professional hockey team and you are ranked last in a 30-team league and yet your payroll is one of the third or fourth highest.

"Well, we know what would happen. The manager would be fired, the coach would be fired, because clearly that's unacceptable. And yet we're allowing that very thing to happen when it comes to health care in Canada."

It's true. Canada's health-care system is ranked 30th in the world by the World Health Organization and yet we are one of the top three or four spenders. Every country ahead of us has a public health-care system that is supplemented by private medicine.

Dr. Day, who is president of the Canadian Independent Medical Clinics Association, has become one of the leading voices in the country calling for some sort of public-private system in Canada. A system he believes is inevitable, if for no other reason than the baby boomers will demand it when they discover it takes two years to get a new hip.

"We think things are bad now in terms of health-care costs," Dr. Day says. "We haven't begun to see the worst of it. And we can't sustain it at present rates. It's been proven that a limited private system will actually reduce costs. I've seen it happen."

St. Paul's Hospital, for example, has recently been contracting out work to the private clinic in Vancouver where Dr. Day and a dozen or so other physicians work. He says the hospital will soon disclose that for every $1,000 in surgery work it contracts out, it saves $300.

France has the No. 1-rated health-care system in the world, according to the WHO's latest report on the subject. In 2002, France spent $2,700 (U.S.) per person on health care, while in Canada we spent roughly $2,900 a person.

"I think that says something about the inefficiencies in our system," says Dr. Day, who yesterday opened a two-day conference in Vancouver on public-private health care. "And they're there because there's effectively a monopoly provider in this country, and we all know what happens where there's a monopoly."

Personally, I'm with Dr. Day on this one. And I think we should take offence when politicians say that any form of private health care equals the American system. That simply is not the case. In fact, it's incredibly irresponsible to suggest it and amounts to fear-mongering.

The U.S. has a largely private system, one that is ranked 37th in the world. Why would we want to fix our broken system by copying one that is worse than our own?

In Europe, however, they have a blend of public and private health care that works far, far more effectively than the one we have here in Canada.

It's time we got beyond this romantic notion that universal medicare is what defines us as Canadians. It doesn't. At least not any more. No one is looking here and saying: "Boy, that is the system to copy. That is the system that is really working." Are you kidding me? Other governments look at what it's costing to prop up our system and recoil in horror.

It simply isn't sustainable.

The sad thing is politicians are afraid to even broach the subject of a limited private health-care system in Canada, even though some opinion polls show we are more open to the idea than ever before. And Lord knows politicians won't do anything before they've seen a poll giving them the green light to go ahead.

The fact is Prime Minister Paul Martin, Conservative Leader Stephen Harper and a host of premiers all know that limited private health care is a good thing, not a bad thing. That's why premiers in some provinces, especially here in B.C., have been turning a blind eye to private medicine for years now.

Dr. Day opened his private clinic in Vancouver in 1995 when the New Democratic Party was in office. It was an open secret that people were going to the clinic for surgery and having relatives pay to get around the strict rule of the law regarding private health-care visits.

Dr. Day was hoping the NDP would take his clinic to court so he and his colleagues would have a forum to discuss what they were doing.

So, why didn't the government?

Because every person who went to the private clinic was one less person taxing the already overtaxed public system.