Dr. Brian Day @DrBrianDay

Canadian Medical Association

NORMAN SPECTOR

The ascendancy of Vancouver orthopedic surgeon Brian Day to the presidency of the Canadian Medical Association, although long anticipated, still gave rise last week to a predictable spate of teeth-gnashing and hair-pulling on the political left. To be fair, not all concerns about the CMA's likely agenda under his leadership are misplaced. However, supporters of public health care have more to fear from so-called defenders of the system than they do from Dr. Day and his colleagues.

It was the political left that created Dr. Day, when the Mike Harcourt government gave injured workers a route to jump the queue through the Cambie Street clinic. And, by clinging tenaciously to the status quo to protect their trade union friends, it's the left that continues to create openings for Dr. Day's agenda.

Heads nod in agreement when the new CMA president notes that some of those who criticize him have extended health-care plans, and that others will never have to wait in line when they need medical attention. And many Canadians find it hard to understand why, in times of sickness, they are not permitted to spend their hard-earned dollars on health care, as they can on their pet cats and dogs.

Yet, even with the support of many on the political right, doctors have been unable to break the Canadian consensus on health care. For years, Jean Chrétien dined off the supposed intentions of Alberta premier Ralph Klein to introduce U.S.-style medicine into Canada. And it was only after he swore fealty to single-tier medicine at a Fraser Institute forum that Stephen Harper became electable at the national level. Meanwhile, here in British Columbia, Premier Gordon Campbell has repeatedly deferred his agenda in favour of "investigative" trips to Europe and through "conversations" with the public on health care.

Let's face it: A large segment of the medical profession has always been against socialized medicine. Indeed, doctors went on strike when Saskatchewan introduced what eventually became Canada's most cherished social program. However, doctors were then and will always be a very small minority of the population, and, in our system of government, it's the majority that rules.

Notwithstanding their grumbling, therefore, doctors will continue to be virtually the sole professionals whose incomes are effectively controlled by the state. Although few will shed a tear for a group that's vastly better off than most British Columbians, it's understandable that physicians and surgeons would be irked by the fact that dentists and lawyers, to take two examples, have the power to set their own fee structures.

Nor do governments limit the number of clients these and other professionals can serve, which perhaps explains why a group of small-minded doctors, at their Vancouver meeting last week, nixed the idea of pharmacists prescribing drugs. And it was undoubtedly these same frustrations that led them to defeat a motion proposing patient "co-payments" only by the slimmest of margins.

Having his access to operating theatres limited by budget-conscious hospital administrators has long been the bone in Dr. Day's throat. Now, according to a report by The Globe and Mail's André Picard, his goal is to eliminate patient queues completely - notwithstanding the huge overexpenditure in capacity, both public and private, this would entail.

Until now, governments and the medical profession have set the more realistic objective of establishing medically acceptable waiting times. But it would be folly to think that Dr. Day's message will not resonate with a large segment of the public. Indeed, as the boomers approach their twilight years, we can expect Canada's public health-care system to come under increasing pressure from a generation that has grown up having its way. That said, let there be no illusions on one point: Although he tries hard to fuzzify his intentions with the trite observation that the current health system is a blend of private and public delivery, Dr. Day's fundamental objective is an extension of two-tier health care.

That said, anyone who genuinely cares about the future of public health care would be wise to steal his more sensible ideas.

Funding hospitals based on the patients they serve and rewarding them for providing service are ideas that surely are worth testing. And, within the framework of a single-payer system, why not experiment with private clinics? If the Shouldice Clinic outside Toronto was good enough for Jack Layton when he needed a hernia taken care of, shouldn't publicly paid, privately run clinics be available to shorten waiting times that afflict long-suffering ordinary Canadians?

nspector @ globeandmail.com