Yes, it's that time again. What has set poor, obssessed Tim off this time? Once again, it's Dr. Brian Day, head of the Canadian Medical Association.
VANCOUVER (CP) - The incoming president of the Canadian Medical Association says the country's public health-care system is headed for crisis, but a greater role for private health care could be the right prescription.Dr. Brian Day said in his inaugural speech to Canada's medical establishment Wednesday that contracting out health services isn't new and has helped slash wait lists.
"Let's be clear: Canadians should have the right to private medical insurance when timely access is not available in the public system," he said to applause from about 270 delegates at the annual convention.
Day, a Vancouver orthopedic surgeon, said the Supreme Court of Canada has already made a decision favouring such a move.
The Chaouilli case, named after the Quebec doctor who initiated it, struck down Quebec's ban on private insurance in 1995, saying it contradicted the provincial charter of rights.
Day said injured workers in some provinces are treated in private facilities, saving workers' compensation boards millions of dollars in wages and keeping people off long wait lists.
Day, who opened Canada's first private surgery clinic in 1995, has often been criticized for his pro-privatization views that some say could pave the way for a for-profit system much like in the United States.
"No one I know wants to adopt a so-called American-style health system," he told delegates at the association that represents 65,000 doctors across Canada.
He said the private-versus-public debate is largely irrelevant and counterproductive but that new ideas and concepts are bound to face opposition and skepticism.
Actually, the introduction of private care into a public system is far from a new idea. Corporate health care lobbyists have been pushing it for decades, and there is plenty of evidence to prove that a mixed private and public system is not only far less equitable in terms of accessibility, it's also more expensive. That's been the case in the Australian experience.
The Australian experience with a dual system of health care has been mixed. Certainly, consumers (and the medical profession) welcome and support the wider choices arising from the existence of private hospitals. But this choice has come at the expense of equity, with access to elective surgery particularly affected: those with health insurance have faster access to elective surgery than those without.A further worrying aspect of policy direction in Australia has been that those with private health insurance have become a group with political influence. Private-health-insurance lobbyists have mounted a successful campaign over decades to obtain government financial support for their industry: now, that support is greater than subsidies to agriculture, manufacturing and mining combined. This support is inefficient, in that the government expenditure for each additional patient treated in the private sector is well over the contemporary price paid for treating additional patients in the public sector. The additional government support is also probably impeding the ability of government to expand the public sector.
The Australian experience suggests that Canadians should be wary about allowing a significant private sector to develop in Canada, particularly if it seeks the level of subsidy that the Australian private sector has been able to garner.
In fact, this is exactly what the CMA is suggesting in its new plan for Medicare, which it calls "Medicare Plus." Thus, money that could be used to improve our public health care system would be going to prop up a supposed private sector. Does that sound like a better use of public funds?
The result has been the same in the United Kingdom, where the National Health System has become increasingly expensive for the public purse since privatization was introduced.This led two top British physicicans to write the CMA this month warning them about the pitfalls involved in introducing private care into a public system.
A letter from British doctors to the Canadian Medical Association (CMA), the second of its kind, raises serious questions and advises Canadian counterparts of the pitfalls inherent in a number of proposals for privatization.In the letter, Dr. Jacky Davis and Dr. Peter Fisher, executive officers with Britain's National Health Service Consultants Association (NHSCA), advise members of the CMA to beware of the fantasy fixes suggested by privatization.
Dr. Davis' letter makes it clear that the romance with privatization in Great Britain's health care system is over. Both the newly appointed Minister of Health and the governments of Scotland and Wales have called for a serious reduction and even an end to the privatization of services. The British Medical Association also opposes the competition model.
Dr. Davis and Dr. Fisher write, "Those in support of privatization often cite the 'English Experiment' as proof that the private sector can "save" public health care. They point to significant reductions in waitlists since the reforms were established. However, that is hardly surprising given that health spending has more that doubled since 1997. The reality is that money has been lavished on politically sensitive wait lists for elective surgery through expensive and unsustainable deals with the private sector. This has been to the detriment of many patients with more long term needs."
Dr. Davis and Dr. Fisher indicate that doctors, including members of the British Medical Association, and politicians throughout Great Britain, are becoming weary of solutions that result in higher costs and increasingly limited access to services.
When it comes to "performance-based funding, known in Britain as performance-by-results (PbR), Dr. Davis and Dr. Fisher are unequivocal: "This shift (to payment by results) - begun three years ago - has resulted in so many perverse incentives and unintended consequences that its future is now in doubt. One downside particularly relevant to you (Canadian doctors) is the fact that PbR may lead to unnecessary admissions."
Examples of activity-based funding initiatives already exist in B.C. and Ontario. The B.C. government's new $16.4 million performance-based hospital funding pilot project uses a commercially-inspired incentive system to achieve outcomes that could be achieved with a global budget and a democratic, evidence-based decision making process - one that uses less overhead. The $1 billion Ontario Wait Times Strategy is also a concern because it prices procedures, rewards competition between facilities, and favours specialized hospitals.
The current leadership of the CMA is advocating more, not less, private sector involvement in Canada's health care system. Specifically, the recent CMA policy paper titled Medicare Plus recommends that government allow Canadians to purchase private health insurance and allow doctors to practice in both the public and private system. It also urges governments to consider funding private sector health services.
The British experience should tell Canadian doctors and Canadians that strong public policy providing for stable funding and collaboration, not marketing miracles and private investment, are needed to move Canada's health care system forward.
"We must conclude," says the British doctors' letter, "that neither payment by results, the increased use of the private sector or the 'patient choice' agenda have proved their worth. On the contrary, they have resulted in a destabilized and damaged public service. The government has sought to introduce a set of policies for which there is no evidence, policies which are incoherent and contradictory. These policies have fragmented health care, discouraged collaboration between healthcare professionals, and wasted money. This is why patients, the public and healthcare workers are seriously worried."
Pretty damning evidence, but it has been blissfully ignored by the CMA, and by the media, who trumpet every medicare opponent's complaint while failing to educate the public about the pitfalls of privatized care that are the hallmark of virtually every attempt to integrate the two systems.
I have no reason to doubt that Dr. Day is a dedicated physician who cares deeply for his patients, but when it comes to the privatization of medical care, his prescription is simply wrong. And given that he is the operator of a private clinic, he is also in a rather large conflict of interest when advocating publicly for the private care option. He is caught between two warring bottom lines: what is best for the health of all Canadians, and what is best for the health of his business.
Frankly, when doctor Day says that "no one he knows" wants to adopt "a so-called American-style health system", he lies. I've read about conventions on private health care that this man apparently attended where they were in fact talking about little else, with few bones made about it. Perhaps he means no one he knows is talking *to the public* about an American-style health system.
Similarly to the way no one anybody knows seems to be talking about the SPP. And indeed, for all we know health care is among the things to be "harmonized", for the better prosperity and security of the American HMOs.
I don't disagree with anything here, other than the CMA's claim that it "represents" 65,000 doctors across Canada. All of this is a product of the physician-politicians running the organization - the opinions of the "represented" aren't factored into it.
If the CMA wants to act like the CAW, it's welcome to do so. But it must thus drop any pretence of being a professional organization.