Canadian health-care: go wait in line and die if necessary

This is a thread of Canadian health-care related stories, spanning from 2005-2007:

This story, "B.C. private care specialist plans Ontario clinic", by Tom Blackwell, with files from Lee Greenberg, (National Post, Dec.3, 2005):

"One of the pioneers of private medicine in Canada said yesterday he plans to open a for-profit surgical hospital in Ontario by 2007, and called the spread of such private health care a necessary and "unstoppable" force.

The announcement by Dr. Brian Day of Vancouver's Cambie Surgical Centre comes after all four party leaders have spoken out against allowing a parallel tier of private health care. Dr. Day's plan also appeared to set the stage for a lively political and legal battle in Ontario, where the Liberal government has said it is deeply committed to protecting the medicare system from private incursions.

Dalton McGuinty, the Premier, said yesterday his government wants to be known as a "champion" of public health care -- and has legislation to back up its stand. That law, the first passed by the Liberals after they assumed power in 2003, provides for fines of up to $25,000 for those who charge out-of-pocket fees for medically necessary services.

Dr. Day said he is willing to fight the province in court and is convinced he could win, citing the Supreme Court of Canada's ruling in the Chaoulli case, which said Quebecers could buy private health insurance if wait times did not improve.

"The Ontario government would have to show the judges were wrong in the Chaoulli decision," the Vancouver orthopedic surgeon and entrepreneur said after addressing a conference in Toronto. "They would have to argue it's OK for patients to wait and suffer and die on waiting lists ... They would have to demonstrate it's OK to keep patients with cancer waiting to get biopsies."

Dr. Day said he is meeting with potential partners this weekend to discuss the idea. He said his associates do not want to be named at this point but include businesses already in the health care field, other Canadian entrepreneurs and foreign investors.

The facility would likely cost $8- to $10-million to build and would offer mainly out-patient services, such as orthopedic surgery, cataract operations, urology, plastic surgery, gynecology and major dental work on children that has to be done under anesthetic.

Several possible sites have been scouted in and around downtown Toronto, but no decision on a location has been made, he said. He and his partners are also envisaging an Ottawa hospital at a later date.

"This is going to happen," he told the conference, called Timely Access to Health Care in Canada. "The environment is perfect. You've got a provincial government that is left-of-centre. You have a large group of patients that need to get treated ... This would be good for the city, good for the province, good for patients."

The Cambie centre, founded in 1996, offers a similar range of services. Its customers include the B.C. Workers' Compensation Board, as well as RCMP and Armed Forces members who are covered by separate health plans, which sometimes use private facilities. Others pay out of their own pockets or through private health insurance.

Many of Cambie's patients come from Ontario, Dr. Day said.

But Mr. McGuinty made it clear that such an operation would not be welcome in his province, which he said is working hard to cut wait times in public health care.

"We have in place legislation which is designed to lend further support and to send a strong signal to all Ontarians, indeed Canadians, and people in the international community that we are champions of public health care," the Premier said.

"Whenever I speak with people, they are not asking me for the right to pay more money for more private health care, they're asking for better quality public health care. We accept that challenge, and that's what we are devoting ourselves to."

The legislation, called the Commitment to the Future of Medicare Act, bars anyone from charging fees for a service that is covered by the medicare system. Those found to contravene the rules face fines of as much as $10,000 for individuals and $25,000 for corporations.
Dr. Day vowed that his clinic would open its doors regardless and wait for whatever action the province decided to take, though he predicted the government would turn a blind eye to avoid an embarrassing confrontation.

David Spencer, a spokesman for George Smitherman, the Health Minister, said he could not predict exactly how the situation might unfold but stressed the province would be informing Dr. Day about the Future of Medicare Act.

"One of the main focuses of this bill is to ensure that access to care in this province is based on need, not on the ability to pay," he said. "Patients cannot be charged for access to publicly insured services."

Meanwhile, he noted that the province is taking steps to reduce wait times in the public system and has already funded more than 250,000 additional procedures in areas subject to delays."

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This editorial, "Chaoulli comes to Ontario", was from the National Post, May 3, 2007:

"Had he trusted Ontario's government health care monopoly to treat him, Lindsay McCreith would likely be dead today. At the very least, his health would have been permanently diminished. Unacceptably long waiting lists for simple diagnostic tests and basic treatments forced the 66-year-old retired auto body shop owner from Newmarket to pay more than US$27,600 out of his own pocket for timely cancer treatment in the United States. Now, with the help of the Canadian Constitution Foundation (CCF), Mr. McCreith is challenging Ontario's ban on private health options. If he wins, Ontarians would finally be allowed to buy insurance that covers their care when the state monopoly fails them, as it too often does.

That anyone would have to go to court to secure such a basic right strikes us as bizarre in a free society. But there is much about Canada's single-payer system that is bizarre and antidemocratic. Nowhere else in the free world -- indeed, nowhere else in the entire world outside of Cuba and North Korea -- are citizens prohibited from buying private health insurance to pay for their essential health needs.

In January, 2006, Mr. McCreith suffered severe seizures as a result of a brain tumour. But as John Carpay, the CCF's executive director, explains in a signed column appearing on this page, Mr. McCreith was told he would have to wait more than four months to obtain an MRI to determine if the tumour was cancerous. He would then face a further eight-month wait for surgery if the tumour did turn out to be malignant (which it was) -- a total of more than a year from diagnosis to treatment. (The medically acceptable wait period is considered to be 10 weeks or less. Otherwise the patient risks having his cancer spread to such point where it is inoperable.)

But although Ontario's monopolistic hospital system could not even diagnose Mr. McCreith within an acceptable time period, he had no legal alternatives within Canada. Fortunately for him, he was able to pay for an operation in Buffalo, N.Y., which he was able to obtain in less than half the time he would have had to wait for the Ontario MRI alone.

Consigning Canadians to prolonged pain, loss of income and even premature death in the name of preserving equal health care for all is outrageous in a free country. Our laws "make it illegal to spend your own aftertax dollars on your own health, and the health of your loved ones. This violates the Charter right to life and security of the person," writes Mr. Carpay. He is entirely correct.

Mr. McCreith's experience with our politics-before-patients system mirrors that of Suzanne Aucoin, a former St. Catharines, Ont., Catholic school chaplain who was diagnosed with colorectal cancer in 1999. In late 2005, her oncologist recommended Ms. Aucoin begin treatment with a drug not commercially available in Canada. But when she applied to have treatments in Buffalo paid for by the Ontario Health Insurance Plan (OHIP), she was turned down.

While she waited for an appeal of her case through the Ontario health bureaucracy, Ms. Aucoin found a clinic in western New York state that could provide the drug she needed at $4,000 per treatment, about half the cost she would incur at an American hospital. She began weekly sessions on her own.

Two months later, Ms. Aucoin was cleared to take the same treatments in Hamilton, Ont. Again, OHIP refused to pay. Then, three months into her Hamilton therapy, OHIP finally agreed to pay for her sessions -- in a Buffalo hospital at double the cost of her clinic treatments and nearly five times the cost of her sessions in Hamilton. Even then, OHIP refused to reimburse Ms. Aucoin for the $52,000 she had dished out on her own while it dithered over her case. Not until January of this year, when Ontario's ombudsman intervened, did OHIP relent. In a stunning rebuke of the health monopoly's Byzantine process, the ombudsman chastised OHIP for its "cloak-and-dagger approach" to out-of-country treatment funding. He found the process secretive and the decisions inconsistent. Patients were often given no reason for being turned down. Such is life under a system governed by government apparatchiks rather than market forces.

Far too many politicians and health officials put defending Canada's universal health system ahead of curing patients. When patients cannot receive the treatment they so badly need from our "free" health care system, they should be free to seek that treatment wherever it is offered, and in a timely fashion. That is not to say that governments should pay for whatever treatment patients want, wherever they can find it. But it should at least be legal to buy private insurance to cover extraordinary treatments or shorter waits and to receive treatment in Canada.

Every other industrialized democracy in the world permits its citizens private health options. And most of them have better health outcomes for rich and poor alike than Canada.

We hope Mr. McCreith's challenge to Ontario's antiquated, socialist health system is as successful as the 2005 Chaoulli litigation in Quebec. That would force Ontario politicians to stop living the fantasy that they can prevent private health choices and at the same time shorten waiting times and provide better care.

It simply is not possible to reform medicare without permitting private options, and the sooner Canadians have those choices, the sooner we can get on with the task of making care better for every Canadian."

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Danielle Martin, M.D., board chair of Canadian Doctors for Medicare, wrote in “More medicare is the answer” (National Post, May 14, 2007):
"Re: Taking Ontario's Health Monopoly To Court, John Carpay, May 3; and Chaoulli Comes To Ontario, editorial, May 3.

Why Lindsay McCreith's doctor could not get him a timely MRI and follow-up care is unclear, particularly since the Ontario government has significantly increased spending on MRIs as part of its strategy to reduce wait times. What is clear is that the introduction of private insurance or private-for-profit health care for medically necessary services is not the answer to anyone's problems. The majority of Canadians couldn't afford either. Numerous studies have shown that the quality of Canadian health care is equal or superior to that of both the American model and the European models that permit parallel private insurance within the health care system.

John Carpay's tired depiction of our system as ranking 30th in the world based on a World Health Organization study has been widely discredited. Changes in the U.K. and other European jurisdictions that allow two-tiered parallel private insurance have led to increased costs, a drain of highly trained professionals from the public system, and "cream skimming," as private clinics choose the healthiest patients and leave the most complex to an increasingly overburdened public system.

We should never abandon patients to inadequate care, but there are many successful initiatives already underway in our hospitals to streamline care, reduce wait lists and promote innovation. Throwing the baby out with the bathwater, as some private entrepreneurs would have us do, would only make the system worse for everyone. The aim, as numerous expert reports have said, is to restore and strengthen medicare, not destroy it."

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Dr. N.B. Hershfield, clinical professor, University of Calgary wrote in “More doctors, not more medicare” (National Post, May 16, 2007):
"Re: More Medicare is the answer, letter to the editor, May 14.

Dr. Danielle Martin is wrong in her letter. More medicare will only magnify the current chaos in Canadian medicine. A journey through most (if not all) of the emergency departments in our urban hospitals is a case in point. Legions of patients, suffering from a broad spectrum of diseases, wait on gurneys, attended by paramedics.

The infrastructure is woefully underfunded; the main deficiency is the huge lack of caregivers. There is a great shortage of personnel in every single aspect of the health care profession. We need many more health care professionals. The profession should begin to descend on our schools and start interesting our young so that they consider entering these fine job opportunities. We must use modern marketing techniques to entice young people into our enterprise.

Meanwhile, our Colleges of Physicians must start allowing foreign doctors to fill the gap. They are excellent physicians, and we need them before their own countries prevent them from coming to our needy shores."

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Dr. Merrilee Fullerton, Kanata, Ont. wrote in “Look abroad, as patients go abroad” (National Post, May 17, 2007):
"Re: More medicare is the answer, letter to the editor, May 14.

Dr. Danielle Martin, board chair of Canadian Doctors For Medicare, writes that "the introduction of private insurance or private-for-profit health care for medically necessary services is not the answer to anyone's problems."

What she seems to be missing is that so many Canadians now travel to other countries for medically necessary care that there are now individuals and companies that make a living facilitating this exodus.

Dr. Martin mentions that the aim should be to "restore and strengthen medicare, not destroy it." People who look for alternatives -- and the physicians who provide it -- are not likely seeking to destroy medicare. Instead, they are providing a needed alternative.

In coming decades, medicare will be further strained by an ageing population, new technologies and new geneticoriented diagnostics and treatments. If we value individual patients, instead of idolizing a "system," then patients should be permitted to access the care they need, be that outside medicare or outside their country. And doctors should be advocating for patients, not bureaucracies."

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David Gratzer wrote in “Who’s the real sicko” (National Post, Jul.6, 2007):
“ "I haven't seen Sicko," says Avril Allen about the new Michael Moore documentary, which advocates socialized medicine for the United States. The film, which has been widely viewed on the Internet, and which officially opened in the United States and Canada on Friday, has been getting rave reviews. But Ms. Allen, a lawyer, has no plans to watch it. She's just too busy preparing to file suit against Ontario's provincial government about its health care system next month.

Her client, Lindsay McCreith, would have had to wait for four months just to get an MRI, and then months more to see a neurologist for his malignant brain tumor. Instead, frustrated and ill, the retired auto-body shop owner traveled to Buffalo, N.Y., for a lifesaving surgery. Now he's suing for the right to opt out of Canada's government-run health care, which he considers dangerous.

Ms. Allen figures the lawsuit has a fighting chance: In 2005, the Supreme Court of Canada ruled that "access to wait lists is not access to health care," striking down key Quebec laws that prohibited private medicine and private health insurance.

In the United States, 83 House Democrats voted for a bill in 1993 calling for single-payer health care. That idea collapsed with HillaryCare and since then has existed on the fringes of the debate - - winning praise from academics and pressure groups, but remaining largely out of the political discussion. Mr. Moore's documentary intends to change that, exposing millions to his argument that American health care is sick and socialized medicine is the cure.

It's not simply that Mr. Moore is wrong. His grand tour of public health care systems misses the big story: While he prescribes socialism, market-oriented reforms are percolating in cities from Stockholm to Saskatoon.

Mr. Moore goes to London, Ont., where he notes that not a single patient has waited in the hospital emergency room more than 45 minutes. "It's a fabulous system," a woman explains. In Britain, he tours a hospital where patients marvel at their free care. A patient's husband explains: "It's not America." Humorously, Mr. Moore finds a cashier dispensing money to patients (for transportation). In France, a doctor explains the success of the health care system with the old Marxist axiom: "You pay according to your means, and you receive according to your needs."

It's compelling material -- I know because, born and raised in Canada, I used to believe in government-run health care. Then I was mugged by reality.

Consider, for instance, Mr. Moore's claim that ERs don't overcrowd in Canada. A Canadian government study recently found that only about half of patients are treated in a timely manner, as defined by local medical and hospital associations. "The research merely confirms anecdotal reports of interminable waits," reported one newspaper.

While people in rural areas seem to fare better, Toronto patients receive care in four hours on average; one in 10 patients waits more than a dozen hours.

This problem hit close to home last year: A relative, living in Winnipeg, nearly died of a strangulated bowel while lying on a stretcher for five hours, writhing in pain. To get the needed ultrasound, he was sent by ambulance to another hospital.

In Britain, the Department of Health recently acknowledged that one in eight patients wait more than a year for surgery. Around the time Mr. Moore was putting the finishing touches on his documentary, a hospital in Sutton Coldfield announced its new money-saving linen policy: Housekeeping will no longer change the bed sheets between patients, just turn them over. France's system failed so spectacularly in the summer heat of 2003 that 13,000 people died, largely of dehydration. Hospitals stopped answering the phones and ambulance attendants told people to fend for themselves.

With such problems, it's not surprising that people are looking for alternatives. Private clinics -- some operating in a "grey zone" of the law -- are now opening in Canada at a rate of about one per week.

Canadian doctors, once quiet on the issue of private health care, elected Brian Day as president of their national association. Dr. Day is a leading critic of Canadian medicare; he opened a private surgery hospital and then challenged the government to shut it down. "This is a country," Dr. Day said by way of explanation, "in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Market reforms are catching on in Britain, too. For six decades, its socialist Labour Party scoffed at the very idea of private medicine, dismissing it as "Americanization." Today Labour favours privatization, promising to triple the number of private-sector surgical procedures provided within two years. The Labour government aspires to give patients a choice of four providers for surgeries, at least one of them private, and recently considered contracting out some primary-care services -- perhaps even to American companies.

Other European countries follow this same path. In Sweden, after the latest privatizations, the government will contract out some 80% of Stockholm's primary care and 40% of total health services, including Stockholm's largest hospital. Beginning before the election of the new conservative chancellor, Germany enhanced insurance competition and turned state enterprises over to the private sector (including the majority of public hospitals). Even in Slovakia, a former Marxist country, privatizations are actively debated.

Under the weight of demographic shifts and strained by the limits of command-and-control economics, government-run health systems have turned out to be less than utopian. The stories are the same: dirty hospitals, poor standards and difficulty accessing modern drugs and tests.

Admittedly, the recent market reforms are gradual and controversial. But facts are facts, the reforms are real and they represent a major trend in health care. What does Mr. Moore's documentary say about that? Nothing.”

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Guy Caron, health care campaigner, Council of Canadians, Ottawa wrote in “Wrong Prescription” (National Post, Jul.7, 2007):
"Re: Who’s the real Sicko?, David Gratzer, July 6.

David Gratzer's expressed contempt for public health care and non- profit delivery of health services misses the point of Michael Moore's new film, Sicko. Sicko is not about uninsured Americans (even though a movie could certainly be made about them), but rather about those who are insured and are denied health coverage because the industry bows to the profit motive before any humanitarian concern.

Contrary to Dr. Gratzer's assertion, the debate about universal health insurance in the United States is alive and picking up steam in many states. Some have already adopted mandatory health insurance, and the Californian Legislature is debating the adoption of a single-payer public health insurance program.

U.S. policy-makers are waking up to the reality that Canada's public health insurance is less expensive, more comprehensive and more efficient than what their private system can provide. Why Canada should follow Dr. Gratzer's prescription for more privatization is beyond comprehension."

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Dr. Danielle Martin, board chair, Canadian Doctors for Medicare, Toronto, wrote in “A vote for medicare” (National Post, Jul.10, 2007):
"Re: Who's The Real Sicko? David Gratzer, July 6

David Gratzer's polemic against the Canadian health care system and socialized medicine ignores the facts. After reviewing 38 studies comparing the U.S. and Canadian systems, 17 leading Canadian and U.S. researchers confirmed this year that the Canadian system leads to health outcomes as good, or better, than the U.S. private system, at less than 50% of the cost.
As for Dr. Gratzer's prescription for Canada -- U.K.-style competitive market "reforms" -- the evidence shows that procedures in England's private Independent Sector Treatment Centres cost an average of 11.2% more than those carried out in the public system. From 2005 to 2006, the National Health Service ran up 547-million ($1.1 billion) in debt, and in 2005 the British Medical Association called for less competition and more co-operation in health care.

The World Health Organization and the Organization for Economic Co-operation and Development have concluded that medicare is not only more equitable, but also more efficient and produces higher- quality health care than the alternatives.

This is not to say the Canadian system doesn't need reform, with successful initiatives already underway. In May, the Canadian Centre for Policy Alternatives reported dramatic cuts in waiting times for surgery in B.C., Alberta, Saskatchewan and Ontario without any need for competition -- just improved administration and team-based care."

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Richard K. Baker, Timely Medical Alternatives Inc., Vancouver, wrote in “The big health lie” (National Post, Jul.11, 2007):
"Re: Who's The Real Sicko? David Gratzer, July 6; Wrong Prescription, letter to the editor, July 7

All socialist societies are propped up by a "big lie." In Canada, the big lie we are asked to accept is that we have the best health care system in the world. The World Health Organization -- which ranks us 30th in the world--and the families of the many Canadians who die every year while languishing on long waiting lists would argue otherwise.

Lindsay McCreith, mentioned in Dr. David Gratzer's column -- who opted to have surgery in Buffalo, N.Y., instead of waiting for months to see a Canadian neurologist for a malignant brain tumour -- is just one client whose life has been saved by leaving the "best health care system in the world." Others include an eight-year-old girl in Vancouver who was unable to get treatment for a massive cranial infection that had caused her to lose her hearing. Her parents brought her to us after waiting nine months on a 17-month waiting list. A Seattle surgeon told us that she would have died long before the end of her 17-month wait.

Some Canadians feel that the people dying on interminably long medical waiting lists is the price we must pay for the best health care system in the world. As long as well-meaning but misguided people and organizations, such as letter-writer Guy Caron and his Council of Canadians, continue to assure us that our health care system is working well, there will be no meaningful change and my organization will continue to work overtime to save the lives of our fellow Canadians."

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Dr. Roy Eappen, Montreal, wrote in “Waits, cash and private health care” (National Post, Jul.12, 2007):

"Re: A Vote For Medicare, letter to the editor, July 10

Dr. Danielle Martin certainly represents a minority of doctors in Canada. Most of us believe that the time is long overdue to break the government monopoly on health care. Since Dr. Martin forgot to mention long waits in almost every area, I will. She also neglects to state the amount of suffering before the equivalent outcomes are reached. Ask a patient who has waited 11 months to have hip surgery if they would have preferred faster care in a private facility, even at higher cost. The fact is that every public health care system in the world has a concurrent private system as well. It is a matter of fairness. Those who want to get faster care can do so by paying. I do support public care, but I also think that private care is long overdue. The government has poured billions into the public system and the same problems remain. Why should we be hostages to the government monopoly?

There has already been a Supreme Court decision mandating expeditious care in Quebec.

Challenges to the monopoly are now being raised in Alberta and Ontario. It is time for the left to wake up and realize there is a role for the private sector in health care."

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Dr. Irfan Dhalla and Dr. Danielle Martin, Canadian Doctors for Medicare, wrote in “Private care will only make things worse” (National Post, Aug.2, 2007):
The CMA's prescription for two-tier Canadian health care is hardly a "new vision." It represents the same old ideas rejected by Canadians since the advent of medicare, when we recognized that access to health care should be based on need rather than ability to pay.

As physicians, we should recommend policy solutions that will benefit all our patients, not just a few wealthy people at the expense of the majority. Despite challenges in Canadian medicare, Canada's health care costs are comparable to those of other countries within the Organization for Economic Co-peration and Development and our health outcomes as good, or better, than the American system at significantly lower cost. In addition, we do not suffer the dangerous side effects that plague two-tier systems, including private clinics' cherry-picking of healthier patients, a drain of health professionals from the public system, unnecessary procedures and a fractured system of medical education.

The answer is to improve medicare, with improved queue management, electronic health records, team-based care, disease prevention and management and population health approaches. The CMA's supposed "new vision" is nothing more than an ill-informed and self-interested push for private care, and one that many, if not most, physicians, and the majority of Canadians, will reject."

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Kate Jaimet wrote in “Top doctor admits to queue jump” (National Post, Dec.4, 2007):
"When his five-year-old daughter's bone scan revealed a tumour that might be cancerous, the man who is now president of the Canadian Medical Association decided to jump the queue.

His wife, also a doctor, had taken their daughter into the emergency room of a Vancouver hospital after the little girl experienced a sudden pain in her leg, Dr. Brian Day recalled. The initial bone scan indicated a tumour, but couldn't reveal whether or not it was cancerous.

"The hospital said: 'We'll do a CT scan, bring her back next week,' " Dr. Day said. "To me, it's completely unacceptable, sending a mother home for six days not knowing whether her daughter has a malignant or a benign bone tumour. I made the phone call ... I made them do it that day."

Dr. Day's experience is one example of what he calls the "parallel public system," a system of social connections that make it easier for people in a certain class of society to get quick access to medical treatment.

He admits he himself used the system when he needed knee surgery, jumping a long queue to get the procedure done within a week by a surgeon who was also his friend.

It's not realistic, Dr. Day believes, to expect people not to use their connections to jump the queue when their own or their family's health is at stake.

What is realistic, he said, is to eradicate medical wait times, so there's no queue to jump and everyone -- no matter what their social class -- can get quick access to medical care.

"There shouldn't be wait times in a country that's a rich country, that's got a booming economy, that's got taxes going down," Dr. Day said in a meeting yesterday with the Ottawa Citizen's editorial board.

And while he acknowledged there would be an up-front cost to eliminating wait times, he said patients on waiting lists actually end up costing the system more money because their condition deteriorates by the time they get to the front of the line.

"At all levels, waiting costs money," said Dr. Day. "If it costs $7-, $10-billion dollars to get rid of wait lists, it's worth it."

An orthopedic surgeon, Dr. Day worked in the public health care system for 20 years. He opened a private clinic in Vancouver, the Cambie Surgery Centre, in 1995.

He has proven an outspoken and controversial figure since taking over as president of the CMA in August.

Dr. Day said yesterday he wants to open up a public debate on health care, because politicians are too afraid to speak frankly about the subject.

"Politicians of all stripes want to sweep health care under the carpet," he said. "Any call for change in the system is targeted as attacking the 'national identity' of Canada."

He said the first step toward eliminating wait times would be to change the way hospitals are funded.

In the current system, he said, each hospital is given a lump sum of funding. Any treatment given to patients is then taken out of that lump sum, creating a negative entry on the balance sheets. Instead, he said, hospitals should be given money for each time they treat a patient. That would give them an incentive to treat more patients, and keep their operating rooms busy instead of letting them lie idle.

"Fifty per cent of newly trained orthopedic surgeons leave the country within five years because they can't get operating time ... [It's] our system, the way the hospital is funded, where the patient is a cost, not a value," Dr. Day said.

"The instant you tell hospitals you're going to get revenue for treating patients, they're going to start treating patients."

The change would result in more specialists staying in Canada, and even coming to Canada from abroad, he said. And with no wait times, Canada could begin attracting U.S. medical tourists, a multi- billion-dollar industry, Dr. Day said.

He added the pay-per-procedure model has been successful in Britain, where wait times have gone down to zero since it was introduced in 2004.

But in an open letter to Dr. Day in August, a group of British doctors argued this model of funding, combined with more contracting out of publicly funded services to private clinics, have led to "a destabilized and damaged public service" in the U.K.

The doctors in Britain's National Health Service Consultants Association argued in their letter policy reform such as those advocated by Dr. Day has led to unnecessary hospital admissions and private clinics scooping up contracts for quick, lucrative surgical procedures while leaving public hospitals to provide low-paid, day- to-day care to the chronically ill.

"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," the letter stated.

But Dr. Day said it was the government's fault if it signed bad deals with private-sector clinics, and examples of bungled contracts don't disprove the value of the funding model.

Besides the issue of wait lists, Dr. Day said a public debate is needed over what medical procedures should and shouldn't be funded by medicare.

He pointed out there are many medically necessary treatments -- such as physiotherapy, dental care, and drugs -- not covered by the current public health care system.

This leaves about 30% of the population, who have no private health benefits, in the underclass of what is de facto a two-tier system.

That raises questions about whether the current system is fair, or whether public funding should be allocated differently, he said.

As well, with an ageing population demanding more high-tech medical interventions -- and with new, and more expensive, medical procedures being developed such as gene therapy, stem-cell treatments and nanotechnology -- Canadians will have to make hard ethical decisions about what will and won't be publicly funded in the future.

"You can't give everyone robotic heart surgery. It's impossible," he said.

However, Dr. Day wouldn't give an opinion as to what criteria should be used to decide which procedures receive public funding.

"We need to give [the public] the facts. You can't have everything, so what do you want?," he said. "Those questions need to be asked of Canadians. It's not our role to dictate to them." "

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This was an editorial, “Brian Day hardly alone”, from the National Post, Dec.5, 2007:
"Dr. Brian Day, the controversial president of the Canadian Medical Association (CMA), has made his biggest headlines yet after an interview on Monday with the editorial board of the Ottawa Citizen. Dr. Day has tongues wagging because he dared to mention, and admit to using, one of the hidden tiers in our "equal-access" health care system.

The orthopedic surgeon told the Citizen how he had taken his daughter, then five years old, to a clinic for an examination after she experienced a sudden pain in her leg. Initial results suggested the presence of a tumour. Dr. Day was told to "bring her back next week" for a full CT scan of the leg.

Your average, duty-minded Canadian might have accepted the instruction and taken his child home to live in quiet terror of a cancer diagnosis for a week. Dr. Day pulled strings at the hospital and had the scan done that day. In his chat with the Citizen board, he also owned up to another occasion upon which he used his influence with a friend to beat the queue for his own knee surgery.

On the crackling airwaves of talk radio, much of the reaction to Dr. Day's confession seems to have revolved around whether he can be considered "fit" to be head of the CMA -- as if the position were a public sinecure, rather than merely the leadership of an influential lobby group. As far as we know, sainthood is not one of the qualifications for the job.

By admitting to the presence and power of personal pull in our medicare system, Dr. Day hopes to encourage more honesty from doctors and politicians -- almost all of whom have done exactly the same thing he did --and to bring about the appetite for change. This is in stark contrast to those who claim to love our "single-tier" system of long queues for basic procedures, and reject the influence of money, but who hypocritically use one of medicare's relief valves -- patronizing a private clinic, stealing across the border to take advantage of the hated U.S. system, or using one's authority or friendships to queue-jump.

At this point in history, well-heeled advocates of the "single -tier" seem much like those who supported the bizarre sumptuary laws of early modern Europe, which jealously outlawed the wearing of certain luxurious fabrics and items by the increasingly wealthy mercantile classes. If you are an upper-class Canadian whose doctor friends can be trusted to help you out in a crisis, you don't want them facing a large economic opportunity cost for pushing you to the head of the queue -- which would be the case if all those pushy middle-class folks were permitted to use their money to buy the health care they want. And you definitely don't want a system that encourages maximum use of those doctors' work hours. Otherwise, you won't be able to get your physician golfing buddies to squeeze you in on short notice.

And if you're a politician, of course you don't want people to be able to pay for faster access to care; it would devalue the currency of prestige and power if some working-class schmuck were able to get his hip fixed before yours, just because he had saved up for it or bought insurance. Why trade in one's status as a miniature potentate vested with budgetary powers of life and death for the lesser glory of being a mere customer?

But most of us, we suspect, would love it if doctors and hospitals treated us the way we are treated at supermarkets or coffee shops -- as clients rather than perpetual nuisances. That Dr. Day appears to recognize this fact -- and is so candid about the flaws and hypocrisies that inhere to Canada's current state-dominated system -- marks him as a leading voice in the debate over the future of Canadian health care."

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A comment on the above editorial was posted by Yo (Dec.5, 2007 , National Post website):
"The notion that the "in" crowd finds a way to jump the queue is not new, and Dr. Day's statements are an authoritative acknowledgement in a sea of silence coming from all the other "in" jumpers. Bravo, Dr. Day.

What is most missing from ongoing discussion is Dr. Day's analysis of the inherent flaw to the current public-administered and -financed system: hospitals (and, may I add, physicians who have "capped" income ceilings on their billings) view their clientele as liabilities that drain budgets, rather than customers who bring in income. What a stupid way to run a system!
There is a 10-month wait for MRI (and don't even bother signing up for the wait-list for a PET scan, if a PET scan even exists in your province), and yet your local hospital's MRI machine is likely shut down evenings and weekends and holidays, and two-week Christmas / New Year's slowdowns, and midsummer slowdowns. This makes sense only because there is NEGATIVE incentive for players in the health care marketplace to actually see and help patients.

Imagine for a moment if government would "nationalize" automobile maintenance, or groceries, or plumbers' services. Then ask yourself why something as important as health care has been left to the incompetent boobs occupying the third-through-eleventh floors of some ministry office building four blocks away from the provincial legislature.

It's beyond insane."

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Dr. Fergus Ducharme, Comox, B.C. wrote in "Some MDs support Day's queue jump..." (National Post, Dec.7, 2007):

"Bravo, Brian Day. Unfortunately, due to politics and the bureaucratic mismanagement of our health plan, we must queue up for required medical care regardless of the severity of our afflictions.

One's place in the cursed queue for access to care should and must be determined clinically, and not as it is now, chronologically. Also, hospitals should be paid on a fee-for- service basis. When will they learn?"

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Dr. Joseph Berger wrote in "Some MDs support Day's queue jump..." (National Post, Dec.7, 2007):

"Re: Top Doctor Admits To Queue-Jump, Dec. 4.

Far from being controversial, Dr. Day is the right person at the right time for the Canadian Medical Association, an organization that has only slowly come to the realization that the Canadian health care system is decaying because of a lack of competition and alternatives. Dr. Day did not "queue jump," he just practised good medicine and good parenting by insisting on a necessary procedure being performed promptly, just as it would have been done in most other countries that have not allowed themselves to be held back by Stalinist wannabees."

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Dr. Danielle Martin, Dr. Maurice McGregor and Dr. Robert Woollard, Canadian Doctors for Medicare, Toronto, wrote in “...other MDs say he was wrong...” (National Post, Dec.7, 2007):
"Re: Top Doctor Admits To Queue-Jump, Dec. 4; Brian Day Is Hardly Alone, editorial, Dec. 5

Dr. Brian Day and the National Post continue to ignore the research evidence in their quest to bring private, for-profit care to Canada.

In 2006, in its discussion paper It's About Access, the CMA reviewed evidence from other jurisdictions and concluded that Canadians would not benefit from private insurance. Under the British system, advocated by Dr. Day, procedures in Independent Sector Treatment Centres cost an average of 11.2% more than those carried out in public hospitals. Parallel private systems drain professionals from the public system and result in "cream skimming," as private clinics choose the healthiest patients, leaving the most complex to an increasingly overburdened public system.

Meanwhile, a study released this year by the Canadian Centre for Policy Alternatives found that innovations in team-based care and centralized management across Canada are dramatically reducing wait times and improving patient safety without sacrificing the benefits of medicare. There is much room for improvement in Canadian health care -- but regrettably it must be said that Dr. Day's solutions to the complex issues we face offer no solution at all.

As for the Post's suggestion that Canadians would love their doctors and hospitals to treat them the way they are treated at coffee shops and supermarkets, we suspect the reality is much different."

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R. Bobak wrote in the National Post, Dec.7, 2007:
“Re: Top Doctor Admits To Queue-Jump, Dec.4

How dare someone have the nerve to demand that he or his family receive immediate medical treatment.

A true Canadian would obediently do as they were told, by those who know best: go wait in line and die if necessary while bowing gratefully at the altar of Tommy Douglas’s grand health care Utopia.”

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Rick Fuschi, Windsor, Ont., wrote in the National Post, Dec.7, 2007:
"The defining characteristic of our health care system, which, both distinguishes and damns it, is its promise of universal coverage. Such a promise cannot possibly be kept. Hence, the system is a straitjacket to those who cannot access alternatives. It was created to assure everyone of access regardless of means, but in the end, it assures the poor and middle-class only a waiting list, and denies them hope. Canadians must acknowledge the failings of our system."

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David Gilmour wrote in “Dr. Day’s crime”, (National Post, Dec.8, 2007):
“Re: Top Doctor Admits to Queue Jump, Dec 3

At first glance this headline implies that Dr. Brian Day, president of the Canadian Medical Association, is guilty of some heinous crime. He is in fact guilty of something very different -- caring deeply for his family and not holding them hostage to this country's state-controlled health care monopoly.

Moreover, Dr. Day's assertion that politicians are afraid to debate health care issues is 100% correct. Somehow, it seems doubtful that the wife of the Prime Minister would be asked to return next week for a CT scan.”

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Richard K. Baker, Timely Medical Alternatives Inc. Vancouver, wrote in “Health ‘research’ proves nothing”, (National Post, Dec.10, 2007):
"Re: Top Doctor Admits To Queue-Jump, Dec. 4; Other MDs Say He Was Wrong, letter to the editor, Dec. 7.

"Drs. Danielle Martin, Maurice McGregor and Robert Woollard of Canadian Doctors for Medicare are intent upon maintaining the status quo with respect to our health care system, citing research studies which "prove" that a parallel private health care system won't work.
This is akin to holding a press conference in the middle of a busy highway at rush hour, to announce the findings of a study proving that horse drawn buggies are more efficient than the automobile. The person advocating maintaining the buggy is apt to get left behind the motorists, if not run over.

No amount of studies will change the fact that parallel private health care systems are splendidly efficient. One need look no further than the systems in place in Sweden, Switzerland and Japan. All of these countries deliver timely health care, with comparable or better outcomes than we have in Canada, and at a lower cost.

It is time for Canadians to end the mind-numbing rhetoric and join the rest of the civilized world."

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Yes, here we are in Dec. 2007, still saying it's time "to end the mind-numbing rhetoric"; time to end Liberal healthcare duplicity; time to rewrite the federal Canada Health Act; time to abolish Ontario's Commitment to the Future of Medicare act.

How many more patients have to suffer under Ontario's no-choice, Liberal-government state-run monopoly health-care system?
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