Tuesday, August 21, 2007

Dr. Brian Day & Canadian Medical Association declare war on Medicare

Bill Tieleman’s 24 Hours Column
Tuesday August 21, 2007

Watch out for new CMA boss


The public has tasted private health care - and they like it.

- Dr. Brian Day, March 30, 2006

Charge! The Canadian Medical Association has declared war on our public health-care system.

And tomorrow, Canada's doctors install as their commander-in-chief the most radical and outspoken health-care privatization advocate in the country.

Dr. Brian Day becomes president of the CMA weeks after the organization representing Canada's physicians said its members should be able to work simultaneously in both the public and private health-care sectors.

That position is so extreme even Conservative Prime Minister Stephen Harper rejects it. Last year in a letter to then-Alberta premier Ralph Klein, Harper warned the province to back off the same approach the CMA now favours. And rightly so.

"Dual practice creates conflict of interest for physicians as there would be a financial incentive for them to stream patients into the private portion of their practice," Harper wrote on March 31, 2006. "Furthermore, dual practice legitimizes queue-jumping as it provides an approved mechanism for patients to pay to seek treatment at the front of the line."

But don't expect Day, owner of the controversial private Cambie Surgery Centre, to worry - he has previously argued to "repeal the Canada Health Act" that protects the public system.

And Day has described Medicare, our public health system, as a "Berlin Wall" blocking patients from treatment, and like "Aeroflot" - the former Soviet Union airline.

Fortunately, some doctors disagree.

"As CMA members and physicians, we need to ask our association why, if some physician resources are being underutilized, isn't the CMA advocating for solutions that would increase patient care to all Canadians, on the basis of need, within the public system?" asks Dr. Danielle Martin, chair of Canadian Doctors for Medicare.

And a British organization called the National Health System Consultants' Association wrote to Day last week warning him not to make the same mistakes that England has.

"In closing, we must conclude that neither payment by results, the increased use of the private sector nor the 'patient choice' agenda have proved their worth. On the contrary, they have resulted in a destabilized and damaged public service", Drs. Jacky Davis and Peter Fisher concluded.

Ironically, Canada's doctors chose Day despite the fact that until elected, he had never attended a CMA convention or been involved with the B.C. Medical Association.

Now the radical outsider is in charge and the CMA is pushing for the public to get much more than just a "taste" of health-care privatization. If successful, it will be a bitter one.


G West said...

And Bill, that's just what Gordon Campbell wants.

Anonymous said...

The doctors' campaign against public health care should be no surprise to anyone who reads history. They waged all-out war trying to stop the creation of Canada's public healthcare system in the first place, with dire language reflected in Day's "better dead than red", McCarthy-style scaremongering.

As citizens/patients, we've since been lulled into thinking that doctors & their CMA somehow represent or ought to represent our interests or the system itself. This idea is encouraged by journalists who constantly quote the CMA as speaking in that role. (Oddly enough, journalists who'd never give the BCTF or nurses' union that level of credibility!).

In fact, the CMA speaks solely for the industry of doctoring, not for patients and not for the healthcare system. Day's appointment and the doctors' renewed campaign against public healthcare has lifted that veil. That's a good thing, IMHO, as long as the media stop supporting their pretence of speaking for us and our healthcare system.

...oh, and by the way, double-dipping doctors are already very much a reality in BC, with all the predicted ill effects. A friend recently waited (in agony) for over a year for surgery to repair a torn shoulder muscle, until she finally caved in and agreed to pay the same surgeon thousands to do it (the next week) in a private clinic. She had to sign a waiver swearing not to complain.

Anonymous said...

My Doctor is on a salary along with other doctors, nurses, and Nurse Practitioners at the clinic we attend. Best place we have ever dealth with. None of those presky extra fees for prescription renewals over the phone.Wait around for a hour or so to actaully see the MD. The nurses take all the information before you see the doctor and any outside testing being done rates a phone call with the results. Brian Day operated on my leg three times a number of years ago when he was working at UBC Hospital. He was talking then about wait times.
Check out his clinic and notice the specialists there who show themselves as working for the General Hospital in Vancouver as well. The old excuse that those private doctors don't upset the other system is BS. The guys can't be in two places at once. I got the offer twice about going private but certainly not from the doctors I have available to our family right now. It was suggested I should buy a MRI, and here is the phone number. The specialist who suggested that route was most upset that the system has fallen so low. But as he said in his report. This should be now not 8 months from now. It was offered the same day I phoned.I didn't use the private approach. A consultation would be within ten days and operation within two weeks. If the private system is so great, wonder why so few patients? Most folks simply don't have that much money available. Dl

Mark Crawford said...

I would like to see a pubic debate between Brian Day and a good health economist like Robert Evans.

The point that Evans and others repeatedly make is that health care is not only "special" because of the way we "feel" about it. It also has special properties as a market, and those properties have been well understood at least since Kenneth Arrow's seminal article "Uncertainty and the welfare economics of medical care" in The American Economic Review over 40 years ago. (It is a bit technical, but a good summary can be found in the February 2004 Bulletin of the World Health Organization.)

Put simply, information asymmetry, "moral hazard" on the part of healthcare providers, and "adverse selection" on the part of insurers, are all utterly pervasive in health markets.

Even basic supply and demand is problematic in this context. If the demand for people who can make life-or-death medical decisions doubles, can we just churn out more supply, like they were cars or widgets, without adversely affecting the quality of care, incidence of malpractice, insurance rates?

Private physicians' fee-for-service already has a built-in incentive to NOT be cost-efficient--hence doctors bill for services that could be cheaper or which could be done by nurses or nurse practitioners. To move to two-tier service, as Day would have us do, would introduce an additional layer of perverse incentives--to use public monies to subsidize private practice, to keep public queues long so that there will be brisk demand for 'premium service', and so on. That is why I belong to the "you're in or you're out" school.

As for user fees--wouldn't it be odd to move to a system of user fees just when we are being told that we need to stress prevention more instead of just reactive treatment? I can't think of a better way to discourage preventive health care.

Day may be right that we need to sort out what is truly the most medically necessary, instead of treating everything done by a physician or a hospital one way and drug and home therapy differently. I would extend the single payer Medicare system to drug therapy and home care, but with doctor payment on a capitation basis. User fees, if utilized at all, should only be for services that are not "medically necessary".

Hopefully doctors would go along with losing some of their fee for service business (that portion which can be handled by nurses and nurse practitioners)in exchange for a "capitation" portion of their income.

I believe that the rather disappointing evidence about market-based experiments in Britain and New Zealand, and of two-tier in Australia, can be explained largely in terms of ecnoomic theory. In this special market, we gain more by pooling our risks and our purchasing power, and by eliminating as much of the moral hazard and adverse selection as possible, than we can gain from the benefits of for-profit competition.