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Doctors must 'wield the power they have': Brian Day, the Canadian Medical Association's next president, gets ready to fight for more private care.

Born Jan. 29, 1947, Liverpool, England

President-elect, the Canadian Medical Association. Orthopedic surgeon, Co-founder and medical director of the Cambie Surgery Centre, Vancouver

Former president, Arthroscopy Association of North America. President, Canadian Independent Medical Clinics Association


WS: Some critics have characterized your election in August, to the presidency of the Canadian Medical Association, as a threat to the public medicare system. How do you respond to that?

Brian Day: That's disingenuous and disrespectful to the physicians of Canada that have elected me to the post. I have never wanted to privatize medicare or have U.S.-style health care. But I do believe there's a significant role for the private sector in the Canadian medical system. It already exists and, as we've shown in British Columbia, it works. The example par excellence is the case of the B.C. Workers' Compensation Board, to which our privately operated Cambie Surgery Centre is contracted to provide surgery for workers injured on the job. We have actually eliminated wait lists. So workers don't need to jump the queue because there is no queue for them. It's a co-operative partnership between the public and private sectors, and everyone wins.

Your own clinic provides surgery to cash-only patients. If you're doing it, why can't others? And if they can do it too, then does the system really need to be reformed?

The vast majority of what we do is Workers' Compensation, and in other areas like Insurance Corp. of B.C., the RCMP, and visiting tourists. As well, three days a week now we treat people off the Vancouver hospitals' public wait list. The Vancouver hospitals send patients, who are fully funded, and use our capacity to get rid of patients waiting. And the patients, I can tell you, are just ecstatic that they are removed from the wait list.

What about the cash-only patients off the street? How is it legal for them to do this under the health care system?

Well, it does operate within the system because the Supreme Court of Canada ruled last year in Chaoulli that Quebec's lengthy waiting list was unconstitutional. It's our view, and the opinion of Canada's leading constitutional lawyers, that the decision applies in every province. Governments have kind of buried their heads in the sand over that decision. Even Quebec hasn't dealt with it yet. They were ordered by the Supreme Court to revamp their legislation by early June of this year and did not do so. So that means that if a Canadian is suffering on a wait list, it is unconstitutional to make them stay there.

Following that decision, is there really any more health care reform required provincially or federally?

There may be additional constitutional challenges. But here's why I sought the position of president of the Canadian Medical Association, a position I don't actually assume until August 2007. I think, going back to it, there's no clearer example than that of injured workers. They don't pay a penny. They don't wait. They get a consultation right away. They get a test, or an MRI or a CT scan right away. And they get surgery right away. And they use the public and private system together. The WCB saves hundreds of millions of dollars ... [and] we know that if you treat people who are sick earlier, before the illness or injury has caused the body to deteriorate, it's much cheaper in the long term.

What can the CMA do about this?

The reason I wanted to take on this role is to respond to what the court has called the "extreme inertia" of government. There's been a lot of talk. The court has said the inertia has to stop. My position is the CMA has to be more assertive. And if government doesn't respond to assertions, [CMA members] have to be more coercive, and start to wield the power that they have, because I think they do have a lot of power of persuasion and through the fact they are a very large organization. And one of the things we have to remember is that health care in Canada is a provincial matter, and therefore, actually, any single province, if it wanted to, could ignore the Canada Health Act, for example, and the only comeback that the federal government has is [to cut] transfer payments.

Can single-payment, government-run medicare work, to the exclusion of private care, if hospitals were simply more efficient and/or governments simply paid more money?

Not really. People who believe that also have to believe that a monopoly is good for the consumer. And I've never found one that's good for the consumer.
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Title Annotation:QUESTION PERIOD
Author:O'Neill, Terry
Publication:Western Standard
Article Type:Interview
Geographic Code:1CANA
Date:Sep 25, 2006
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