Some provinces are already confronting the challenge, centralizing heavily sought procedures at designated hospitals, and increasing funding. They report success in reducing waiting times and increasing patient volume for many operations in demand.
B.C, in fact, is pioneering a concept known as patient-focused funding, a system that pays institutions for each procedure instead of providing them with huge sums, regardless of what they do.
Dr. Day, a long-time advocate of the idea, says the private sector should be allowed to compete for those patients. "There would then be no queue jumping, because there would be no wait lists."
He believes the decades-long debate about the role of private clinics in Canada's public health-care system has finally reached a tipping point. There will simply not be enough tax revenue for medicare to manage the pending influx of aging baby boomers, Dr. Day argues, without opening the door to the private sector.
Full day of surgery
If he is correct, this is what the future looked like on an unseasonably warm fall morning at the Cambie Surgery Centre.
His full day of surgery was replete with patients thumbing their noses at the principle that no one should be able to buy their way to the operating table. Four had travelled here from Alberta, rather than wait for publicly funded treatment in their home province.
One was Daniela Acimov, a dental assistant. Dr. Day's initials were printed on her right knee in big black letters, marking the spot where he would reconstruct her torn anterior cruciate ligament.
After being told she faced lengthy waits for both consultation and surgery, Ms. Acimov opted to have her operation at the Cambie clinic for a hefty price tag of $10,250, some of which she may be able to reclaim from Alberta's health-care plan.
"I couldn't believe how hard it would have been to get this done in Alberta," Ms. Acimov said, before being wheeled into the operating room. "I was in a lot of pain. I couldn't go to work. It was just ridiculous."
Dr. Day pioneered arthroscopic ACL reconstruction. He's done thousands over the years, and he has no problem combining a steady stream of chatter ("It's supposed to be 23 degrees today…") with the work at hand.
But near the end, it was all business. "The drill next," said Dr. Day, as the complex, interior network of bones, sockets, tendons and ligaments played dramatically across the video screen. A short while later, there was an audible tap, tap with a small hammer on an awl-like instrument, then bang, bang, bang.
"I'll have a 9x30 tibia screw, please," he told the nurse. Soon, the operation was over.
At noon, there was time for a brief checkup on patient Mike Klein, a stocky equipment operator wearing a T-shirt extolling jailed pot crusader Marc Emery. Mr. Klein's knee operation was paid for by WorkSafeBC, formerly the Workers' Compensation Board, which has been using Dr. Day's clinic to obtain early treatment for injured workers since the mid-1990s. Their clients still comprise nearly 40 per cent of the facility's patients.
"It's worth it," Mr. Klein said. "If I had to wait two years, that sucks."
Dr. Day never tires of pointing out the ethical conundrum of having patients injured on the job green-lighted for treatment at his clinic, while individuals who suffer identical injuries at home have to wait months for their procedures at public hospitals.
WCB patients, plus members of the RCMP, the military and inmates of federal prisons, are excluded from the Canada Health Act.
There are halting moves to rein in the Cambie clinic's skirting of medicare rules, which Dr. Day says provides about 10 per cent of its business. B.C. health officials are seeking an audit of the facility, and the B.C. Nurses' Union has a longstanding lawsuit to force a government crackdown on Dr. Day. Both cases have bogged down in court.
"The Canada Health Act is more of a bikini than full Islamic regalia," said Mr. Lewis, the health policy consultant. "It doesn't cover every conceivable circumstance. There is deliberate, unenforceable vagueness on what must be carried out in the public sector."
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