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Dr Brian Day an orthopaedic surgeon (L) assisted by Dr. Anne Wachsmuth during an operation at the Cambie Surgery Centre in Vancouver September 30, 2010 . (JOHN LEHMANN/John Lehmann/The Globe and Mail)
Dr Brian Day an orthopaedic surgeon (L) assisted by Dr. Anne Wachsmuth during an operation at the Cambie Surgery Centre in Vancouver September 30, 2010 . (JOHN LEHMANN/John Lehmann/The Globe and Mail)

Part 1: Is this private clinic surgeon a crusader or criminal? Add to ...

The low hum of soft rock drifts through the operating room. A shortish, 63-year-old surgeon in white rubber boots stares at the video screen, his left and right hands deftly manipulating a series of instruments through two tiny incisions in Dennis Geidt's left shoulder.

After much meticulous work inserting screws and tying knots, the surgeon informs the anesthesiologist: "This is it, Bill." A brief flurry of activity, then: "There's the tendon, reattached."

Moments later, an hour after he began, Brian Day is rolling up his light-blue gown, stripping off gloves, mask and skull cap and heading out the door.

Other than the enduring magic of arthroscopic surgery, there is little that is remarkable about this tableau, except for one thing. Some would call it a crime scene.

Dr. Day and his 76-year-old patient have willfully contravened a sacred tenet of the Canada Health Act and British Columbia's own medicare legislation. Namely, that Canadians may not buy their way to the head of the queue for medically necessary treatment.

Mr. Geidt, the man on the operating table, has done exactly that. Rather than wait the year or longer he was told it would take to be treated under medicare, Mr. Geidt, racked by pain, opted to fork out $7,010 from his own pocket to have his left shoulder repaired - within weeks - by Dr. Day.

Neither Mr. Geidt nor Dr. Day is in any danger of being cuffed and carted away. The privately owned Cambie Surgery Centre, where Dr. Day plies his skillful trade, has been allowing patients to pay for such procedures for years. So far, authorities have done little more than wave an admonishing finger.

"It's the Neville Chamberlain approach," said health-policy consultant Steven Lewis, a strong critic of for-profit medicine. "Peace at any cost. Don't ask. Don't tell."

No one could accuse Dr. Day of not telling. As he said matter-of-factly of Mr. Geidt and countless previous patients who have sought costly but speedy relief at the Cambie clinic: "It is a violation of the B.C. Medicare Protection Act, and I make no apologies for that that."

Is it sustainable?

The clash between Dr. Day and the Canada Health Act is a compelling example of the need for a vigorous, new, public examination of our creaking medicare system. Is it sustainable? As the price of providing universal health care continues its relentless drive upward, where will the money come from?

With federal transfer payments to the provinces and territories set to expire in just three years, critics of the status quo say we should consider a bigger role for private care in a system that is largely publicly funded.

What began as a government-paid insurance program to ensure physician and hospital care for all has expanded over time into an awkward amalgam of public and private funding. Distinctions between the two are often blurred.

Today, The Globe and Mail begins a weeklong series on health care, designed to clear up some of this confusion between private and public, and set the tone for an informed discussion on where to go from here.

While never more urgent, a debate on the sins and virtues of private, profit-oriented health care is hardly new, and Dr. Day's state-of-the-art facility on a lovely, tree-lined Vancouver street remains ground zero.

No one has been more prominent than Dr. Day in espousing the controversial right of patients to pay for their own health care at for-profit clinics. His clear, outspoken views propelled him to the presidency of the Canadian Medical Association in 2007-2008.

While critics disparage the concept as two-tier medicine, the veteran orthopedic surgeon says it's the future.

"It is inevitable," he said. "As baby boomers start to retire, the system is going to be hit with a tsunami of illness."

With the use of new, expensive technology expanding at the same time, costs will continue to rise dramatically, Dr. Day contends, and pouring more and more public dollars into medicare is simply not sustainable. "There's only one other type of money out there, and that's private money."

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