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The Globe and Mail

Politicians must heed the public need for two-tier health care

That adage, "If the only tool you have is a hammer, everything looks like a nail," was demonstrated once again at the recent premiers' discussion on health care in Halifax; where they decided to elevate the fixes to, in the words of PEI Premier Robert Ghiz, "the premier level."

Thus, instead of unleashing the innovation potential of those working in the system, the smothering command and control structure is to be moved up yet another level. The conference press release gives the impression that one might soon see a premier wearing medical whites at your local hospital, working on: "reducing complications from foot ulcers, improving clinical guidelines for treating heart disease and diabetes, establishing more team-based models, sharing continuous improvement principles, reviewing the appropriateness of certain tests and procedures and improving communication about health human resources and labour markets."

If all of this bureaucratese sounds familiar, you're right. This is the 19th major examination of the Canadian health care system in the past 15 years. Once again, the "nail" each study has continued to hammer is stuck in the paradigm that Canada's health-care system must remain a government-run monopoly. That paradigm was starkly enunciated by Health Council of Canada member and former Vancouver General Hospital President Charles Wright, who stated: "Administrators maintain waiting lists the way airlines overbook. As for urgent cases, the public system will decide when their pain requires care. The individual cannot decide rationally."

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Just days before the premiers gathered, in Halifax, the B.C. Medical Services Commission moved to stamp out the green shoots of patient care choice by ordering two private Vancouver clinics to stop collecting fees for providing treatment facilities to patients on waiting lists. In response, Dr. Brian Day, the clinics' founder, served notice of a lawsuit against the Commission, the B.C. Attorney General and the provincial health minister.

Supporting Dr. Day's lawsuit are four patients who received treatment at his clinics after suffering long waits in the public system. One of those patients is 36-year-old Mandy Martens, who was told she would have to wait nine months for a colonoscopy after blood was detected in her stool and an ultrasound detected three masses in her liver. After an expedited colonoscopy at Dr. Day's clinic confirmed metastasizing colon cancer, she was finally able to access lifesaving treatment.

Dr. Day's lawsuit is expected to go all the way to the Supreme Court of Canada. The facts are essentially the same as Quebec's 2005 landmark case in which the Court held that patient Jacques Chaoulli's rights were violated when he was prevented from seeking timely treatment. In their decision, the judges wrote: "The evidence shows that delays in the public health-care system are widespread and patients die as a result of waiting lists for public health care."

Studies by the Fraser Institute and the Macdonald Laurier Institute found, respectively, that the average wait time to see a specialist in Canada was more than four months, and that our country ranked 26th out of 34 OECD countries for access to a doctor.

And contrary to popular belief, the problem isn't a lack of doctors. The surgeon who treated Ms. Martens at Dr. Day's clinic couldn't accept more patients within the public system because his hospital operating room time was limited to a few hours a week. Moreover, every patient treated at private clinics frees up a place for someone on the public system waiting list and aids overstretched hospital budgets.

But why must Dr. Day resort to the courts in order to give patients the same freedom of choice that exists in virtually every other country? Do the premiers actually believe Canadians should be forced by law to accept that "the system will decide when their pain requires care"? Or is it that they think Canadians aren't ready for what some call two-tier health care? If that is so, then they should take heed of a recent Ipsos Reid survey that shows 76 per cent of Canadians support a "mixed model" of health care, giving them the option of spending their own money for private care.

It's time that politicians caught up with the people on this issue. A good start would be to get rid of the B.C. Medical Services Commission, save the taxpayer money that would be wasted fighting Dr. Day's court case, and take freedom of choice to the people in the next election.

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