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Canada’s nationalized health-care system, admired by the left all over the world and deplored by the right all over Canada, took another hit last week. The Canadian Medical Association, long its unfailing supporter, suddenly turned against it.

The CMA elected as president Dr. Brian Day, a Vancouver surgeon and one-time supporter of state medicine, who is now an outspoken critic of Canada’s “Medicare” system. In fact, he runs the largest private clinic in the country, offering an array of surgical procedures to people prepared to pay for them. In doing so, he challenges the Canada Health Act, which prohibits for-profit medical practice.

For two reasons, Dr. Day’s election was viewed as a tidal change in the CMA attitude. For one, he not only opposes Medicare, he is one of its most articulate critics. “This is a country in which dogs can get a hip replacement in under a week,” he told the New York Times earlier his year. “Humans can wait two to three years. … In a free and democratic society, where you can spend money on gambling and alcohol and tobacco, the state has no business preventing us from spending our own money on health care.”

Raised in Britain, he came from a socialist family and began by supporting the state system. “But then when you find that your operating room time is cut from 22 hours a week progressively over the years to five hours a week, and you have 450 patients waiting for health care, you realize that something has to give.”

Second, that Dr. Day had to stand for this election at all was an intriguing irregularity. The CMA has a rotating presidency, and it was British Columbia’s turn to provide its chief officer. In the B.C. voting, Dr. Day won handily over the other candidates, all of whom ran on the understanding that the B.C. winner would not be opposed nationally. But one man among them reneged.

Dr. Jack Burak, also of Vancouver, an unreserved supporter of state medicine, decided it was his public duty to force a national election. After all, with an important social cause at stake, why quibble over some trivial moral principle about keeping promises? He campaigned vigorously, probably on the assumption that B.C. doctors may be prepared to allow for-profit medicine but the national body would prove more “truly Canadian.” So the national vote became a referendum on the state system. Dr. Burak and the state system both lost.

Once elected, Dr Day hastened to protest that he does not favor dismantling the public system; he merely thinks Canada needs supplementary private services. This did not reassure Medicare’s defenders, who viewed his election with obvious consternation. “Medicare has been good for patients and it’s been good for doctors,” said outgoing president Dr. Ruth Collins-Nakai. “If we begin to put doctors’ interests ahead of patients’ interests … we will lose public trust.”

Added Dr. Danielle Martin, chairwoman of Canadian Doctors for Medicare: “CMA delegates appear to be out of touch with the evidence, with the values of Canadians.” The union-financed Canadian Health Coalition and the Registered Nurses Association of Ontario declared that Day’s election clearly indicated withdrawal of CMA support from Medicare.

This was the second reversal inflicted upon Medicare this summer. In June the Supreme Court, arguably the most liberal judicial body in the Western world, decided that even it was not quite liberal enough to endorse the Medicare monopoly. It thereupon threw out a Quebec ban on private medical insurance. “Access to waiting lists is not access to health care,” observed Justice Jack Major, who wrote the decision.

Long waits for medical and hospital services are the system’s chief symptom of failure. The causes are many, not least a steady exodus of young Canadian doctors to the U.S. – which means, of course, that Canadians are training many doctors to work elsewhere. System proponents, however, cite an exhaustive report on Medicare commissioned by the late Liberal government, authored by Roy Romanow, previously the socialist premier of Saskatchewan. Its conclusion: Spend more money and let the government fix the system.

But more and more Canadians are starting to wonder whether any government can fix much of anything and are ready to contemplate alternatives. Not long ago, for instance, one B.C. surgeon publicly offered to take over the majority of surgeries of the local regional health board and perform them at 60 percent of present cost. The offer was angrily rejected as frivolous. The doctor who made it was Brian Day.



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