The doctor suing to free Canadian patients from deadly medicare waiting lists
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Summary
Dr. Brian Day is a former head of the Canadian Medical Association. He s been active in a number of different healthcare groups throughout his long career, and he joins me now from Vancouver. Dr. Day talks about how he came to Canada and why he thinks we should have a private healthcare system.
Transcript
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We love to have endless debates about healthcare in this country.
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Do we have a public system, a universal system?
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Do we allow private care at all in this country?
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Of course, if you have followed the healthcare system at all, been involved, seen a doctor,
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chances are you realize that we have a mixed system.
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For the most part, it's publicly paid for, but even not all of that is covered by various
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But there's one man who has been involved in a fight for private healthcare in this country
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for some time, and we want to talk to him in a moment.
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But before we get to Dr. Brian Day, though, I do want to remind you to subscribe to the
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I'm the guest host of Full Comment for this week, and you can subscribe on any of the platforms
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that you're listening to right now or your preferred platform, be it Amazon, Apple, Google,
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Dr. Brian Day is a former head of the Canadian Medical Association.
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He's been active in a number of different healthcare groups throughout his long career,
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How did you end up where you are out in Vancouver practicing as a physician, as a surgeon?
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So I came to Vancouver in the 70s as a trainee in orthopedic surgery, and initially was planning
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to stay for just a year because I had another position back in the UK, but I enjoyed my year
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in orthopedics and stayed on, and that was the story of how I came here.
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So I did my orthopedic training in Canada, in British Columbia, and I've been, over the years,
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I used to be in charge of the academic program for orthopedic surgeons at UBC, and I was chair
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of the national committee on credentialing, the test committee on credentialing orthopedic
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But then, you know, everything was working perfectly in our health system until the late 80s, and
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then things started to go haywire and have been going, getting worse ever since.
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What was it like when you came to this country, and when did you start seeing a change?
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Because you came out of a system that was even more government-oriented with the British
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National Health Service than what we've generally had here.
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So I'm guessing you weren't always opposed to the type of medical setup that we've got.
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When did you start saying, hmm, there's a problem here?
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I came to Vancouver at a time when, you know, doctors and nurses were in good supply.
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Back then, we were fourth in the world in the number of doctors per population.
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We're now 69th in the world in doctors per population.
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Access to family physicians and specialists was instantaneous almost, you know, within a week or so.
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And gradually and progressively, mostly due to government policies, they cut medical school intake by 10 to 30 percent.
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They had this weird theory that doctors and nurses were causing the waiting lists to go up because they were treating too many patients.
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So their simplistic solution was to cut back medical schools.
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And they were cut back across the country by up to 30 percent.
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And now they complain there's a shortage of doctors and nurses, which is a kind of, you know, ironic.
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But yes, until the late 80s, there were no problems.
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But then the rationing that took over started to impact and the shortages that the government itself had created started to take over.
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And the big difference between the NHS and every other country in the world, and I think I stress every other country in the world,
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is that none of them bans competition for the private, for the public system.
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So Canada is the only health system that operates for physician and hospital services as a state-run monopoly.
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Every other system in the world, including the communist countries, including the British NHS and the New Zealand system.
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So our system is largely based on New Zealand and Britain, but we did one thing differently.
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And in the countries I just named, like New Zealand, even countries like Sweden and Belgium and Denmark, which are not every other country in the world,
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allows a little bit of competition, both funding and delivery, from the private sector.
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And I, you know, I've always believed, and I still believe, there is no monopoly of any kind, especially a government monopoly,
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If you've got no choice, you have a badly run system.
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We see that in British Columbia, because British Columbia has a government monopoly on, say, on car insurance.
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And it's not a coincidence that we have the highest car insurance premiums in the country.
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And so that's been, that's, that's basically the historical situation as to how we got here.
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There's private delivery of public services, and then there's private pay.
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And I want to talk about private pay in a few minutes, but I want to ask you about this controversy in Ontario,
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where the, the government is moving in what I think are very moderate baby steps,
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moving towards allowing cataracts, hip and knee surgeries in private clinics.
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And it's being portrayed as if it's, we're going to US style healthcare, is what Jagmeet Singh said,
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as if he doesn't know that the province he represents in the House of Commons has been doing this a long time.
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Tell me what it's like in British Columbia, because we don't talk enough about differences in our own country.
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We know more about what's happening in the United States quite often than what's happening elsewhere.
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What Ontario is about to do is something British Columbia has done for decades, I understand.
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Yes, we, so the NDP government in the 90s introduced, you know,
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we actually had the first contract at our private clinic with the NDP government back then,
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and have, and they still to this day contract out thousands of procedures to the private sector
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based on, on the rationale that they're more productive, more effective, they have less complications.
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So, for example, and, and, you know, this is something that might surprise people,
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but, you know, our clinic in British Columbia is ranked by the Accreditation Canada,
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which is the national body that accredits hospitals and teaching hospitals across Canada.
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We are the high, we've achieved the highest rating, higher than, which is, you know,
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a minority of hospitals in Canada have public hospitals.
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We, we know from government data that there, for every hundred admissions to a public hospital,
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We know from college, so in, in over 25 years of operations.
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There is one preventable death for every hundred admissions to a public hospital.
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In over 80,000 admissions at our surgical center, there has not been one death.
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So, these, what Ford is doing will not only save hundreds of lives every year, but, and this
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is also significant, the College of Physicians and Surgeons of British Columbia collects data
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on complications like infections and superbug infections and all of that kind of thing.
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They're almost 40 times more common in a public hospital than in a private clinic.
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So, these clinics are safer, they cost less money, they are built and operate with the construction
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costs, do not cost the taxpayer, and the, the technology that's included and bought by the
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private sector does not cost the taxpayer a penny.
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So, if they don't work out, taxpayer doesn't lose anything.
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And, most importantly, if they make a profit, those, that, those clinics pay taxes to all
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But, as you, as you say, what Ford is doing, quite apart from the fact that it's going to
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help patients, and it will also repatriate nurses.
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So, in a single Detroit district, which is, you know, just across, not, you know, just
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across the border, there are over a thousand, in one district, over a thousand Ontario trained
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This will, this will cause many of them to come back because the working conditions at
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our public hospitals have become, have deteriorated to a level that they're toxic now.
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Nurse, there is actually, if you look at OECD data, there is no shortage of nurses in Canada.
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We have a higher than average number of nurses per population, but the environment in our public
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Well, especially in the ICUs and emergency rooms.
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I mean, those, those are the ones that are really having the trouble.
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And, and I think one of the things that a lot of Canadians don't understand, and this is
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at the heart of that, of the problem, is we are the only developed country that block
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So, a public hospital, like, say, the Vancouver General Hospital, is given a couple of billion
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dollars every year by the government to operate.
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That means that every patient that comes to an emergency department or is admitted for a
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Therefore, if you want to be a successful chief financial officer and administrator at
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a hospital, public hospital, the last thing you want is patients, because they are using
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It's a crazy form of funding that is unique to Canada to be carried out exclusively.
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This is a funding system in Britain, in New Zealand, in, in France, countries that have
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universal health systems, the funding follows the patient.
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So, there is, in, in, in New Zealand, if a patient goes to a public hospital, they carry
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So, the, they want patients in the emergency department.
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They want patients coming in for surgeries, because that brings government revenue.
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Equally, those, so what's interesting, public hospitals in those countries, and also treat
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There are no way, you know, if you, if, and, and use the revenue to supplement the treatment
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I'm an honorary member of the Cuban Orthopedic Association, the Frank Pays Hospital in downtown
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Havana, only 150 beds, generates $20 million U.S. in treating private patients, mostly tourists,
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And they use that revenue to increase the funding of their public system, buy new technology,
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Yeah, well, actually, you know, I was a guest speaker at an international conference in Budapest
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So, they invited me because they didn't believe Canada would outlaw private health insurance.
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And, you know, delegates from all over the world were there.
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Afterwards, the delegation from China came up to me and said, you know, you remember Tiananmen
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And I was shocked they would bring up Tiananmen Square.
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I said, if the Chinese government tried to outlaw private health care, there would be
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100 million protesters because in China, we don't believe the government owns your body.
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And that is the, that is pretty well the stance taken by Canadian governments.
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More than half of all the hospitals in communist China are private.
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It's, you know, one thing we might ask Jagmeet Singh is, because I use education as an analogy.
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There's no one out there suggesting that we outlaw private education and private schools
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And one should maybe ask Jagmeet Singh how he justifies having gone to the most expensive,
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one of the most expensive private schools in North America.
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One thing that you mentioned a couple minutes ago was the safety record of the hospitals.
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And I was gobsmacked, or of the clinics like yours, like Canby Surgical Center.
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You say that the BC College of Physicians and Surgeons tracks the safety record, and it's better than the public hospitals.
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When Ford was announcing that his changes, which include allowing a limited number of hip and knee operations to be performed in these clinics,
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the head of the College of Physicians and Surgeons of Ontario was calling around to other people in the health profession saying,
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we've got to stop this, it's not safe to do hips and knees in clinics.
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She's not an orthopedic surgeon, by the way, but she was saying that this is unsafe.
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And by the way, the data on hospitals is government data.
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The college doesn't collect the data on hospitals.
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So the college collects the data on the private clinics.
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So it's government data that show the incidence of infections and complications.
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Now, you have to remember, the College of Physicians and Surgeons of Ontario is one of 13 such colleges in Canada.
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So we have, they're part of the massive health bureaucracy that defines Canada's health system.
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There is a reason why Canada is ranked 10th out of 10, according to the Canadian Institute for Health Information Commonwealth Fund data,
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10th out of 10 in amongst the universal top, you know, developed countries with universal health care.
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We're ranked 10th out of 10 in quality, in overall quality and access.
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And one of the reasons is this massive health bureaucracy that we have.
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We have, we have, as I say, 13 jurisdictions who act as a college to, to qualify and accredit doctors.
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Equally, and in parallel, we have 14 ministers of health and 14 health ministries.
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So this is why the data shows that for every health bureaucrat, public health bureaucrat that Germany has,
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and in Germany there are no wait lists, for every public health bureaucrat that Germany has, we have 11.
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They are consuming this massive budget that Canada uses at the taxpayer's expense.
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And we should just have one Canadian health system, one ministry of health.
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We should have one college that accredits doctors.
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So the last thing the College of Ontario wants is for, to be open to the possibility that ending the monopoly will mean the end of this bureaucracy.
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I mean, I think if we had one College of Physicians for the whole country, which is what other countries have,
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the other 13 colleges, and a lot of the staff are doctors, could go back into looking after patients instead of being bureaucrats in a college.
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So I'm all for eliminating 12 of the 13 colleges.
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We need to take a quick break, but we'll be back with Dr. Brian Day in just a moment.
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And when we come back, doctor, I do want to ask you about your push for private insurance and what that means for people who say,
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So, Dr. Day, in addition to looking at different ways of delivering, and you've given us a mountain of stats
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and probably sending an awful lot of listeners to Google to say, wait a minute, is that actually true?
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11 health bureaucrats for every one that Germany has.
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You've been involved in a court case that's been going on for a long time.
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To allow Canadians to buy private insurance, or is it to pay for services?
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I mean, to me, it sounds an awful lot like the 2005 Chaloui Supreme Court decision, which only applies to Quebec.
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Are you essentially trying to bring that to the rest of Canada or to British Columbia?
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What we're going, and we hopefully will get leave to appeal to the Supreme Court of Canada,
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we lost at the lower court levels in British Columbia.
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We weren't surprised because Chaloui in 2005, 2004-05, lost at the lower courts in Quebec,
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but eventually went to the Supreme Court of Canada.
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We're essentially asking the Supreme Court of Canada to make a decision as to whether patients outside of Quebec
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should have the same rights under the Charter that they granted to residents of Quebec.
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And we will hopefully hear about leave to appeal in March of this year.
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But yes, we are asking for the right for Canadians to obtain private health insurance.
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So what we have in Canada right now, or to pay, but preferably, well, our prime thing is private insurance.
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What we have in Canada right now is a situation where governments across the country
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have developed benchmarks on the maximum safe time you can wait before you undergo a procedure
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or have a procedure once you're referred by the doctor.
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And in many thousands of cases, we've got millions of Canadians waiting,
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and the majority now are waiting beyond the safe time.
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So we're saying to the court, should a government be able to promise health care,
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which it does under the Canada Health Act, in a timely manner,
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and then at the same time outlaw a citizen's right to take measures into their own hand
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and look after their own health with private insurance.
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So we are, I'll reiterate this, the only country on the planet
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where it's unlawful to obtain private health insurance for medically necessary services.
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Along that line, we arbitrarily designate essential services,
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such as ambulances and prescription drugs, dentistry, physiotherapy,
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artificial limbs for patients who've lost a leg.
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We arbitrarily designate those as not necessary and make people pay or buy insurance for those.
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So, yes, we're fighting for the same rights that the citizens of every other country on the planet have
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and the citizens of Quebec have, and that case, we hope,
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will be heard at the Supreme Court of Canada later this year.
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I don't think you can argue that Quebec's public health care system has fallen apart.
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I think it's middle of the pack when I look at different barometers most times.
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But it's, you know, there is a thriving private market in Quebec
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that the rest of us just are not legally allowed to have.
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Right. If you cross, you know, the other paradox is all you have to do,
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I mean, I spent a lot of time in Ottawa when I was president of the Canadian Medical Association.
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A lot of Ontario patients travel across to Quebec.
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You know, just go across the bridge from Ottawa and you can get private MRIs and private health care.
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And once you go across a provincial border in Canada, you're in a different system
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and you're allowed to access private care if you wish.
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But what we're arguing for is private insurance because most people,
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I mean, about 70% of Canadians have extended health insurance that covers prescription drugs
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And by the way, those services are included in most countries' universal systems.
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Unlike Canada's, our system isn't comprehensive.
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We don't ensure, we don't cover many necessary services.
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To me, it's ludicrous that the diagnosis of an infection is covered, but the treatment is not covered.
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And the argument about, oh, will the rich be the beneficiaries is also ludicrous.
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Right now, every injured worker in the country has private health insurance if they're injured on the job
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And as I said earlier, federal employees are exempt.
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You treat, I just want to jump in on that point.
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Do you do knee replacements on federal workers in your private clinic or procedures, surgical?
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We do surgical procedures on federal employees.
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I mean, I've personally operated on prisoners and judges who are federal employees, so to speak,
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as well as federal police officers, RCMP, and Canadian Armed Forces,
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If you're a federally employed person, you are exempt from the restrictions.
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So basically what we're saying, we want the same rights for ordinary Canadians that federal employees have,
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that injured workers have, that prisoners have, that judges have.
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And then, you know, I do want to address this, is it private insurance for the rich question?
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The wealthy, there is no country on the planet in which the wealthy suffer,
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because they get on a plane and go somewhere else.
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Wealthy Canadians go down to the United States.
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Politicians go down to the United States if they can't get access here.
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We know that there are many of them have done so.
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It's on the public record that Jean Chrétien has used the Canadian Armed Forces,
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when he was prime minister, went in the Canadian Armed Forces jet to Minneapolis for private health care.
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And all of the major politicians that you could name, I mean, fill a page of individuals who've used the U.S.
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But what we're talking about is adding the legality of private insurance for medically necessary services.
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So the same insurance companies that offer ambulances and prescription drugs and so on, dentistry, will be allowed to add on and cover that.
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And in most cases, these premiums are supported or funded by employers in Canada.
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And so, you know, this is actually something that the wealthy already are taken care of.
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So let's not talk about this as a wealthy versus poor thing.
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And finally, and I think this is very important, in countries where – so I lived and worked in Switzerland for six months.
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Low-income individuals in Switzerland have their premiums paid by the government, private premiums.
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Because Switzerland mostly has private hospitals and private insurance.
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Because in Australia, you know, which is a country very comparable to Canada in terms of population and population density,
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millions of Australians in the lower economic groups have their premiums for private health care funded,
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either fully paid or partially funded by the government.
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So if the fear – this question about the fear of introducing private insurance benefiting those with more money is a red herring,
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because the government has two ways to handle that.
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Number one, they can make the public system good enough that it's irrelevant because there's no queue to jump,
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Number two, they can – if the private system is performing better – pay the premiums for lower socioeconomic groups.
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One of the stats – Stats Canada right now has data showing that in Canada,
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the worst health access and the worst health outcomes are in lower socioeconomic groups.
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So our system is not doing what it promised to do.
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What would you say to those who believe that you just want to get rid of the public system?
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You want two systems that will work hand in hand rather than one above the other.
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Or what would you say to those people who say you're an attack, you're a danger to the public system?
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Well, as I said earlier, you know, when I say private, I would support private non-profit to show.
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This is not about private companies making a profit.
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We have a government that promises healthcare, fails to deliver it in a safe timeline,
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and at the same time makes it illegal for you to access that healthcare independently.
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So, what I am arguing for is a little bit of competition will improve any monopoly,
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but no monopoly serves the user of the services well.
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I don't – and if anyone can name one, I've never heard anyone –
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no one's ever been able to name a monopoly that is better for the consumer.
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And so, yes, we are attacked for this profit motive.
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Well, as I said earlier, if these clinics make a profit, more than half of it goes back to the government anyway.
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And secondly, I have no problem with private non-profit.
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As long as it's not a government-run, bureaucratically overrun system, fine.
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But we need competition for the state-run monopoly that defines Canada's health system.
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Dr. Brian Day, thank you so much for your time.
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This episode was produced by Andre Pru with theme music by Bryce Hall.
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Kevin Libin is the executive producer of Full Comment.
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You can subscribe to Full Comment on Apple Podcasts, Google, Spotify, Amazon Music,
00:32:14.780
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