Walkom puts Brian Day under the knife
Thomas Walkom peers more closely at the dubious arguments of Dr. Brian Day, the private health care guru on the verge of heading the Canadian Medical Association.
I went off to hear Brian Day again this week. … As always, Day was roguishly charming. A veteran of Vancouver’s scrappy media culture, he rarely bothers with building a logical argument in the traditional style, preferring to rely on a flurry of power-point-assisted assertions â€” some factual, some less so â€” that are designed to leave an impression. The impression he wants to leave is that Canadian medicare is a mess, that everyone else in the world has figured this out but us, that two-tier medicine (which he sometimes calls private delivery and sometimes European-style medicare) is the only way to go, and that well-to-do Canadians shouldn’t feel guilty about health-care queue-jumping because, really, equality is impossible. . . .
… His style is to cite as fact a dramatic statement and then move on: Canada spends more on health care than any other country save the United States; Ontario’s ban on queue-jumping is reminiscent of Communist China; the World Health Organization has ranked Canada’s health system as number 30 in the world, well behind France (number one) and even behind Colombia and Morocco.Yet, the facts don’t always hold up. According to the latest figures from the Organization for Economic Co-operation and Development, Canada doesn’t spend more on health than any other country outside the U.S.; Germany, Switzerland, France, Iceland and Norway spend more as a percentage of their national economies. Canada is tied with Greece.
The WHO rankings? These came out in 2000 and were based on 1997 figures. The methodology of that study was so controversial that it has never been repeated. In one critique, University of Toronto health policy analyst Raisa Deber points out that the WHO rankings were adjusted for the educational level of the population to such an extent that, essentially, all they prove is that Canadians are better-educated than the French.
In any case, does anyone seriously believe that Canada’s health system is worse than Colombia’s? Day likes to say that he isn’t espousing a U.S.-style system, although realistically I suspect that this is where his recommendations (more private insurance, less universality) would take us. He cites France and Germany as models, or maybe Switzerland and Australia.
This is convenient since most Canadians know little about the health systems of these countries. Doctors who applaud the French model, for instance, might be horrified to discover that physicians are paid less there. Fans of the German system would be interested in knowing that the country is now facing a strike by tens of thousands of health-care workers, including doctors, angered by low wages and long hours.
Australia? Evidence from that country indicates that a parallel private system (subsidized through tax dollars) has led to wait-time increases in the public stream. The reason is that specialists, understandably, prefer to work privately where they can charge more.
Day prefers not to dwell on these details. And why should he? Skipping lightly across the factual terrain seems to work. Of the roughly 50 orthopedic residents who cast ballots after the debate this week, 43 voted with Day. We shall hear more from this interesting man.
What I always wonder is this: Just how much money does Day stand to make from more privatization in the health care system? Why does someone with such a massive vested interest in greater private health care have any credibility when tallking about health care policy?
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I agree with Thomas Walkam’s assessment of the motivations and the methodologies of Dr. Day in espousing half truths and questionable facts in his campaign to promote private health care or an increased private mix of services. As I am not a statistician, I tried to look at the issue in a common sense way. His manifesto sent me off scurrying through the WHO, OECD and other world sites on a quest to discover how bad Canadian public medecine was and why we were 30th ranked in the world. What I discovered was actually not counterintuitive, but the facts.
Canadian private health care has delivered, and placed Canada’s longevity in or near the top ten. Like most publicly funded systems our level of public vs. private care was a 70/30 split, while some countries approach a 73% level. There was a high correspondence between life expectancy and the level of public funding.The U.S. in contrast. has a life expectancy anywhere from 38th to 42nd in the world and the portion of public funding is approx. 45%.
So in estimating how much our health care system would “improve” as we lowered our level of public vs. private funding to say 60%/40% or 55%/45%, I looked for evidence of the flaws of private American insurance practice “creep” in the promotional material of B.C. private insurers. Sure enough, the evidence of private insurance weakness, that pesky failure to cover universally, was there. One such policy offered to insure a person as long as they were not too “old,” (over 75), or too “sick”, (no pre-existing illnesses for at least two years), wouldn’t cost too much, say over 1 million ( but what’s a million in a world where a consult costs 500-800 dollars?) and finally, would face a wait period for surgery of 45 days or more.
As I am doing the math, the average wait time for “cardiac” in B.C. is listed as 80 days, whereas the wait time in Ontario for a coronary bypass (in which 9 of 10 patients have received surgery or had their exam) is 54 days. One month of difference in a province dotted with private surgeries. Hmmm…
The wait times, I figure, must be a) tailored to be long enough to drive a certain percentage of otherwise sane, thrifty people to pay for a procedure that is provided free or b) the result of the public system floundering under the weight of all the unprofitable “overly sick” fish, ie. patients thrown back into the public pool. There is a certain artistry to the marketing, no doubt.
Anyway, after reading through reams of available literature, from countries where public/private experiments have been devolutions, leaving a bad taste in the collective mouth, such as England where the College of Physicians stands against the private experience, good hospitals closing and all, to Australia, where private insurers are subsidized by gov’t, to the discarded private experiments of the Netherlands, the capped salaries of French and German physicians, and finally to the astonishing statement of Relman, the former editor of the New England Journal of Medecine, prefering public health care and salaried physicians – I, at least, have failed to find any convincing evidence of the innate superiority, or efficiency, of the private system. There may well be some applications that really work, but without seeing Dr. Day’s earnings, and how he “saves” the system money, preferably, there really is no good way to judge just what his philosophy has to offer. He needs to supply facts to support his statements, and not genralizations.
The difficulty of allowing many doctors to opt into for-profit practise, is, just where do you draw the line? Do 40% or 50% opt to go private, do they all? And why should the public system have to subsidize the “superior” private system, with funding following the patient to the private hospital, leaving the “inferior” public hospital, burdened with the hard caseloads, underfunded? And what about Nafta? Will the private health corporations. and insurance agents face unfair competition from “Canadian” health care subsidies? Like soft-wood lumber?? No I think it best that Dr. Day does not cavort around the likes of Dateline and prime time American TV programs which have a way of making themselves look foolish.
I for one resented seeing a cherished institution, Canadian universal health care, maligned with its millions of “poor souls who don’t have a family physician” (a physician poached by the States no doubt), souls who apparently in Stoessel’s world, don’t have access to the near ubiquitous walk in clinic. Our health care going one on one, put up against the muscle of American medicine’s latest achievement, “store front or mall medicine” where for a mere 59 dollars, one can see a nurse practitioner. I’ll stand up for our vastly “inferior” public system anytime, even if Dr. Day won’t.