Why our health system treats Canadians poorly

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Brian DayFormer B.C. deputy minister of health Lawrie McFarlane’s July 24 commentary on the “Cambie Surgery Centre ruling” (a descriptive that ignores two cancer patients and three children who were co-plaintiffs) contained some valid commentary.

The crisis we now face in our health system is there for all to see and observe. Notably, McFarlane offers no solutions.

For those whose memory is short, the government of his era – he was a deputy minister in the early to mid-1990s – theorized too many doctors and nurses were treating too many patients and that was responsible for rising health costs.

Their solutions were simple. Close beds, cut back medical schools (10 to 30 per cent nationally) and close many nursing schools.

In the 1990s, not a single hospital was built in B.C., and 1,600 full-time nursing positions were eliminated. We now have a shortage of hospital beds, doctors and nurses.

The Index Mundi data show Canada ranks 69th in the world in doctors per population. In the 1970s, we varied between fourth and eighth. Organization for Economic Co-operation and Development (OECD) tables show we rank 31st in hospital beds on a population basis.

McFarlane repeats his prior claims that the reason for our legal challenge to the status quo is based on a wish for doctors to “boost their income,” repeating former attacks where he described “excessive compensation demands by various health professions” and statements that “our health service has fallen victim to the desire of a group of specialists to stuff their mouths with gold.”

The B.C. Court of Appeal refuted those claims, and our five patient plaintiffs had nothing to gain by increasing doctors’ incomes.

According to the Canadian Institute for Health Information, Canada now spends 12.7 per cent of its gross domestic product (GDP) on health care. That’s more than any other country that offers universal care.


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For our population of 35 million, we have 14 ministries of health that include 11 public health bureaucrats for every one Germany has. And their public health system outperforms us in every way.

Every country in the world allows a non-government option, while Canada operates a state monopoly in hospital and physician care. I am not aware of any monopoly that serves its users well.

Statistics Canada reports that low-income Canadians suffer from the worst access and outcomes and, among 10 developed countries with universal care, Canada ranks last in equity.

The Appeal Court confirmed wait lists were dangerously long, with many B.C. patients dying because of poor access. The court appeared to condone the current system because of a theoretical negative impact that a non-state safety valve might have on disadvantaged citizens. That fear ignores the government’s ability to fund private insurance or care for lower-income patients, just as they do for prescription drugs, dentistry, ambulances, etc.

Inequality has always existed in our system for groups like WorkSafe B.C. and other exempted groups, including non-residents, prisoners and federal employees (including judges).

The 89,000 patients treated in private B.C. clinics each year leave the public system and increase hospital capacity. They add resources to the public system, and our government contracts out care to the clinics.

The surgeons who work in clinics have rationed access to operating time in our public hospitals. The nurses who work in private clinics include many who would otherwise leave Canada because of the toxic workplace that the government has created in our public hospitals.

The following quotes from the B.C. Court of Appeal judgment confirm that this was not a clear victory for the government:

  • “We are not examining what objectively would be the best, most efficient, or socially just means of delivering health care to British Columbians. That is beyond our mandate and our expertise and jurisdiction.”
  • “Wait times in considerable measure flow from government rationing of health care.”
  • “Irremediable harm and increased risk of death in order to preserve a public health-care system that is intentionally under designed in order to achieve fiscal sustainability.”
  • “When the province assumes a monopoly power over the provision of medical services it is under a constitutional duty to ensure that the service is provided in a timely fashion.”
  • “We have found that the judge understated the scale and impact of the Charter infringements on thousands of patients.”
  • “The court recognizes that the provincial law is upheld at the cost of real hardship and suffering to many for whom the public system is failing to provide timely and necessary care.”
  • “The provisions’ effect of eliminating the availability of timely private care comes at too high a cost to the life and security of those individuals who cannot access timely care in the public system, but who would be able to access private care.”

Both politicians and the courts are deferring responsibility to each other. The B.C. government ignores the fact they have made the provision of timely access to medical care a legal requirement they are required to honour.

It’s surely unacceptable that, having failed to meet that obligation, they then seek to enforce another law that prevents individuals from stepping in and caring for themselves and their loved ones.

It begs the question: Do we or the government own our bodies?

Brian Day is an orthopedic surgeon, health researcher and medical director at Cambie Surgery Centre in Vancouver. This piece was supplied by the Frontier Centre for Public Policy.

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By Brian Day

Dr. Brian Day graduated in medicine from the University of Manchester and undertook further training at the Royal Postgraduate Medical School in London, obtaining British specialist qualifications in both internal medicine and general surgery. He later completed his orthopaedic specialist training at UBC.

4 comments

  1. I am totally disgusted with our Health Care Bureaucracy. Especially the part that I have had interactions with (Mental Health; Addiction). AHS is ineffective and spends massive amounts of money to no effect. More to the point, ASH has no ability to change course and stop doing things that don’t work, and instead double down and do more of what is not working

    I am convinced that Alberta Services should have two departments. Accounts Receivable/Payable and Fraud Prevention; Investigation. (Perhaps an expanded Health Savings account such as being proposed by Danielle Smith) All the rest of the administration should be turned loose to deliver services to Albertans, and let their patients decide how much their services are worth.

  2. Excellent column. It is odd that the Supreme Court of Canada ruled in favour of increased private care in Quebec, but the B.C. Court of Appeal takes the opposite view here. One wonders what the Supreme Court of Canada will do if this case comes before them. I can’t think of a credible or convincing reason why people living and paying taxes in Quebec should have more control over their own bodies and enjoy greater rights to access health care than residents of B.C.
    Read Jock Finlayson

  3. Excellent column. It is odd that the Supreme Court of Canada ruled in favour of increased private care in Quebec, but the B.C. Court of Appeal takes the opposite view here. One wonders what the Supreme Court of Canada will do if this case comes before them. I can’t think of a credible or convincing reason why people living and paying taxes in Quebec should have more control over their own bodies and enjoy greater rights to access health care than residents of B.C.
    Read Jock Finlayson

  4. Excellent column. It is odd that the Supreme Court of Canada ruled in favour of increased private care in Quebec, but the B.C. Court of Appeal takes the opposite view here. One wonders what the Supreme Court of Canada will do if this case comes before them. I can’t think of a credible or convincing reason why people living and paying taxes in Quebec should have more control over their own bodies and enjoy greater rights to access health care than residents of B.C.
    Read Jock Finlayson

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