Dr. Brian Day
President, Canadian Medical Association

You’ve spent much of your year as head of the CMA evangelizing a different kind of health care. How would you describe it? In one phrase, it’s “patient empowerment.” When you go to a hospital for an MRI or a blood test or a surgery, they should say, “Welcome. We want you because when you put in your care card, it’s revenue for us.” Right now, you’re using up their revenue. We’re the only developed country that does this block funding.

Your appointment was controversial—the meeting was picketed. How do you respond to critics who say you champion two-tier health care? I don’t think there’s anything immoral or unethical about spending money on your own health. We already have private insurance anyway. Many of the groups who demonize private insurance have it themselves [through extended health benefits]. This private insurance pays for what, in most parts of the world, is considered medically necessary: prescription drugs, physiotherapy, dentistry—even an ambulance.

Is a single level of public care unachievable? In 10 or 15 years’ time, your generation is going to be paying massive income tax to look after me, because I’ll be hitting the most expensive component of health care, big time. It’s not sustainable—unless you’re happy to work harder, pay more tax, and put more money into us old people. Drugs that cost $700,000 are coming onboard, and after them? Stem cells, gene therapy, cloning—everything. We can’t afford to pay for it all for everyone. Again, it comes back to making the system consumer-oriented.

This has been the direction in the U.K. since 1997. How has the scene changed there? They eliminated waitlists, and now they have a private wing in their public hospitals. People are going into the private wing of public hospitals and they’re paying privately. But they’re not jumping a queue because there is no queue. They’re going there because they get a nicer room and maybe a glass of wine with dinner. Mostly they’re foreigners. But the hospital’s generating money, and they’re using that revenue to buy new MRIs and what have you. The same could be done here.

So British patients shop around, basing their decision on level of service? Even better, they have the data on each hospital for every procedure they do. If we implemented this here, you’d know complication rates, survival rates. That’s available now, but our hospitals don’t want it released. What if the Transportation Safety Board knew that certain airlines crashed twice as often as others but wouldn’t release the information? We’d be up in arms.

What’s the Mydoctor.ca initiative? Canada’s really backward on information technology. We’re pushing for an “electronic patient health record.” Say you go to Afghanistan. You can be in hospital there, and if you wish to share all your medical history, they can access it. Also, we’ve had discussions with Google and Microsoft because when government has that data, all it takes is the CIA wanting to look at your health records and it can. It can’t do that if they’re housed here. Maybe Canada will become a repository for American health records.

How does our health care system rank in the world? We’ve had the World Health Organization say Canada is 30th in the world for health care. This year the European Consumer Index said we were 23rd compared to 30 European countries, and last in value for money. The Commonwealth Fund from New York ranked us against eight developed countries and we came at the bottom in everything. We should be the best. Anything less is failure to me.—John Burns

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