In British Columbia, there are roughly 70,000 people waiting for surgery, enough to form a line around 21 kilometres long. If you need an arthroscopic procedure on your knee, for instance, you might wait a year to see a specialist and another year or two to get into a hospital operating room.
But if you belong to a very special class of people, you can get it much sooner at a private clinic in downtown Vancouver — by one of the best knee surgeons in the world.
But the vast majority of Dr. Brian Day’s patients are not the queue-jumping rich. Many are among the province’s poor. Ironically, the largest group of patients who pass through his clinic are unionized health-care workers — whose union is his harshest critic.
Dr. Day treats people who are covered by what’s known as third-party insurance — workers’ compensation, for example. Under the Canada Health Act, some third-party payers are not obliged to use the public system. The workers’ compensation board saves millions by getting people treated quickly and back on the job.
This is just one of the countless absurdities that riddle health care. Other third-party payers that send patients to Dr. Day include the federal government and the social assistance system. So he’s allowed to operate on Mounties, aboriginals, poor children whose teeth are so bad they need major dental surgery, and, theoretically, convicts (he says he’s declined the convicts). If you happen to live in B.C. and don’t belong to any of these groups, however, it’s illegal for him to operate on you.
Dr. Day, or “Dr. Profit” as he’s known in some quarters, thinks the Romanow report will probably be good for business. That’s because it will hasten the day when the province is forced to contract out essential services to people like him, in order to address its waiting-list woes. “What Romanow’s talking about is expanding medicare, and that’s going to withdraw resources from medically urgent surgery,” he predicts. “He didn’t even attempt to calculate the costs of capital replacement for equipment. Most of the new money will be gobbled up in refitting obsolete hospitals.”
But Dr. Day (whose parents were working-class British socialists) is motivated by more than profits. He thinks the present system is immoral.
He tells the story of a mother who wrote to him for help, because her three-year-old risked a permanent deformity to the foot without timely surgery. He tells another story about a teenage soccer star who had been offered a fully paid scholarship to an elite U.S. university, but risked losing it because of a knee injury that would take the public system 18 months to fix.
“It’s morally wrong that patients must wait that long for necessary surgery,” he says. (He pulled strings to get the child through the public system faster; he operated on the teenage soccer star himself and accepted third-party payment from her soccer club, which is probably illegal.) He also argues that the great divide in health care isn’t between the wealthy and all the rest. It’s between the middle class — people like you and me, who can figure out how to pull some strings — and the lower middle class, who can’t.
Dr. Day and his clinic, the Cambie Surgery Centre, hit the headlines a couple of years ago when he offered a cut-price deal on contracting out to the NDP government’s regional health service. He said he’d take on any procedures the health service wanted done, at 60 per cent of the price it figured it was already paying for them. That’s how much more efficiently he figured he could deliver medicine.
Needless to say, his offer was spurned. “Ludicrous,” said the chair of Vancouver’s Health Board, David Levi. “The public is against the privatization of health care.” But the public was not too happy to learn that the province had sent at least one knee patient to a private clinic in California, at a cost of more than $20,000, rather than send him across the street to Dr. Day for $3,500.
Today, business is so good that Dr. Day is doubling the size of his clinic to meet the demand. He has better equipment than the public hospitals do, and soon he will have more operating rooms than the province’s leading teaching hospital. Mr. Romanow, no surprise, would like to shut him down by expanding the Canada Health Act to include third-party insurers.
Dr. Day makes money from doing surgery on people. The more the better.
Meantime, hospitals are funded so that they can’t afford to do all the surgery that people need. The more the worse, which is why they are forced to impose rationing.
Every Monday, Dr. Day does surgery in a major public hospital. “Last Monday, my whole day of surgery was cancelled because there were no beds,” he says. “And on Friday, the whole place was closed for a ‘reduced activity day’ in order to save money.”
Perhaps the staff spent their day off reading the Romanow report.