GLOBE AND MAIL
Wednesday, August 17, 2005
MDs change tactics, refuse to denounce private health care
By Andre Picard
Public Health Reporter
EDMONTON -- For the first time, the Canadian Medical Association has opened the door to endorsing the creation of a private, for-profit health system that operates parallel to the publicly funded Medicare system.
But it did so in a backhanded manner by defeating a resolution that said a parallel private system should not be permitted and endorsing another that said patients who are not treated in a timely manner should be entitled to seek private care and be reimbursed.
"Canadians should no longer be forced to wait, suffer and die," Victor Dirnfeld, a physician from Richmond, B.C., told the CMA annual conference.
He said of the 28 member countries of the Organization of Economic Co-operation and Development, 26 have parallel private and public systems, with only Canada and the Czech Republic stubbornly clinging to monopoly state-funded health systems.
But Benjamin Hoyt, president of the Canadian Association of Interns and Residents, said physicians should be leery of private care, and seek instead to reform the public system.
"We recognize the status quo is no longer good enough. But we refuse to accept that paying out-of-pocket is the solution."
By soundly defeating the motion condemning private health care, doctors also implicitly rejected Ottawa's position that a single- payer system is the way to go.
One day earlier, federal Health Minister Ujjal Dosanjh told CMA delegates that private health care was not a panacea and that giving Canadians a choice between private and public care is a "problematic" notion that would create inequities.
While the CMA policy discussion was touted in advance as a watershed moment for the "Parliament of Canadian medicine," the debate itself was dispassionate, and marked more by procedural wrangling and wordsmithing of resolutions than by profound philosophical discourse.
The last time the CMA tackled the issue was in 1996 when the notion of private health care was rejected after a heated debate.
Yesterday, the group representing Canada's 62,000 doctors took a different tack, referring the tough decisions on the proper balance of private-public care to its board of directors, mandating them to produce a discussion paper on the issue within six months.
Albert Schumacher, president of the CMA, said doctors were not ducking the issue, just being responsible.
"Like most Canadians, we don't have all the facts yet. We need to do our own research."
He stressed that CMA delegates had strongly endorsed the principle that access to medical care must be based on need and not ability to pay.
But Dr. Schumacher added that while doctors support Medicare, they "cannot stand and blindly give endorsement to the notion that everything is rosy in Canada."
He said the support for private care flows from frustration with shortcomings of the public system.
"Every doctor that practices medicine has a daily frustration with the ability to deliver timely care. You won't find a single physician who doesn't think the system cannot be improved."
But Sacha Bhatia, spokesman for the New Health Professionals Network, a group representing 20,000 new doctors, nurses and pharmacists, said the debate was a letdown.
"We're a bit disappointed. It was a great opportunity for physicians to stand up for the system that is admired worldwide, and they didn't do it."
Harvey Voogd, co-coordinator of the Friends of Medicare, also accused the CMA of copping out.
"When it came down to the nitty-gritty, Canada's doctors refused to reject private, for-profit health care," he said.
"The debate was hushed and rushed. The CMA backed a parallel private system and it did so in a circuitous manner," he said.
However, Dr. Hoyt, who had moved the motion calling for doctors to reject private care, said he was not disappointed with the process. He said his sense is that doctors do not support private care, but rather that they are "increasingly frustrated" with the limitations of publicly funded care.
"That doesn't mean the answer is privatization. It means the answer is to fix the system whichever way is best," Dr. Hoyt said.