Halifax Chronicle-Herald, August 20, 2006, p. A17

ONE WOULD think that the candidate selected by British Columbia doctors as president-elect of the Canadian Medical Association would be acclaimed because he advocates better health care for patients, and better working conditions for professionals. Yet, some members of the CMA have made this normally routine election controversial by preferring ideology to better outcomes for patients.

This week, Canadian doctors are meeting in Charlottetown to choose a new president-elect, who assumes office one year later. The election pits an advocate of giving real choices to patients, Dr. Brian Day, against Dr. Jack Burak, who supports a government medicare monopoly. I believe that delegates to the CMA conference who wish to meet their obligation to doctors and the Canadians whom they serve must vote for a president who favours multiple sources of funding and delivery for important clinical services.

Dr. Brian Day supports improved health care for patients. He believes that patients, and governments, should be able to purchase excellent and timely care from the public or private sector, whichever does it best.

Services provided by firms with a monopoly are often scarce, expensive and of poor quality, a view that underpins the Supreme Court’s decision in the Chaoulli case last year. It is no surprise, therefore, that as long as government alone delivers health care, Canadians will suffer from lengthy waiting times and poor quality. Oddly, many Canadians, including physicians, continue to lobby for a health care system that virtually guarantees limited access and unacceptably poor quality.

The public health care monopoly limits the choices of Canadian Medical Association members and their patients. Doctors in Canada can choose to take the working conditions and fees that government-employed administrators deem appropriate or leave clinical care to provide clinical services in other countries, or uninsured non-clinical services in Canada.

Dr. Day supports conditions for health professionals and patients by suggesting that, where public health insurance and public administration are inadequate, doctors should be encouraged to provide services in ways that allow them to meet their professional obligations. Why force Canadians to travel to Bangalore or Boston for timely care when Canadian doctors and nurses are able to provide high quality care?

Private delivery (paid for by public or private insurance) is often more efficient, allowing one clinician to care for more people. In Nova Scotia, one gastroenterologist working in a hospital may do as few as six endoscopies in a working day. A privately organized gastroenterologist, using two rooms, might do as many as 16 to 20 scopes in a day. It is no surprise that waiting times in Nova Scotia and elsewhere are unreasonably long.

Throughout history, price controls are associated with poor quality and rationing. Rent controls in the Bronx, New York City, meant that property owners would neither construct new buildings nor repair old ones. Consequently, many parts of the Bronx came to resemble a war zone. In New Brunswick, government sets the price for gasoline, but some gas station owners closed rather than sell at a loss. Access to medical care is declining for the same reason.

Family doctors in Canada provide a narrower range of services compared with 10 or 20 years ago because government, as the only insurer, pays about $27 for an office visit — a price that includes the full cost of running a medical office and communicating with patients.

Current price controls are contributing to the continuous breakdown in our health care system. Simple economics suggests that the supply of services increases when professional and financial rewards increase.

Professional associations that do not encourage competing payment systems are harming both their communities and their members. Members are harmed because the inability to provide private care means that some members must choose between delivering delayed and poor quality care, and engaging in non-essential clinical activities.

Delegates to the CMA convention have an opportunity to contribute to improved lives for all Canadians, including their members. CMA delegates must challenge the monopoly delivery of essential health services. Only the most heartless delegate will vote to support a system that guarantees delayed access and poor quality care. Optimistic and forward-thinking delegates will vote for the proposition that Canadian patients must be able to choose for themselves between public and private delivery of essential services.

Dr. David Zitner is director of medical informatics at Dalhousie University, and fellow in health care policy with the Atlantic Institute for Market Studies, a public policy think tank in Halifax.