Mr Campbell goes to Europe

BC premier comes home with
plenty of P3 souvenirs

By Julia Cyboran

But now that Mr Campbell is back, the government is still not revealing how it plans to use the info it collected in Europe. "We haven't formed any conclusion," insists Health Minister George Abbott, who did not join the premier in Europe. He does promise that it won't be the last we hear of it. "We'll be engaging British Columbians in a debate about healthcare."

Despite the government's vagueness, critics say Premier Campbell had already made up his mind before he even boarded his plane for Europe. Some eyebrow-raising details from the trip didn't help, namely his choice of travel companion. "Certainly we're concerned that one of the people Gordon Campbell took with him was Dr Les Vertesi — his brother-in-law — an avid private healthcare proponent," says Maryann Abbs, a coordinator at the BC Health Coalition, an anti-privatization advocacy group. Dr Vertesi is famous for declaring that universal healthcare is nothing less than a throw-back to communism. "We have brought the destructive elements of Lenin's experiment home to bed with us," he wrote in his self-published book, Broken Promises: Why Canadian Medicare Is In Trouble.

"We actually asked if we could send a representative on the tour with Mr Campbell," says Ms Abbs. "We even offered to pay the costs — but we were told it wasn't appropriate." The government's refusal to let them tag along, she says, proves the premier went to Europe with very clear intentions. And she's not alone.

"My concern is that what one takes away from a series of such visits will depend critically on what one chooses to see and visit," says Dr Morris Barer, scientific director of the Institute of Health Services and Policy Research and a professor at UBC. "I'm sure that I could arrange two itineraries for the premier, covering the same countries, from which he would come away with two completely different impressions."

Dr Gordon Guyatt, a health policy expert and professor of medicine at McMaster, agrees. "If Gordon Campbell went [to Europe] in an objective fashion he would come back saying we need a national pharmacare program, among other things," he says. Dr Guyatt believes that Canada should definitely integrate some of the aspects of European systems. But he's quick to point out that these systems strike a different balance between private and public care than what's presented in the mainstream media. "If one looks intelligently at European systems like France, Germany and Scandinavian countries, we see a greater proportion of public funding," he explains. Although all those countries have two-tier systems, public funding is as high as 80%, whereas here in Canada it's only 70%.

EUROPEAN DESIGN
Not even Ms Abbs can deny that several European countries have shorter wait times and better delivery of quality care. "There are positive things to find in Europe," she says. "For example, in Denmark and a little in Sweden they have vastly superior homecare services."

But Dr Brian Day, founder of the Cambie Clinic — a Mecca of private surgical care — and the CMA's president-elect, is a little more cynical. "I don't think any one [of those countries] is a perfect model, despite there being no wait times in France, Germany and Belgium," he says. "Canada has the advantage to design a system that takes the best from countries and discards the parts that aren't so good."

The BC Medical Association's stance is in line with Dr Day's. "I am actually really pleased that Gordon Campbell went to Europe," says Dr Michael Golbey, the BCMA president. "But I don't think there's any one system that's perfect. Each has its advantages and disadvantages."

Mr Abbott says there were indeed elements from each of the systems that impressed the BC delegation. "There were particular lessons that were learned in certain jurisdictions," he says. "But not every idea will be transportable to British Columbia." Prevention will be a key priority for the ministry, he says. "We can learn a lot from Norway and how they manage their prevention program." He was also keen on some of the primary care initiatives happening in Sweden and the significant advances in electronic health records in Great Britain.

P3 ATTACK
One of the more controversial issues raised by the trip was the delegation's particular interest in how the UK has set up public-private-partnerships (P3s). Mr Campbell even told the Vancouver Sun he was interested in using such partnerships in the building and operating of hospitals and in the delivery of medical services. "The UK is an international leader in this regard, particularly under the current Labour government," says Mr Abbott, adding that Partnerships BC, a government-owned company that implements P3s, has been watching and learning from Britain's experience over the years.

This is what's got defenders of universal healthcare most worried. "We're deeply concerned about what appears to be a sprint towards private healthcare in BC," says Ms Abbs. "And we're also really concerned with the Throne Speech where Premier Campbell raised the issue of sustainability." The provincial Liberals are saying that the healthcare system in its current state isn't sustainable. Minister Abbott blames it on the aging population. A problem, he says, that will only get worse as boomers hit 65. "The more seniors and the more frail elderly we have the more of a challenge it is to manage the healthcare system," he says.

But critics say more private care might only make things worse. "One of the most common claims is that allowing people who can afford to, to pay directly for their care will improve access for those using the public system. This is nothing more than propaganda," says Dr Barer. "It makes no common sense and there's no evidence to support the claim."

Dr Day has another point of view. Though he agrees private healthcare won't solve all our problems, he does think it's a necessary move. "All provinces are coming to the conclusion that the status quo isn't a solution. I think some different decisions have to be made and some elements of private delivery will introduce competition."

Dr Day puts much of the blame for our failing healthcare system on the government. "Canadians have been duped by politicians," he says. "[They] are responsible for this mess because they pounded the public with statements about how great the system was. Those are ludicrous statements."

Still, that's no excuse to go ahead with drastic changes to the way healthcare is delivered. "I think this is something negative that will make the system less equitable," says Dr Guyatt. "The ethical practice of medicine is to give care in terms of equity."

At the end of the day, says Dr Guyatt, the issue is pretty simple. "We just don't have enough doctors and nurses," explains Dr Guyatt, "and the chance of them having higher incomes will lead them to be sucked out of the public system."

For more see "Curtains for our Health Act?".