SEPTEMBER 30, 2007
VOLUME 4 NO. 16

POLICY & POLITICS

The Interview

Dr Brian Day: Change now or go down

Dr Brian Day, the country's most notorious private-healthcare advocate, is now at the helm of the Canadian Medical Association. But is he really sounding the death knell of medicare? The wait list-obsessed Liverpudlian surgeon took a break from his presidential duties to talk to NRM about Canada in denial, dining with Jacques Chaoulli and his short-lived boxing career. Plus we put him on the spot with tough questions from you, our readers.



Photos: Lyle Stafford

I know it's early days, but give us an assessment of how your presidency is going so far. I'm just a couple of weeks in and most of my time has been spent talking to the media in interviews. But also I'm starting to try and strategize as to how I — or we, the CMA — can achieve some of the goals we set up for this year.

Like what? The number one thing I'd like to see is an acknowledgement that the status quo is not working. Secondly, some definitive action that will achieve a significant reduction — or at least lead to a strategy to make a significant reduction — in all wait lists in Canada. I think it's a realistic goal.

That's realistic? Really? Yeah. I think one of the things Canadian governments haven't realized is that it's cheaper not to keep people waiting. Amongst developed countries, Canada and the US are fighting it out for last place. I do resent when people accuse me of wanting a US-style healthcare — I don't. The US has a ridiculous healthcare system that's going bankrupt.

So what country's healthcare system do you want then? The UK, France, Germany, Belgium, Japan, Austria. None have wait lists for necessary services, all have access based on need and not ability to pay. By coincidence, or perhaps not, all have some private components. Governments in Canada are starting to look at what the positives and negatives are in each country.

The British system isn't without its detractors. True, they have made some mistakes but we can learn from their mistakes.

In August you received a letter from British colleagues urging you to do just that — "learn from our country's mistakes and reject market-style policies leading to privatization." For some disgruntled doctors to write a letter doesn't influence me at all.

NRM readers put Brian Day through his paces

Dr Chris Chan, from Lloydminster, AB, asks: Do you think the controversy about public and private healthcare has been overblown? Yeah, I think the private-public debate is nonproductive. Patients want excellent healthcare. They don't care whether it is delivered privately or publicly — they just want access.

Dr Johan L Van Zyl, from Melville, SK, asks: Will public and private care coexist or do you think one will eventually beat out the other? They already coexist. We have private delivery of public healthcare for the most part in family practice in Canada. As we expand availability and the scope of what we can do in healthcare, tax-funded healthcare won't be able to offer everything to everyone for free. That's the reality.

Dr Roy Maroney, a South African IMG from Kelowna, BC, asks: How can the CMA better look after IMGs who are being exploited by slave wages during their qualification? [Laughs] As you know, I'm an IMG, so I'm obviously supportive of IMGs. We have to understand that every College has to be able to validate the qualifications, but they don't have the capability to audit every medical school in the world. It's a very complex area — there has to be a way to get more doctors, and IMGs shouldn't be used as slave labour.

As the owner of a private surgery clinic, you'd stand to benefit from more private healthcare. Isn't that a conflict of interest? One of the reasons for unhappy doctors in Britain is that when you eliminate wait lists, private businesses suffer. It's a paradox. In Canada, by using patient-focused funding, not only will it reduce demand for private healthcare, but it will increase opportunities for unionized healthcare workers, which is why it's strange they're in opposition to the concept.

Um, that doesn't really answer my question, but let's move on. Has your election boosted your Cambie Surgery Centre's business? No. And it's actually lessened it for me — I've had to cut down on my time there.

By how much? I don't know yet, but significantly. I would think I'll have to cut back between 50-60% of my clinical work compared to before I got involved with the CMA, before last year. I had to cut back already last year as president-elect.

What will be the biggest health story of 2008? Michael Kirby. I have a lot of respect for him. If his [Mental Health Commission] report comes out next year, that's it. The hardest doctors to see in BC are psychiatrists.

Do you want to slay the Canada Health Act? I want it updated for the 21st century. The trouble now is a minority government is unlikely to want to dabble in it. I don't think the principles of the Canada Health Act are being kept — none of them.

None? Is it equal with costs for drugs? Is it accessible with massive wait lists? Is it portable when Quebecers can't come to BC because doctors won't take their health cards? Is it universal? Not really, we have prem iums in some provinces. Is it publicly administered - well, okay, that's the only one.

Do you have any aspirations to get into non-medical politics someday? No, I think medical politics is a lot more challenging.

You hesitated just then. Yes, but it depends what you mean. I wouldn't see myself doing that at all. I do admire some politicians because they take so much abuse. I take some abuse, but they get a lot.

What caused the biggest stir at this year's CMA meeting? Co-payments. This is one of the myths I'd like to break - co-payments are absolutely rampant in the Canadian health system in every area. You can get a better cataract lens or better hip replacements if you pay.

Are you pals with Jacques Chaouilli? I get along well with Jacques. He's a very affable man. We were at the Supreme Court together. We're not close friends, but I don't think we have any bad words to say about each other.

If you guys hang out, what would you get up to? He's French, and French food is my favourite, so if I was in Montreal, I might go to a French meal with him.

Speaking of food, what's your fave Vancouver eatery? I have two - no, three favourites - no, four. One is Le Crocodile, pure French food. Another is Cioppino's, which is Italian. Another, Il Giardino, also Italian. Another is Bishop's, continental west coast.

Have you ever been in a fight? When I was a kid, many times. I used to box as a kid. I stopped once I lost.

You must have lost badly. I got my nose broken. That was pretty bad for an 11-year-old. I still like watching boxing on TV, though it's probably not supposed to be acceptable for Canadian medical leaders.

Interview by Sam Solomon

See our earlier Q&A with Dr Brian Day: "The man behind the melee" (November 15, 2006)

 

 

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