Social and political theorist Isaiah Berlin once wrote: "Values may easily clash within the breast of a single individual. And it does not follow that some must be true and others false. Both liberty and equality are among the primary goals pursued by human beings through many centuries. But total liberty to wolves is death to the lambs."
That is the dilemma we face as a society over health care. Does our belief in, and desire to have, a public universal health care system conflict with our human and individual right to have timely access to the care we need if the system is not responsive? In essence, that is the question that will soon be again before the courts. In 2005, the Supreme Court of Canada ruled that the Quebec government could not prevent private insurance for health-care procedures covered under Medicare. The court said that banning private insurance for services ranging from MRI tests to cataract surgery was unconstitutional, particularly since the public system has failed to guarantee timely access.
For decades, the health care debate in Canada has been polarized and divisive. Dogma and ideology have hijacked what should be a rational discussion on the best way to deliver health care to people that need it. Yet there has never been any middle ground permitted in discussion on how to create a responsive and sustainable healthcare system in Canada. It has been an all or nothing. You're either for Medicare and a universal public system, or against it. Because of that, all three political parties have pandered and avoided. They have irresponsibly punted the tough and substantial questions to the future.
The future is now. Dr. Brian Day, former president of the Canadian Medical Association, is forcing the issue. He is now CEO of the Cambie Surgical Centre in Vancouver, a private, for-profit hospital. We aren't supposed to have those in Canada, but we do. Everywhere. Why? Because there is a huge market demand for timely and quality health care that is not being met by the public system.
This business, and others like it, is filling it. The B.C. Medical Services Commission has ordered Day's facility to cease charging patients for services already offered in the public system. The Ministry of Health said the province would seek an injunction to enforce the order "shortly."
Day argues that a ban on private health care violates their democratic rights. "How are you going to argue that a 79-year-old cancer sufferer with terminal cancer should be forced to wait 18 months?" he said.
I don't like this idea -- at all. And I like even less the notion that rich people can access health care in Canada easily, while the middle class and working poor can't. These are the very people who not only can't afford private care, but also cannot afford to be without care. Most people have no clue that a parallel private hospital and health care system exists in Canada and has for many years.
But let's get personal for a moment. When it comes to the health of my family, no bureaucrat is going to tell me what to do. I will do what I must to ensure they are protected.
My wife and I have been customers at the False Creek Healthcare Centre, a private hospital in downtown Vancouver. It wasn't because we wanted to be. After all, like everyone else, we assumed that through our tax dollars, Medicare looked after all our health needs. That was wrong. Very wrong.
My wife had to have minor surgery performed and the wait list was 18 months. Although the condition was not life threatening, it certainly seriously eroded her quality of life. She couldn't wait for a procedure, and I wouldn't let her, even if she had wanted to. Another time, she injured herself and needed an MRI. That wait was at least six months. There was no way I was going to allow my wife to wait that long to see if she had any serious head injury.
I've been to False Creek, too. The pain I was suffering because of a hockey injury to my knee was excruciating. I had trouble sleeping at night, had to take painkillers and eventually needed a cane for short walks. Fixing it in the public system would have taken at least a year, and very likely much longer. I decided that I wasn't going to wait to get my knee fixed. I just couldn't. The pain was affecting everything -- my work, my sleep, and how I related to my family and others. I wasn't much fun to be around.
Within a week of the decision to pay for a surgical procedure, I was on the operating table. The problem was fixed, and with physiotherapy -- also expensive and not covered by Medicare -- I was fine within six weeks.
My very first exposure to the "two-tier" health system in Canada was in 1992. I had just become vice president of a large and publicly listed, Montreal-based corporation and was told that I was required to undergo an annual medical physical examination. The company had an arrangement with the late Dr. Abe Mayman, a wonderful and highly respected GP. A full work-up with Dr. Mayman that took at least five hours cost about $1,000. If I had a problem, or if I had to see a specialist, it was arranged by Abe's assistant virtually immediately. The care I received was always first rate and I never waited. The company paid for this service. While I was pleased to benefit from it, I had no idea that these private set-ups even existed.
After Abe retired, my company switched to Medysis, another private clinic operating in Montreal. They performed the same services, were equally competent and cost about the same. Their offices were in a nearby office tower in downtown Montreal. The facilities were spotless and equipment state-of-the art. Staff was always pleasant and treated you as if you were in a spa. If you're appointment was at 8:00am, that's when you were ushered in to begin your check-up. When we in arrived in Vancouver a decade ago, we couldn't find a family doctor, so I looked up Medysis, saw that they had an office here, and I've been there ever since. So I've been paying for private health care for more than 20 years now.
I have been doing that because the nonsense that politicians feed us that, "Canada has the best healthcare system in the world" is a lie and a cruel joke. Unless you have a life-threatening condition, you go on a waiting list. Equipment is far from state of the art, doctors and nurses are in short supply, hospitals are grungy and crowded and staffs are stressed to the limit.
There is a distinction between the "system" and the people within it. In all my experiences with our health care system in Canada -- good and bad -- I have never once encountered gross incompetence, negligence or lack of caring. Doctors, nurses, volunteers and staff have generally been incredibly kind, compassionate, generous and warm. How could they be anything but? They have dedicated their lives to helping people through some of the most difficult and painful episodes of their existence as human beings. Our broken system is not their fault; they are simply coping the best they can within it. And like our public school teachers, we ask much of them.
In 2006, my 72-year-old mother died of lung cancer. Her diagnosis came in December of 2005. She had not been able to find a family doctor to quarterback and co-ordinate her treatments. She was shuffled from one hospital to another seeing specialists, taken by my then-80-year-old father, because my brothers and sister live hundreds -- and in my case -- thousands of miles away. Mama waited to see doctors for hours upon endless hours in crowded, noisy and dirty waiting rooms. When she got past triage, she was relegated to a hallway in an acute-care ward until she could be seen. At best, that was several hours, again. Once that was done, she waited again, because professionals are overworked and understaffed. Eventually she was released, but usually that happened a lot faster than was safe, prudent and comfortable -- to make room for others because there were no available beds. That was, until the next round. She died with my brothers and sister at her side in a dirty room at the Montreal General Hospital. It was far from the compassionate and dignified death that we are led to believe is the right of every Canadian. The experience almost killed my father, too, and was an enormous strain -- including financial -- on the rest of us.
A few month's ago, one of my wife's acquaintances separated his shoulder. He makes a living doing maintenance work on heavy equipment. He can function reasonably well other than the fact that he can only do heavier work with one arm. He also has to regularly take painkillers. Not a great idea for this man, who happens to be a recovering alcoholic, an addict. Painkillers for an addict is like giving a child loaded handgun.
One of my dear friends, Fred Davies, has an adult daughter Jacquie, who suffers from a severe form of schizophrenia. The family has struggled with Jacquie's illness for many years in large part because she couldn't gain admittance to a psychiatric hospital. Jacquie was an accident waiting to happen. Allowed to go free, she brutally assaulted and almost killed two innocent people. Jacquie was found criminally not responsible for the attacks and remanded to the St. Joseph's Mountain Health Care Facility in Hamilton. For years before, Fred and Jacquie's mother has begged and pleaded for the people at St. Joseph's to admit her. They wouldn't. It was only after Jacquie almost murdered two people that the court ordered it.
This is not the way our system is supposed to work. Access means timely and quality care and treatment, not living in pain for a year or two or living with the uncertainty that you may have done serious damage to your head and neck, as my wife believed.
One thing we do know is this: The health care system in Canada is broken and is intransigent to change and meaningful reform. The only way to change that is political leadership.
At the August 2011 annual meeting of the Canadian Medical Association, its president, Dr. Jeffrey Turnbill said: "We have seen a slow and steady decline in what we would all now agree is a deeply troubled health-care system. To be clear, this pillar of Canadian society is eroding." Turnbull is chief of staff at the Ottawa Hospital. "I don't think any of us would have thought that we would be practicing in a system where five million Canadians do not have access to a family doctor, or (where) one in 10 Canadians cannot afford their medications. Where getting a knee joint replacement for severe and disabling pain within one year is considered to be an ideal target for quality care -- incidentally a target we don't achieve very often."
In 2010, just as the debate over President Obama's health policy reforms was heating up, Canadian parliamentarians spent an inordinate amount of time "defending Canadian health care" on cable news networks in the United States. They may have thought that was good public relations, but what we need are for politicians to defend and get serious about Canadian health care in Canada, not against Fox News and not on the Stephen Colbert Show. And "defending" our health care system should mean working to improve it, not pretending we live in health care nirvana.
Regular people don't live in a world of absolutes; only politicians seem to. Dogma won't solve the health care challenge. Facts and practical solutions will. That and honest debate are the three things that our elected politicians seem incapable of confronting.
That is why I sincerely wish Dr. Day well in his efforts. Unlike the politicians accountable to us, he has the guts and fortitude to force the issue on the public agenda in a straightforward and honest way.
And while a citizen is doing that noble public service, our political leaders retrench once again to the safety of their traditional and indefensible positions. Meanwhile, Canadians continue to suffer from the impotence and cowardice of politicians that wax eloquent over a system that is disintegrating under the weight of its own perverse mythology.
Berlin said that: "The notion of the perfect whole, the ultimate solution in which all things coexist seems to me not merely unobtainable -- that is a truism -- but conceptually incoherent."
He's right. And it is up to strong and honest political leadership -- encouraged and supported by an enlightened citizenry -- that will find the necessary balance so that all interests are effectively served.