New York Sun, August 24, 2006

With the cost of health care looming as an election issue in America this fall, doctors in Canada are speaking out about their own system and voicing some serious displeasure. The latest sign is the selection this week of the head of Canada's largest private hospital, Brian Day, to become the president of the Canadian Medical Association in August 2007. Dr. Day's election is being viewed as a sign that Canadian doctors are getting fed up with socialized medicine. After all, their president-elect has been a forceful advocate for a greater private role in medicine and is technically a criminal, since the law bars clinics like the one he heads.

For any American politician who bothers to look north, Canada is a glaring warning signal about the dangers of a government-run single-payer system. On average, Canadians wait 17.7 weeks between being diagnosed with an ailment by a general practitioner and being treated by the specialist to whom the GP refers them.Waits on orthopedic procedures can be even longer. The median waiting time for hip and knee replacements can be as high as 54 weeks, with many patients waiting even longer than that.

One patient, George Zeliotis, got so fed up he sued the provincial government in Quebec for the right to pay for his own hip replacement at a private clinic and won in Canada's highest court last year, but change has been slow in the wake of the ruling. Quebec has tweaked its laws but still allows private care only for procedures covered by a "waiting-time guarantee," and even for those procedures patients have to wait as long as nine months before they can turn to the private market, just to prove they're waiting too long under the government system. The change also covers Quebec only — the court ruling is having little discernable effect, so far at least, in the rest of the country.

Canada's woes are not due to lack of money. Canada operates the third most expensive universal care system in the developed world on an age-adjusted basis. Rather, the system provides few incentives for patients to consume health care judiciously, fails to produce enough new doctors, and doesn't take full advantage of the doctors it has.

Into the fray will step Dr. Day. How much influence he will exert is still an open question.The CMA is not as much of a political force as the American Medical Association is in this country, and the group's 65,000 members are still divided on what should be done to fix the system. In electing such an iconoclast — to use the word of Sally Pipes, an expert on Canada's healthcare problem at the Pacific Research Institute and a friend of Dr. Day — Canadian doctors are sending a clear message that the status quo isn't working for them or for their patients. Whether or not Canadian politicians accept the diagnosis, American politicians would benefit from paying attention.