by Dr. Brian Day
While clothes shopping recently at a trendy store with my 16-year-old daughter, I noticed a $400 shirt-like top that appeared to have worn-out areas and holes over the shoulders. It looked like the kind of clothing one would normally throw out. “It’s the modern style,” explained my daughter (of course I was already familiar with similar worn out holes in the knees of jeans). Change happens, and naturally we need to get used to it.
When I was 16, there was no way I would have ever believed that one day customers might pay $400 for a ripped shirt. Neither would I have believed that we would pay a few dollars for a small plastic bottle of water when (possibly better quality) water came freely out of a tap. And who would have ever dreamed that dog owners would walk their pets, scooping up their droppings, and placing them in a plastic bag?
In the context of healthcare, we have seen equally unlikely changes. Current trainees would be shocked to look at the procedures booked on an operating theatre slate taken from the period when I began my residency; or ponder the working day of a radiologist back then (no MRIs, no CTs, other scans or interventional procedures). Many of the drugs listed in the formularies of that time would now be relegated to a history of medicine course.
Change happens but not, it appears, when it comes to Canada’s health system. The talk from our medical and health associations, politicians, and others about healthcare change (“transformation” is the trendy name) is just that—talk, without action. Our health system is stuck in a time warp from the early 1960s, when its principles were being defined (and the Berlin Wall was being built). In 1984, some of those principles were incorporated into the Canada Health Act.
In theory, Canadian medicare was based on Aneurin Bevan’s British NHS 1948 scheme, which this year marks its 65th anniversary. The NHS has continued to keep up with the changing realities of modern medicine. The NHS is not perfect, but is clearly more efficient and comprehensive than our system. It includes, for example, drug and dental coverage. From its inception, the NHS never excluded private insurance or funding. Its architects were self-confident enough to believe that they could perform without a legally mandated and enforceable monopoly status.
It’s time to embrace necessary change and recognize that the 65-year-old system on which ours was modelled has, like every other country that provides universal care, never embraced monopolistic ideals and principles. Health systems around the world are undergoing change. It’s time that we, our governments, and our medical associations, did more than pay lip service to that necessity.
Dr. Brian Day is a Vancouver-based orthopedic surgeon who served as President of the Canadian Medical Association in 2007-08.
