The single-payer model: a foundation for professionalism

By Randall White, M.D.
Canadian Healthcare Network (Toronto), Oct. 8, 2014

Obtaining orthopedic services in British Columbia is harder than it needs to be. People sometimes wait for months, but successful programs to expedite access exist, such as the Osteoarthritis Service Integration System, operated by Vancouver Coastal Health. Although the government should create more such programs, such efforts are diverted in the defence of our single-payer, not-for-profit universal healthcare system from a group that hopes to break the “government monopoly” on healthcare funding in Canada.

Dr. Brian Day, founder of Vancouver’s Cambie Surgery Centre, and other commercial specialty clinics are suing B.C. to allow private funding of medical care. This would facilitate expansion of private diagnostic and surgical procedures and undermine the single-payer model. The integrity of Canada’s entire health system could be at risk.

Advocates for commercialized healthcare funding, now prohibited by the Canada Health Act, often promote a “hybrid model.” In 2012, Dr. Day wrote in a newspaper column that European countries successfully combine universal care with a public-private system, but he failed to address the different contexts of North America and Europe.

European insurance and healthcare sectors are highly regulated. For instance, in France, even supplemental health-insurance funds are not-for-profit, unlike in Canada, where supplemental insurance, now limited to pharmacueticals, dental, vision and complementary care, is offered by for-profit corporations.

Canada has extensive commercial ties to the United States, not to Europe, and were the “hybrid” advocates to prevail, U.S. insurers could invoke NAFTA to gain access to an expanding Canadian health-insurance market.

U.S. insurance companies are unlikely to submit to a European-style model in Canada, where regulation in most sectors is already more American than European because of harmonization under NAFTA.

Furthermore, these insurance companies have the resources to get what they want. In 2013 the leading U.S. health insurers reported $12.7 billion in profit on $313.7 billion in revenue (U.S. dollars). According to, that same year health insurers spent $154 million on lobbying U.S. lawmakers.

Using their financial clout, they could quickly change the landscape in Canadian healthcare funding for not only procedural medicine but primary care, mental-health care and other specialties.

Private-insurance-inspired managed care, capitation, pre-authorizations, routine refusals of reimbursement, restrictions on hospital admissions, onerous and costly paperwork, and loss of autonomy, which plague U.S. physicians (I know because I practised there) could follow.

Investor-owned healthcare delivery goes hand-in-hand with commercial insurance, which is why private-clinic owners are so eager to eliminate the single-payer model. They can benefit handsomely from purchase by larger entities.

For instance, in 2012, the Canadian corporation Centric Health bought Vancouver’s False Creek Healthcare Centre, founded by Dr. Mark Godley, for $24 million. Of course, this is small potatoes for U.S. hospital chains, which might invoke NAFTA to gain access to private Canadian clinics and hospitals were they to grow in size and value.

The potential for fraud also looms, as witnessed In the United States. In 2007, the company PacifiCare overbilled Medicare, the U.S. healthcare program for seniors, for an estimated $423 million. B.C.’s healthcare budget, $16 billion and growing, could become a big target for corporate scammers.

As a psychiatrist, I was especially offended by the scandal in U.S. for-profit psychiatric hospitals that investigative reporter Joe Sharkey detailed in his 1994 book "Bedlam: Greed, Profiteering, and Fraud in a Mental Health System Gone Crazy." Psychiatrists and administrators colluded to hospitalize well-insured adults and children, some of whom had minor disorders, against their will. If we veer away from our single-payer model, are we in jeopardy of creating a similar culture here?

The question for Canadian physicians is whether the guiding principle for organizing healthcare should be the public interest or the generation of profits. For me the choice is clear.

Randall White is a psychiatrist in Vancouver. This article was written expressly for, an online site associated with the publications Medical Post and Pharmacy Practice.