Montreal, Canada's commercial health care capital

In an opinion editorial published in the Toronto Star on September 3 http://www.thestar.com/comment/article/489323, Dr Robert Ouellet, president of the Canadian Medical Association, advances the idea that Canada can develop a European-style health care system with a public-private blend. This fallacy is promoted by politicians and pundits who are enamored of markets as the solution to our problems. But Canada is not in Europe, does not have a European-style social welfare establishment, and is party to a trade treaty with the United States. Once health care becomes a commodity in Canada, U.S. corporations will demand entry under NAFTA and the future of our health care system will be out of our hands, despite Dr. Ouellet's soothing rhetoric.

While it's frustrating for physicians to face an unresponsive bureaucracy, Quebec provides a cautionary tale of what may happen when entrepreneurs take matters into their own hands. Quebec radiologists established imaging clinics independent of the health care system, albeit with the province’s knowledge. The government then let itself off the hook for certain outpatient diagnostic exams, and these medically necessary procedures were delisted (which is illegal under the Canada Health Act). Patients now must pay out of pocket for these tests, and many buy commercial insurance "just in case."

Because markets and investors demand constant growth, established commercial clinics and health insurance will seek to expand into other areas. Dr. Ouellet is a manifestation of this—he is using his influence as the president of the Canadian Medical Association to advocate for more commercialization of health care.

Meanwhile, weeks after neurosurgeon Dr. Phillippe Couillard resigned as the Quebec minister of health, Persistence Capital Partners announced that he had accepted a position as partner. The Montreal firm is, according to its August 18 press release, “Canada’s first private equity fund dedicated to investing in healthcare businesses.”

When publicly questioned about the implications of his hopping from operating room to provincial cabinet to private investment firm, Couillard said, "It's perfectly in line with what I've been advocating for years - a strong public system, well-funded and well-organized." http://www.canada.com/montrealgazette/news/story.html?id=160dd9e1-5407-427e-86e3-6c3d55788825 As his legacy to the well-funded, strong public system, Couillard handed health care investors a gift in Bill 33, which promotes outsourcing to private clinics as a solution to excessive surgical wait times.

Both of these doctors insist that their efforts to commodify medicine demonstrate their devotion to public health care. Some physicians find this disingenuous. Medecins Quebecois pour le regime public issued their response to health care commercialization in Quebec during the August 2008 annual meeting of the CMA in Montreal http://www.medecinspourlacces.ca/position10.php Quebec may be different, but when it comes to health care opportunism in Canada, it is unfortunately not unique.

Randall White, M.D. FRCPC