Article content continued

Many Americans still lack health insurance and even insured Americans may not be approved for every treatment. Among developed countries, Germany has the highest public support for its health system but even there, 40 per cent believe the system requires fundamental changes or a complete rebuild.

Does not mean that Canadians are doomed to long waits for elective surgery forever? There is actually much that can be done fairly easily without resorting to private payment. We can address the supply of surgical procedures, the demand for surgery and improve co-ordination within the system to gain significant improvements.

Increasing the supply of surgery can be achieved by paying hospitals using “activity-based funding” payments for each procedure they do rather than receiving an annual budget in the hope they will meet the demand. Re-imagining the way we use hospitals, incorporating new anesthesia techniques and virtual care to transform common procedures like joint replacementcan reduce costs and free up beds to further increase the supply of procedures.

The demand for surgery is also elastic. Removing people who are not in dire need from surgical wait lists improves access for those in greater need. It also prevents the overtreatment of healthy people, which is rampant in many areas of medicine. Thirty-two per cent of patients waiting for cataract surgery in BC had near-perfect vision is one example.

Ironically, the current case before the court — the most pressing legal challenge to the constitutionality of Canadian medicare — is in part about access to arthroscopic knee surgery, a procedure that might actually cause more harm than benefit in some patient groups.