By Bobbi-Jean MacKinnon

CHARLOTTETOWN – The Canadian Medical Association is sending mixed messages about the future of public health care in Canada.

The group’s executive committee said repeatedly during the four-day annual meeting in Charlottetown this week that access to care should be based on need, not ability to pay.

But delegates elected a private-care practitioner, Dr. Brian Day, as the CMA’s new president-elect.

And while they passed at least one motion acknowledging the “strengths of Canada’s publicly-funded system,” on Wednesday, they defeated motions that would have closed the door on parallel private health care.

“Our board will have to take these back and make some sense out of them,” said Dr. Ruth Collins-Nakai, past-president of the association.

She suggested part of the problem is that some doctors were confusing private-funding and private-delivery.

Publicly-funded private delivery is currently allowed under the federal Health Act, she said. Privately-funded private delivery is not.

Asked how citizens are supposed to make sense of it all if doctors can’t, Collins-Nakai said: “Exactly.

“So we (the CMA board) have to provide some leadership.”

“At the present time, the (CMA) policy is that the reinvestment in the public health care system is still the option of first resort,” she added.

The CMA represents about 62,000 doctors.

But there was an apparent polarization among the several hundred doctors who attended the last day of meetings Wednesday. At one point, debate got so heated, an Ontario doctor accused a group of young doctors pushing to close the door on private care of wasting the general council’s time.

Fredericton-based dermatologist Dr. Dana Hanson rose on a point of personal privilege to chastise the Ontario doctor.

“There’s a broad range – just like the public itself – of opinions that are expressed here at general council. We are a microcosm of Canada,” he told reporters afterward.

“As a group, it’s extremely important that we’re respectful of each others opinions,” said Hanson, who was CMA president in 2002, speaker of the CMA general council from 1999-2001, and president of the New Brunswick Medical Society in 1992-93.

“We may disagree, we may disagree very strongly and feel very strongly about one side or the other, but one must be respectful that others have opinions that they feel very strongly about as well.”

Hanson, a CMA member since 1974, said this isn’t the first time he’s witnessed divisiveness among delegates, pointing to the abortion debate in the 1980s.

But he thinks it boils down to frustration with the status quo not meeting the needs of patients.

“As the system experiences more and more pressure, we continue to see more and more concern expressed by physicians for the care of their patients. I think that’s what’s being reflected here today.”

Dr. André Bernard, outgoing president of the Canadian Federation of Medical Students, who is a resident in Halifax, agrees.

“I think what we’re seeing on the floor of this council is people all working toward the same goal and coming up with different solutions,” said Bernard, whose organization represents about 6,500 medical students.

He disputed any notion of polarization between young and older doctors.

“I think there’s a different experience in the system and different levels of frustration as a consequence of length of exposure, but I think all in all everyone has that passion for a system that serves the needs of Canadians.”

Still, some of the most impassioned pleas for a strengthened public system came from young doctors attending the meeting.

Dr. Ben Hoyt, a fourth-year ear-nose-throat surgical resident in Halifax, and past president of the Canadian Association of Interns and Residents, moved the two anti-private motions the CMA solidly rejected.

One of them was to “urge the governments to recognize that parallel private health insurance for medically necessary physician and hospital services is inconsistent with the principle that access to medical care must be based on need and not ability to pay.”

It was defeated 61-38 with one doctor abstaining.

His other motion on behalf of the group was to “urge governments to oppose new parallel private health insurance systems as a solution for improving wait times for needed medical services,” which was defeated with a vote of 72-28.

“A single mother of three who can’t afford health insurance should not have a lesser quality or a poorer access to health care than myself as a physician, or my neighbour as a lawyer, or anybody else who can afford insurance. We’re all equal,” said Hoyt, who is from Fredericton and plans to return home to practise.

“Health care is a right, not a privilege. We should all have equal access to quality care in Canada. That’s what makes Canada great and we should maintain that system.”

Hoyt, whose group represents about 7,000 interns and residents – more than 10 per cent of the CMA’s membership, expressed frustration with what he described as the CMA’s “inconsistent messaging.”

“I kind of feel like they continue to try and sit on the fence and seem reluctant to express a clear opinion,” he said.

“We’ve heard them say time and again access should be based on need and not ability to pay. That’s exactly the sentiment we feel very strongly about. But at the same time, they continue to pass motions that either support the parallel health insurance options, or refute closing that door.

“To us, those two principles don’t gibe and we’d like to see them express a bit more clarity on the issue.

“We’ll continue to make our message clear to the public so the public has at least some reassurance there are physicians out there who believe in the medicare system and all its merits,” he added.

Dr. Rose Anne Goodine, president of the New Brunswick Medical Society and a family doctor in Woodstock, contends just because delegates didn’t close the debate on private care doesn’t mean they’re in favour of it.

“It just means we need to look at access to services and be openly exploring what options we have.’

Privately-funded, privately-delivered health care is at the far end of the spectrum, stressed Goodine. And there’s lots of options between it and the current publicly-funded system.

“I think it’s wrong to close off your mind about what kind of things we can do to deal with the No. 1 issue, which is making sure our patients have access to care,” she said.

“There’s no point in having a publicly-funded system that is completely funded if there’s no access. If everything is free, but you can’t get it, then what’s the point in having it?”

It’s like going to a store where a sign says everything inside is free, but the shelves are empty, she said. “Are you served very well by that?”