“Capitalism has improved the lives of billions of people—something that’s easy to forget at a time of great economic uncertainty. . . We need a more creative capitalism: an attempt to stretch the reach of market forces so that more companies can benefit from doing work that makes more people better off. We need new ways to bring far more people into the system—capitalism—that has done so much good in the world.”—Bill Gates
Several years ago a critic labelled me “Dr. Profit.” I was asked later whether that offended me. I replied, “Not at all. I prefer that to Dr. Deficit.” The fact is that all Canadian health workers profit from treating sick or injured patients. Across Canada, hospitals depend on financial support from corporate “profiteers” who donate millions from the proceeds of their private enterprises. Likewise, most of the world’s great universities—and medical schools—depend on the generosity of benefactors who fund scholarships and endowments that allow subsidized education for those in need.
A recent “Salon” editorial in the CMAJ epitomized crooked thinking. A senior editor attacked philanthropy (dictionary definition: “the effort or inclination to increase the well-being of humankind”) and equated charitable donations with tax avoidance. If I donate $1,000 and receive a tax receipt, I will still be out of pocket by about $500. Perhaps the writer has never personally donated to a charity, or lacks an understanding of simple tax rules. Editorial staff benefit from the advertising of large pharmaceutical and medical companies, which support staff salaries and benefits. We readers hope and expect that those beneficiaries do not allow this to influence their writing and editing. A similar ethical approach is required of those in higher-learning institutions.
When benefactors supply private funding there is an incentive on the part of the recipient, if they want the practice to continue, to demonstrate that the money received is managed well. Business owners and managers expect results. Government-authorized tax funding is invariably provided without any requirement for performance or quality.
Front-line health workers have seen how those entrusted with management often misuse funds. I recall one big health agency in British Columbia that spent millions of dollars changing its name, only to change it back some years later. Both changes were justified on the basis of “branding.”
Over the past 15 years, shareholders and patients (or their families) of Cambie Surgery Centre (the private care clinic where I work) have donated more than $100 million to the public health system in B.C. I recently attended a fundraising event for a public health foundation that raised $2 million in just one evening. The foundation’s chair, vice-chair, past chair and dinner sponsor had all suffered care access issues that resulted in them seeking help outside the public system. Perhaps their support would be even more effective if it were conditional on system reform.
Critics of Cambie Surgery Centre have accused us of offering the ability for rich Canadians to “queue jump,” arguing that the clinic’s private services undermine the public system. (Exposes the public system’s deficiencies is what they really mean.)
I have a strong belief that monopolies are not good for consumers. An excellent universal system is possible but, as exemplified by the social democracies in Europe, must embrace business principles such as patient-focused funding and rewards for excellence. Competition from private non-government players is accepted there as a challenge. In England, public hospitals, such as the famous Brampton and Royal Marsden Hospitals, generate funding from their non-government work, which they use to deliver better care to the public. In Canada, where there are no full-service private hospitals, our existing public hospitals could expand their hours, create new jobs, and treat more patients with similar revenue-generating activity.
Patient empowerment is a necessary component of improved performance. Hospitals and health authorities need to seek and act upon feedback from patients. In B.C., our health ministry recently established ThinkHealthBC.ca. The health minister described it as “an interactive website to encourage the public’s engagement in an open dialogue about innovations in healthcare and how we together can build a better healthcare system.” The public postings were negative. After several months, the site was abruptly taken down and all content was removed. At charterhealth.ca we have resurrected that approach and reinstituted the ability for “open dialogue” that government promised and then cancelled.
As for philanthropy, let us continue to appreciate all private donations to our educational and health systems. The generosity of philanthropists should be celebrated rather than scorned.
Dr. Brian Day is a Vancouver-based orthopedic surgeon who served as President of the Canadian Medical Association in 2007-08.