The Canadian Bitcoiners Podcast - Bitcoin News With a Canadian Spin - Two Tier Canadian Healthcare w/ Dr. Brian Day and Dr. Mohammad Zarrabian | The CBP

Episode Date: September 25, 2025

FRIENDS AND ENEMIESThis week we welcome two esteemed medical professionals to discuss the state of Canadian healthcare, surgery wait times, the rise in demand for private care options in Canada, and more.A little about our guests:Dr. Brian Day is a prominent Canadian orthopedic surgeon, health researcher, and advocate for reforming the Canadian healthcare system, known for his controversial stance favoring private healthcare options and his legal challenge to B.C.'s Medicare Protection Act, which he ultimately lost. He is the founder of the Cambie Surgery Centre in Vancouver and a former president of the Canadian Medical Association. His advocacy is detailed in his book, "My Fight for Canadian Healthcare," and he remains a significant figure in discussions about healthcare policy in Canada.Dr. Mohammad Zarrabian is the current Head of Spine Surgery at Hamilton Health Sciences. He is a double fellowship-trained spine surgeon, having completed neurosurgical and orthopedic spine surgery fellowships at the Mayo Clinic and Toronto Western Hospital, University of Toronto. Buy Dr. Day's Book Here: https://a.co/d/4bKrBhE____Join us for some QUALITY Bitcoin and economics talk, with a Canadian focus, every Monday at 7 PM EST. From a couple of Canucks who like to talk about how Bitcoin will impact Canada. As always, none of the info is financial advice. Website: ⁠www.CanadianBitcoiners.com⁠Discord: https://discord.com/invite/YgPJVbGCZX A part of the CBP Media Network: ⁠www.twitter.com/CBPMediaNetworkThis show is sponsored by: easyDNS - https://easydns.com EasyDNS is the best spot for Anycast DNS, domain name registrations, web and email services. They are fast, reliable and privacy focused. With DomainSure and EasyMail, you'll sleep soundly knowing your domain, email and information are private and protected. You can even pay for your services with Bitcoin! Apply coupon code 'CBPMEDIA' for 50% off initial purchase Bull Bitcoin - ⁠⁠https://mission.bullbitcoin.com/cbp⁠⁠ The CBP recommends Bull Bitcoin for all your BTC needs. There's never been a quicker, simpler, way to acquire Bitcoin. Use the link above for 25% off fees FOR LIFE, and start stacking today.256Heat -⁠ https://256heat.com/ ⁠ GET PAID TO HEAT YOUR HOUSE with 256 Heat. Whether you're heating your home, garage, office or rental, use a 256Heat unit and get paid MORE BITCOIN than it costs to run the unit. Book a call with a hashrate heating consultant today.The Canadian Bitcoin Conference - https://canadianbitcoinconf.com/The PREMIER Bitcoin Conference, held annually in the great white North, where Bitcoiners come together to share stories, build momentum and have a great time while doing so. Whether your a pleb, business, newcomer or OG, the Canadian Bitcoin Conference wants to see you in Montreal, October 16-18 2025. Don't miss this one!

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the guys some value boost them with some stats bitcoin is the scarcity acid i mean it's just a fact geopolitical national down to the local friends and enemies welcome back the canadian bitcoiners podcast here tonight on a wednesday i am holding down the fort with two esteemed highly credentialed professionals. We don't have a lot of credentialed people on the show. In fact, it feels as I mean like we've made a point of not having credentialed people on the show over the years. But, you know, the older I get, and now that I have a young one at home and having recently gone through some health care stuff of my own with my ACL tear and some other stuff over the years we talked about on the program, I am thinking more and more about health care in Canada.

And, you know, if you've listened to money talks, Mike Campbell or other places where you might might have heard Dr. Day, or even listen to me talk about it on the program. Health care is free in theory only. This is sort of an academic exercise a lot of the time more than anything else. And I say that because when you need health care, especially if something is acutely wrong, you may find yourself in a position where you are not getting the health care that at a very base level you've paid for and at an even more base level you need to survive. And it's unfortunate, but everyone will wind up in that system at some point you or your loved ones.

So it's important we talk about the direction Canadian health care is going. We've seen a huge influx in population, huge influx in a huge change, I should say, in demographics. We obviously have the baby boomers who are aging now into their years of need, we'll call them. And do we have the tools in the current system to provide for everybody? I think not. I suspect my guests are going to agree. And we'll be talking to Dr. Brian Day and Dr. Mohamed Zerabian today about these and other issues in Canadian healthcare.

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We find ourselves well capitalized and looking to make positive changes in our communities in our lives. So go to the Bitcoin conference, get a ticket. And then 256 heat. As I always say, you can't hear my Bitcoin miner running, but it's running right over there. Hashing, heating. It's doing all these things. If you need a space heated, you want to heat your garage, you want to heat a greenhouse,

you want to heat your pool, you want to heat a, I don't know, if you have an airplane hangar, maybe you picked one up on Zillow when things were a little hot in the market. Our guy, Twan, a 256 heat, will help you with that and set you up with something that makes sense. So go to 256heat.com. Tell them we sent you and get set up. My esteemed guess, I was going to say my esteemed colleagues, you guys are colleagues. I'm just kind of tagging along. I appreciate both of you making time tonight. I want to start with some brief introductions. Today, I've been on Money Talk. a few times and my guests will know that you've also been on that show you know they

might know a little bit of your background some of the legal battles you've had and continue to have but give people just a quick um a quick overview of who brian day is well um in terms of my profession i'm an orthopedic surgeon uh that's my primary role um i'm also um parent of six i have six kids So I'm very concerned about the future for them. I mean, they're not kids anymore. They're all young adults. And, you know, I started off practicing a long time ago. And I'm still working and still doing surgeries.

The big issue is being able to treat patients now. When I started practice, everything, you know, it's a long. time ago, but Medicare, which we call it in Canada, the health system, if you can call it, system was working okay. It's not working okay today. You know, you just have to pick up the newspaper or listen to any media outlet on the crisis that's national now, not just quotes elective surgeries, but emergencies, family physician visits. They're all. and they're all in trouble and patients are in trouble and the government has promised health care it's not delivering it and it's also made it unlawful for you to do anything about it unless you

leave leave home yeah it's it's really a sad state of affairs i want to get into all that as well dr arabian sir a little bit of background on you if you don't mind uh yeah i'm much like dr brian day i'm an orthopedic surgeon my uh sub-speciality focus is exclusively on the spine and I'm currently the head of the spine surgery program at Hamilton Health Sciences but prior to that I was a chiropractor did that before I did medicine and I was actually at University of Manitoba there as part of the orthopedic surgery training program for seven years before I got recruited down here so you guys have both quite storied history story pass I think maybe we

should start for the viewers with you know Dr. Day you touched on it there the current state of health care in Canada, you guys are both surgeons, you deal with what I would call acute injuries. It seems to me that the people who speak the most positively about health care in Canada will say that while it's not perfect, you won't die of an acute injury necessarily because there's available treatments and thanks to ER business, things like this. You can get those treatments fairly quickly. Now, you may not get specialist referrals or things of this nature. But as far as the work you guys do, Most proponents would say that this is readily available and the system is working okay.

I think as you put it, Dr. Day, like it was in the past. In your view, we'll start with you, Dr. Day, the issues that we're seeing now, what are they? And when did they become prevalent enough that the average person might discuss this over Thanksgiving dinner, let's say? Well, I think it's, you know, I think that urgent things is. are not being treated well now. What we're doing is we're delaying access to all kinds of health care now, that people are being turned away from emergency departments. Ambulances are, you know, basically lining up to get patients into the emergencies,

the emergency departments of closing. And we know that patients die when they go home, sometimes some of them die and there are many tragic stories but but overall i think the the big issue is that we have a very dysfunctional organization or disorganization would be a better word in this government-run monopoly i think few Canadians understand that we live in the only country on the planet earth where it's illegal to for example obtain private health insurance it's illegal that that laws like that don't exist in all of the authoritarian countries in the communist countries and yet they they occur in canada and this is a this is a bizarre situation and it's all

well and good that for the government can promise you health care and Then they fail to deliver it, and then they make it unlawful for you to do anything about that. That just, in a free and democratic society, that's not right. I find that very bizarre as well. Dr. Zrabian, you have some experience in private surgery. I know we've spoken offline a bit about some of the things that you've championed and are trying to pioneer in more than one province. You know, what is your experience with sort of the differences between what you might see in a public, versus a private setting.

Oh, yeah. So the first experience I had with private was I got a private surgical center in Winnipeg when I was there, certified for outpatient spine surgery. And it was interesting because oftentimes I'd work with the same people that had worked in the public system, but they might be surly or unhappy working in the public system and they were happy to show up on a Saturday and work. Like they didn't have a problem with that. There was a, they were incentivized to do so.

that's probably one of the benefits of a free market, that there's flexibility and the pricing that you can adjust to try to make supply and demand to come to an equilibrium point where there's satisfaction on both sides. So there is that. There are some drawbacks. I mean, certainly there's been some academic papers looking at this, and there is no perfect system. I spent one of my fellowships in the USA at the Mayo Clinic, and it's a world-renowned institution, but I could see how, you know, some aspects and characteristics of private care do alter the way you deliver health care. But overall, yeah, I would say that there's a benefit to blended model.

And then on Ontario side, yeah, I just, I came here two years ago, but I just did the first outpatient and private spinal fusion just actually Monday, just two days ago. And we started that program with simple decompressions probably about four months ago. So when I hear you guys talk about the sort of issues, I hear two things, really. One, that the public is not the beneficiary necessarily of public care at all times, you know, in all situations. There is a benefit to having a blended model. And I also hear that there's a problem with incentives right now. What are the incentives to keep the model as is?

Most people, I think, whether they're my age. or older or new parents or whatever would probably have some issue with the standard of care they're receiving compared to other OECD countries, for example, or other developed democracies, like you mentioned Dr. Day. What is the incentive to keep the system the same? Because it seems to me like everyone wants a change, but here we are 2025. There's still, you know, 12, 15-hour weights in the ER. What is the issue here? Well, the issue is mismanagement. I mean, you know, we have a state monopoly in terms of so-called medically necessary care. And I can't think of any monopoly that serves the consumer of that service.

Well, by definition, monopoly doesn't have to. In Canada, we have this government-run monopoly that puts patients less in terms of a public hospital in Canada, we are unique in the OECD in completely funding our public hospitals with block funding or global budgets. So if a large hospital Ontario is given a budget each year of $5 billion, for example, every patient that goes to the hospital, whether it's emergency, whether it's to be admitted for surgery, is perceived as consuming up the organization's funding. And, you know, it's a bizarre funding system that nobody else has.

So that if I made, you know, if I were the chief financial officer of a public hospital in Canada, the last thing I would want is patients because they're going to use up my money. I mean, that's that you end up to end up. of the year with the successful, successfully in the black, you have to treat no patients. And whereas even in countries like, well, in socialist countries like Sweden and Britain and that a patient that goes to a public hospital is the state, the public insurance system pays a fee to that hospital so that a chief financial officer in those countries wants patients because they bring revenue.

And so that alone is probably the single biggest thing we could change. But the trouble now is that we've let the wait lists get so large, like millions and millions waiting, that there's a massive unfunded liability there. So that if you suddenly change the system, governments have let, you know, have allowed this massive backlog and it would be very difficult to, very difficult to change. And we, so that's, that's probably the biggest single issue that's nothing to do with private or public. That's just to do with how we fund the public system. And, and, you know, the last rankings of, I just saw a recent graph of the top 20 best. health systems in the world. Well, Canada wasn't in the top 20 and yet we're in the top

two or three. I mean, the United States is the most expensive and I agree with Mohammed that I was lived in and worked in the USA for six months only. But but and there are problems with it. But let's face it, guess where, guess where's Canadian politicians when they're really, really sick. They go to the Mayo Clinic or the Campbell Clinic or one of those institutions. And the biggest problem we have now with the emergency backups is that millions and millions of Canadians can't get access to a family doctor. So people are going to the emergency department when they, because the patients don't self-can't self-diagnose, they don't know whether it's urgent. or not. And these are all, but it's government policy. The Canadian governments in the

90s closed nursing schools and across the country, they closed the nursing schools that were independent, attached to hospitals. They cut back medical schools by up to 30% in some provinces. And, you know, we now, guess what? Now we have a shortage of doctors. And this, This was self-created. When I arrived in Canada, we were second in the world in doctors per population. According to a group called Index Monday, who studied this stuff and rank, we're now in the 70s, you know, worse than 70th in doctors per population. That is because of government policy, not because of doctors don't want to work or come here.

We have over 3,500 young Canadians going to foreign medical schools, and they're nearly all very well qualified because they can't get a position in Canada. And I'd say the issues are all multifactorial, but they can be fixed. It's just that we need politicians with enough courage to accept that something that worked in the 60s when, you know, there were no major, no complex surgeries, no robotic surgeries, no stem cell therapies, hardly any medications that were expensive, medications were cheap. and we didn't do heart transplants and lung transplants and yeah it was it worked then to have a government system but it's not working today and we need to do what you do in any situation what you would do and I use the sports analogy if you were the coach of a hockey or soccer team and your team was at the bottom of a league of 15 20 teams and you were spent depending more than the teams at the top three or four,

wouldn't you look at what they're doing differently from you? I don't know. Have you seen the Leafs last 10, 15 years? I mean, things are not. I mean, kidding aside. Okay, Mo, you trained over in the States for a bit. You worked overseas for over in the States for a bit. Like, Dr. Day has made a good point there.

Why would you come back? Like, as you mentioned there, it's like people are surly. They don't want to work in public. It sounds like there's a lot of strain. And so, like, you're, you're sending, you know, what did you say, Dr. Day, 3,500 medical sort of students and training. And so why did you, I mean, not to point a finger at your decision making here, but why did you come back? What was the, my wife who's American does ask me that. She's like, why.

She's from California. I'm from California, and I dragged her to Winnipeg for seven years. And she didn't stab me at any point, so I guess she loves me. But, I mean, there's good, again, there's advantages and disadvantage to you. system. And the American system, it's more of a consumer model. You see the insurance bill. You see your co-pay. You are buying a service. And if you're not happy with that service, you're more liable to sue. There are more lawyers around. That's why liability insurance is higher in the USA. It's just different. It doesn't mean that it's bad, but there's a certain

personality that will go into that and thrive in certain environments. It just depends on what you want. For me, my family is back in Canada. I'm more familiar with the Canadian system. But I am different in that I do see flaws in the single provider socialist system that we have because it doesn't, it's not really sensitive to market structure. It's not forced to innovate per se. I mean, I could, two examples I can think of. The reason I set up that private surgical system in Winnipeg was that you got paid so much to do fusions that these, less complex day surgeries, which is what most of the injured workers needed, would just fall by the wayside.

And they wouldn't be seen for like two to three years. And when I found out that there was this big old backlog of these simple cases, I reached out to the provincial injured worker system, which is WCB, and I just said, you guys want to establish something. And it was immediate because they had some of the worst spine outcomes in the country. But because you had a single provider, you didn't have the flexibility in the system to provide it, you know, you had all these able-bodied people that were just sitting at home collecting checks. And they actually wanted to go to, I remember two of them wanted to go to work.

This was what kicked it off, two firefighters, and they just had to wait a year and half to see someone to say, yeah, you can go back to work. But nobody cared. There's no flexibility in the system. There's no market incentive or structure. So that speaks to the fact that there is a role for private care. And by the time we were done, you could actually, like, if you had a discreination in Manitoba, probably still, you could probably get it diagnosed, treated and as long as you were a surgical candidate have the operation within two months like that still stands you know and during COVID where everything was shutting down because we had this private surgical center that could not be

an ICU we were still we were still doing injured workers we were still doing discectomies decompressions all that stuff again you had this flexibility in the system that when challenged they were better like as spine was better able to handle the challenges of COVID because you had that public-private model there. So I think Mohamed would agree with me that this, the Canadians do tend to and focus on the US versus Canada. And let's face it, there are close to 195 or six countries in the world to look at other

than the United States. And I lived and worked in Switzerland. And interestingly, their system is mostly private. private, mostly private hospitals, mostly private insurance. The role of the government there is that if you're old, what the government does is if you can't afford the premiums, they pay the premiums for you. So you can have universal health care without the state being the sole provider or the sole funder. So a low-income person in Switzerland has the premiums for private health insurance paid by the state.

And they get to go to the same private hospital and get the same private room and the same excellent care as everyone. So what Canadians tend to do, and this has actually been a strategy of those opposed to any change to the system, is compare us only to the United States. Well, we all agree at its best U.S. healthcare is up there as, you know, as I say, it's where a lot of people go when they're really ill, and you can't argue with the fact that they have some of the best health providers and hospitals in the world. But it's not the, it's not, it's a Canadian habit in, in,

when we're talking about this, to focus on them. I also was in Belgium for some time, and similarly, they have a mixed system. These countries don't all have the same system, but the Dutch and the Australians, they also subsidized private health insurance premiums for low-income groups. So that rich versus poor thing gets,

that's put down by, the fact that there's nothing to stop the state, the government, the province, or the federal government, for that matter, from paying the premiums to allow low-income groups to get the same. And they do it now at the extreme on welfare patients. They get dentistry and hospital and physiotherapy and pharmaceuticals. I mean, we are unique in the OECD in terms of. have our public system paying for the diagnosis of an infection, but not paying for its treatment. You know, if someone scratches their spine in the ambulance to take them to the hospital is not covered

because it's not considered necessary. You're supposed to, you know, be carried there by the passers by, I don't know, but it's nonsense that we don't cover dentistry. You know, I would say a little, a little abscess in a big toe that stops you, you know, running a marathon is covered. But an abscess in a posterior wisdom tooth that might penetrate through to the brain and cause an abscess is not covered. You know, you have to pay for that. So these are bizarre situations. And we all know, this is all part of the rationing on which Canadian health system is

operates. I want to talk a bit about the rationing. And I want to point out that Dr. Day, you're maybe the most polite guest I've ever heard. On this show, we have a lot of people saying a lot of things. If everyone wants to go back during this interview and just replace every time Dr. Day says we're unique among the OECD or we're different, just replace those words with like worse or stupid or whatever. Because it seems to me like that's what we're doing. We're making obvious mistakes, things that are clearly causing issues. The Wisdom Tooth one is a perfect example.

And I will say to you that in the same six months, same year, same year. year, when I was in grade 12, I had an ingrownail and a wizzen tooth impaction. And that ingrown toenail was taken care of in two hours at the ER. And that wisdom tooth, my father, God bless him, you know, had to take me to dentist and pay for it. And there was medication afterwards, as you mentioned there. One obviously more dangerous than the other. And yet only one is covered.

Now, this calculation about cost and rationing is one that's interesting. And it's one that I think has got the attention of Canadians, especially as more and more Canadians have become cottage industry budget observers. They're looking at things like health care costs and defense costs and what it costs for, you know, whatever the flavor de jour is, right? What is immigration costing this year? How many people are using food banks? What's that costing?

What does education cost? How are the test results? Things like this. What are we getting for the money? Healthcare is a huge expense in any province. The question that I think a lot of people have right now is if we decide to go, this route where everything is paid for. You have this private option that's subsidized or you increase funding for public so that

there's no wait list and what is the cost to the country, short term, long term, and is it worth that cost? I think you made a good point earlier that things you leave untreated, you know, clearly will become more expensive, but help the listeners understand what it is and how important this is to really understand that waiting for treatment because of this rationing. is costing us like just an infinitely greater amount of money in the long term than it would to just treat these things some other way, whether it's two-tier, increasing funding for the public tier.

What is the gap here in understanding? Well, I think one thing is patients die on weightless and that saves the government money. I mean, that's a cynical thing to say. That's true. Tens of thousands of Canadians have died over the last few years not being treated. And, you know, that that saves the government money. But on the other hand, the biggest thing to me is that governments operate in, Democratic governments operate in three to four years financial cycles.

So they don't plan long term. And we know that in the long term, it's much cheaper to treat people quickly. If you allow someone to become a chronic chronically ill, and this applies both in urgent and emergencies as well as in quotes, scheduled surgeries, that if you delay the treatment in orthopedics, people lose their conditioning and strength and they end up taking longer. But, you know, one example is I gave as how I used to do a lot of, you know, in the early days of my practice, patients with a hip fracture, elderly patients with a hip fracture would be treated, you know, as soon as they were fit for surgery, they were operating on right away. And I remember one weekend at Vancouver General Hospital, back to back,

I operated on 12 fractured hips. On the other hand, to give a personal example, my mother-in-law, she's dead now, but when she was in her late 70s, early 80s, I mean, she was an active 80-year-old skiing, water skiing at 80, but she tripped and broke her hip. They admitted it to the local hospital in Victoria where they, this was, maybe seven or eight years ago and they lay her in a bed and for 48 hours she was just waiting for an OR to open up she developed pneumonia she then that was treated and basically it took three weeks before she was fit for surgery and she never got back to you know she by that time

she lost conditioning and strength and so on so she never got back she became for the next seven or eight years a burden on her family and society, whereas she was previously skiing. And that is what happens when, you know, 20 years earlier, she would have had a hip fracture treated within a few hours of admission and gone home probably in a week or two. That's that, that, that, and the point being that seven or eight years of chronic illness cost society much more, even in, not only in her suffering and personal for her, it costs society in dollars. So, but it's, you know, it's long-term costs. And we know that it's better to treat people quickly and get them back to work. And that's why workers' compensation

wants to, you know, will pay for private health care because they know that their response for patients for the rest, if they have a work injury, they're responsible in perpetuity for that patient's health costs for that particular disease or injury. And they want to treat people quickly because they know the data shows people who are treated quickly cost less in the long term. Yeah, the only thing I'd add to that is

you were asking about what it would take not to have any weightless across the board. And I don't think that's really possible. really possible. The way I look at a lot of this stuff is that my first degree is actually in economics, and although I'm not an economist, it has shaped the way I look at the world and how products and services are delivered. And basically, there's an infinite demand for healthcare. You just, someone who's got a sore throat or a heart attack, they don't know the difference. Arm pain, arm numbness, is it a disc herniation? They will show up to the ER. And there

is an increasingly complex and expensive set of treatments that you could try that won't necessarily work for everyone so it becomes a game of how do you allot the resources and for when facing infinite demand in a finite fashion to maximize utility and what's beautiful about the free market to some degree and i don't think it's free market unfettered because you have problems with that but it's free market with rules is that you have this natural float and um intersection between the demand of supply around a certain price point where the people that are paying for that service are happy with the amount of money they paid in terms of the utility they got out of it and the people that are supplying that service are happy in terms of the number of hours they didn't spend sleeping or

leisure or what have you and you don't have to calculate it it's just it's kind of automatic and that's the beauty point the problem with communism i keep going back well not i keep going keep going back with my wife because she actually graduated from Berkeley and she's she's the one person oh really oh that's no she is the only person I have ever seen go to Cuba and still say you know communism could work well you know I'm an honorary member of the Cuban Orthopedic Association oh really yeah nice I sat I sat next to Fidel for nine hours on the same actually not we're on the same two-man sofa And, you know, it's another topic completely, but believe it or not.

His son is an orthopedic surgeon. I don't know if you knew that, Tony, Tony Castro. And Fidel was not a communist. I mean, that's, you know, that's bizarre. He was forced into communism because the United States were going to put an embargo and, you know, they didn't want, Castro, and the only country in the world that would trade with them and was not afraid of the United States embargo.

In other words, they would ship things right there with the Soviet Union, and the condition was he embraces Soviet policies, and he had no choice. So, yeah, but I say the Cuba thing reminds me of how health care can actually be a revenue, generator for governments because in Cuba they have public hospitals and this happens in other countries, it happens in Britain, where they open the public hospitals in Cuba, this is a communist country, so-called, and treat non-residents. And those non-residents bring in massive revenue at the, you know, at the level of Cuba. And they use quotes the profits to improve to buy equipment and improve the situation for Cuban citizens.

And the British do that, the London hospitals alone in England, generate 600 million pounds a year treating foreigners, and they use that money to enhance the public. These are public hospitals to enhance the public system. So it is, this field of medical tourism is something, I think the 2 million Americans go abroad every year and pay for surgery and not come to the biggest trading partner, Canada, because of our system. Whereas we could be, we could be a massive center for medical tourism. Instead, we have the bizarre situation of over 200,000 Canadians go down to the U.S.

None of this makes economic sense. Yeah, it doesn't. Actually, I've looked at the numbers because I started that spine program in Toronto where we have up to 72 hours of inpatient care. And we are really cost competitive with USA. And I think eventually at some point, I'm hoping when I'm looking at the numbers and we get the system up and running, it's smoother and more efficient, I don't see any reason why Americans actually wouldn't come to Canada. It's way cheaper. The other thing in terms of our manpower situation with physicians, Canada is also unique in, well, not unique, but it's one of the rare countries where only state medical schools exist. So other countries, the United States has 57 private medical schools, and one of the things I've put forward is if the government doesn't want to train doctors and build a medical school,

schools um we should allow private um they can be private non-profit and medical schools to exist in canada and let the private sector train medical students i mean when we look at the united states and the 57 private medical schools include places like harvard yale columbia stanford these are not second-rate these are not second-rate medical schools and and if the public If the government doesn't want to train doctors because they generate, they treat patients and that costs money, let the private sector, even when I say private, doesn't have to be private for profit, it can be private non-profit. Private nonprofits still have to make a profit because they have to stay in the black. So let them, let's open Harvard and Yale type centers in Canada.

that we could do it. There's some threads I want to pull on there from both of you guys. And I want to get to what might upset some of the listeners. Sorry, Joe, before I forget, I actually, it's probably because I'm drinking beer and it's an IPA, but at some point, Dr. Day, I really would like to hear about you and Castro on a love seat. That is, that's the, that's the after hours podcast. You got to pay for that.

That's Patreon only. Yeah, no, I'm, it's, Cuba's interesting country, but I always, I always, I'm, I'm, I fascinated by interesting stories like that. I would love to hear about that, too. The thing I want to ask you guys about is this, like the elephant in the room for people who don't know is that there was a ruling in the early odds in Quebec about what a Quebecer can do in terms of seeking private care, the relationship to wait times, who sets a reasonable wait time, all these things. And Dr. Day, you might be the best guy to ask about this. Talk to me about that, was it four or five? 2005, yeah.

We were interveners in that case, and this was, it lost, like our legal challenge, and we expected it to lose at the two levels of provincial courts, which is the Supreme Court or Superior Court in Quebec, and then the Appeal Court. And both of them wanted, both courts in Quebec wanted to defer to the Supreme Court of Canada because they, you know, the judges were afraid of this big decision. And the Supreme Court, the Supreme Court of Canada granted Quebecers the right to purchase private health insurance saying that it was, you know, the Supreme Court of Canada came out with statements like patients are suffering and dying on weightless, and there's no evidence

that allowing the private sector will harm them. In our case, you know, the court, obviously the individuals had changed almost 20 years later, and they refused to even hear the case. And, you know, that's somewhat, to me and to many judges, that was a cowardly act that they refused to even hear it. And the reason is, just like the highest court in the United States, our Supreme Court of Canada has now become politicized and, you know, they presumably did not want to offend their employer, which is the government. And, you know, this is a reality, you know,

that judges are no longer as independent as they used to be. And we see it now in the U.S. that the judges have become politicized of the highest levels too. But the Chowley decision legalized private health insurance in Quebec. On the other hand, the government of Quebec did not abide by the decision. They kind of went to the Charlie case was about an individual where they basically discussed hip and knee replacements as exactly. samples and cataracts and what happened is in Quebec they legalize the government legalize private health insurance for cataracts and for hip and knee replacements well no one's going to

you know no insurance company there's no market for that none of us would buy a premium an insurance policy to cover us for cataracts and hip and knee replacements I mean it just so obviously it didn't take off it didn't take off or and so private health insurance is still not available in Quebec and I was told and by you know various individuals that that was that was a government directive based on the fact that the public sector trade unions had told the Quebec government that if they introduced if they it oh no they said the public sector unions said to insurance companies if you introduce private insurance we'll take away all of our benefit programs from you and just it didn't make economic sense to risk to

to to risk that so in fact um there there is in practice no private health insurance in Quebec either and the you know the bizarre thing though which we i know you you both know about but the public don't may not realize is once you cross the provincial border in Canada you are in a different world as far as health care is concerned so and i give the i i i albertans often and actually people patients from ontario even come to our center and albertans come to vancouver to to our center and we can operate on them because they have rights they have rights in our province that the citizens of our province don't have and you know i kind of joke what how really we're How would you feel if someone, if you're in Ontario, if a Manitoban could, or a Quebec could cross the border and go through red traffic lights and shoot people because the laws don't apply to them, they only apply to people in your province.

So this is all, the whole thing should be written up as a Monty Python show. With a shuttle bus between provinces. shuttling patients on stretches to the next province to get treatment when they when they need it, not when the government says they can have it. Yeah. It's, you know, there's a lot of interesting touch points. I want to finish with two questions. And the first one probably a little more hot than the last one.

But the question I have, and you kind of touched on it there in Quebec, Dr. Day, who is paying for the opposition to these, you know, what seems to be clear common sense reforms to the health care system, whether you know, you do it incrementally or you try and enact some kind of comprehensive reform, you know, maybe more difficult. But it seems to me like with this much momentum, there's money behind the people who want to keep this in place. You mentioned the public sector unions in Quebec. Obviously, the public sector unions federally and provincially, you know, municipally. They're significant players. Who else is backing the status quo to the best of your knowledge? The bureaucracy.

So, you know, I had a visitor from Germany, a visiting orthopedic surgeon a few months ago, three or four months ago. And, you know, just as an aside, I jokingly said to him, because I know in Germany they have 90% public system and 10% private. And it's compulsory to, to, anyway, that's the. ratio. And I said to him, oh, what about how does it work in the public system? What are the weight list like for, say, a hip or knee replacement compared to the private system? And Alex says to me, this German orthopedic system, it's quite a long weight in the public system for a hip or knee replacement compared to the private system. I said, well, how long is it in the public system? He said, oh, it could be three or four weeks. And only one.

week in the private system now one of the and just in going back to your question one of the other proponents of the status quo is the fact and this is another statistic Canada has compared to the public system in Germany that every public health bureaucrat that Germany has Canada has 11 oh so these individuals don't want to use their jobs And, you know, we see, I used to have a thing, like, years ago, I spoke to all the hospital administrators. I was, for some reason, they invited me to speak. And, you know, I had one of my slides was, why does Vancouver General Hospital need nine vice presidents when the United States can get by with one? And they changed the titles of eight of them to corporate directors.

but now 20 years later they've forgotten that and now they have 13 vice presidents at one hospital and they all earn over half a million dollars a year you know and so this is where the money is going we have a very you know people talk about the high administrative costs in in the United States compared to Canada which they are so so one of the studies that was presented to the Canadian Medical Association by Dr. Barry Tuch and he did this on freedom of information requests that he compared the Canadian and administrative costs in British Columbia to Medicare costs in the United States and we would three times the three times the administrative costs of Medicare in the US which is a similar type of program for

low-income groups there. So yes, the US system is expensive, but a lot of it, as Mohammed was referring to, is not, it's just massive malpractice suit cases. And then they have, you know, you can't, if you go to, I was in LA County, which would be like Detroit, the hospital in Detroit with gunshot wounds and assaults and robbery, you can't blame the health system for some of the, for all of those costs, all at the cost of the U.S. is just, that's why I don't think we should be looking to compare Canada and the U.S. The last time the World Health Organization ranked health systems, and it was on multifactorial things, Canada was ranked 30th, and the U.S. was ranked 37.

So why would we be looking, going back to the sports analogy, you wouldn't be looking at the team that was ranked seven below you and copying them? Now, that was just on, but just reiterating, at its best, the U.S. health system is amazingly good. But I think that, I think there are lots of things. We know, just going back to the question, we have government established maximum acceptable safe benchmarks in every province, for every procedure and every illness. it's the maximum time beyond which patients are likely to suffer you try and get that data from a government and you won't we tried it our trial and ended up having to subpoena a government witness to get the data we had the data only for 2017 they won't release any more data hold on hold on there's accepted guidelines province to province and you can't they're opaque you can't get them no well we go They stopped them by... But they're not public-based.

Wow. The government refused to release them voluntarily. We subpoenaed the data for 2017. And to give you just one dramatic example, this is how specific they are. Bladder cancer, this is one example. Bladder cancer with a high risk of progression, 16% of British Columbians were being.

treated in the maximum acceptable safe time and those are the so even cancers are not being treated in a in a safe time we have that data they have the data in Ontario they have that data in in Manitoba and Alberta but the government won't release the true data they they actually put out fake fake news we had one witness in our trial the president of the BC Children's Hospital We're talking about little kids here, who admitted on the stand where she could, you know, would be perjury to lie. We found out, talking to the doctors that worked at the Children's Hospital, that the administrative staff were instructed to change the dates on the booking sheets. Oh, my God.

This looked shorter than they were. That is unbelievable. You'd expect this happened in the Soviet Union, but not in modern-day Canada. No shit, that is nuts. How do people not know about that? Well, I think part of it is the Canadian identity is really tied into not being American, which is a little unfortunate. I think trying to define yourself as not being someone else is a little sad.

I think there's a lot in Canada to be proud about. And as Dr. Day was saying, there are so many other models. models that you look. We accept, don't you agree. Canadians tend to be passive in accepting government control. You know, so I gave it, I was invited to give an address to a hundred, to a health leaders group in Budapest about three or four years ago. Great city.

Because they didn't believe the Canadian system could be like it was. Afterwards, I gave my talk. There were 150 countries represented. Afterwards, the delegation from Beijing, China came up to me, and the leader was in his 30s, 35 or so, fluent in English. He has a PhD from Stanford. And he says, you know, there are 100,000 protesters in,

I was a bit freaked out when he says 100,000 protesters in Tiananmen Square. if the Chinese government tried to outlaw private health care and private insurance, there would be 100 million protesters because we don't believe the government should, in our culture, the government should not have control of your body. Yeah. And I, you know, that was, I then Googled private hospitals in China just out of interest, because I didn't know this. And 52% of all hospitals in China are private.

Incredible. China has 52% private. It's like, it's almost unbelievable to even see. say it, that there's countries that, you know, we are, you know, I hate to say it, we're spoon-fed these lies with some frequency, you know, this is something you got to be aware of. China's a dictatorship and the states is not a good place. Like, there's always more of the story. And I think Canadians, you know, we see this in Bitcoin a lot. You guys are not specifically Bitcoiners or Bitcoin adjacent. But the big thing that we deal with on a regular basis is things like

CPI, you know, how many people at your Thanksgiving table know that, you know, that, you the CPI data measures you know 70 30 ground chuck now we're in the 80s it measured Porterhouse stakes like nobody knows that right and so these things change all the time these adonic adjustments whether it's for health care or weight times or

it's just it's non-stop and I don't know you both touch on it there's a willingness here to naively accept control everything is handed to you you just stand on the treadmill and the treadmill goes it's a difficult situation

to be in. There's also, you know, Canadians identify with a socialized healthcare system and it's really weird, but to some extent, they're willing to accept some misery as long as everyone is miserable along with them. But they don't realize that it's actually, I mean, the name of this podcast is two tiered, but it's more than that. It's probably three or four tiered. Dr. Day was saying a politician's not going to stick around for the Canadian health care system if there's something really bad. Someone who's wealthy is not. Yeah. If you're an NHL player, you know, I, I would see them when I was in Winnipeg, and they're, you know, they're going to go fly down to USA to have the discectomies.

If my secretary's mom has a problem, they're not going to wait a year or two years. It's probably, it's very difficult to say no to your secretary. Yeah. They're already multiple peers. And then beyond that, there's this whole business. I don't know how many of the flights and seats that Air Canada sells is for patients flying from province to province, but there's a lot of this happening. Really?

People in Toronto, yeah, people, I mean, I know. I mean, I started doing private where patients flew in from outside of the province in probably 2021 with things slowed down a little bit. But now it's really picking up across the country. There are private surgical centers, and I know that there are Ontarians that are flying out to Montreal to have hip and knees done. I know there are Ontarians that have flown out, you know, my weight list is six and nine months. If they want to get it done sooner, then they're going to fly out to

Winnipeg or somewhere else to get it done more quickly. It's happening. They just don't know about it. And so it's one other thing that it's already occurring in the background. Yeah. There's one other thing that we haven't discussed, but it's what a lot of countries do too. Their public system offers a care guarantee so that if you are waiting, this is one of the reasons the government doesn't want to release the data on the maximum acceptable safe time. But if you, exceed that maximum acceptable safe time that the government itself has said is safe they are the government is forced to pay for you to have treatment elsewhere even if that's in another province

or the private clinic in the United States whether you're saying yeah that's that's the way that's a care guarantee and lots of countries in around the world have that and and it's another incentive. But I think, you know, the care guarantee and money following the patient, in other words, and the block funding, those are two things that could be done without, in fact, without changing the public system. But it would, the problem is, and we've let the, we've let the numbers get so large that the government doesn't want to spend the money. Yeah. It's funny. Yeah. There's money. And no, totally. And it's funny. You guys are both mentioning it there, this sort of multiple tier thing. That was going to be my last question,

but I'll pivot to something else. The multiple tier thing is interesting. And I've said this on the show before. Having just gone through my ACL experience, I did this, you know, when I was 23 on my other knee, maybe so 15, 16 years ago. And that experience was a lot different. When I didn't really know anyone, didn't have any disposable income, didn't have any capital, no connections, nothing like that. That was a two-year process. It was, you know, waiting six months for the MRI, you know, a few weeks for the diagnosis, got to go back. to your GP. That takes a month or two. Then you go through your referral system. You get a referral for a surgery. Then finally you get the surgery done. Isn't that crazy? And so now this time,

you know, I had some of those connections and, you know, cash in some chips. And I went from injury to the table in four weeks. And for people who don't understand that there's more going on here than just two tiers, you know, Mo, you had it exactly right. There's blended options for people who have time, resources, and understanding of how these things work. If you can skip the imaging bottleneck, for example, you're in a better spot. If you can pay the fixed surgery price in somewhere like Buffalo or go to a medical school somewhere in the States, you know, if that 20 grand for an ACL replacement is worth a year and a half of your time, especially if you're a younger guy, you go.

That's where the free market, the free market automatically adjusts for that. The free market has its problems, but that's one of the advantages. You don't need someone calculating the demand versus supply. it just naturally gravitates the collier brain point. Yeah, it's 100% true. So I'll ask you guys this. First of all, I want to thank you both. You've been very generous with your time.

I know everyone is busy these days, and this has been a very good discussion. A little off the beaten path for this show, but I think it's important. What, in your view, you know, you don't have to spend 15 minutes on this because I know we're running a little long. What is the system supposed to look like? How should this look? We have public option, some private stuff mixed in. We talked about dental and talked about a few other things. How should this look for the average person?

Dr. Dale, I'll start with you. What should people be after here as an ideal sort of set up? Well, I think as far as the public system is concerned, the two things that need to happen is to end the block funding, so make patients, hospitals and clinics and centers wanting patients, and then a care guarantee, and then solve the doctor and the nurse shortage, which, you know, easily, unfortunately,

And, you know, it'll take that to generate increased medical schools from within. It's going to take a while. But there's nothing to stop us from enticing those 3,500 Canadians back to Canada. The trouble is a lot of them, probably the majority of them, you know, you're in your early 20s and you go to Australia or Ireland and you might meet an Australian or an Irish man or woman. And they never come back. Well over half of them don't come back. Those are very seductive accents.

Seductive accents, both of those. Yeah. So there are lots of things to be done. And we can entice the nurses back. You know, as you probably know, 2,000 nurses commute from Ontario down to the United States every day. I did not know that. That's an insane number.

And the reason is, contrary to what governments say, you know, oh, there's a nursing shortage, if you look at OECD data, we actually have a higher than average number of nurses in Canada, but they aren't being offered full-time work or benefits. They're there when the hospital wants them, so they only, hospitals only want to give them part-time or casual work. and a lot of them, they all want full-time jobs and with benefits that they get down in Buffalo or down in the States. And 2000 a day commuting to work in the US. And this isn't, you know, so there's so many things to that can be done to improve this system.

As I say, the big problem, biggest problem, is governments have let it get so bad that there's going to be a cost to doing it. And I think one of the solutions is to let those that can afford it pay a bit more, which is true socialism by legalizing that option for private insurance. And forget this, oh, it's going to suit the rich. The rich don't suffer in any society. The rich can go, the rich just travel down. to wherever they want to go.

This is about ordinary Canadians, and you solve that rich versus poor thing by saying, we're also going to introduce a care guarantee. And low-income Canadians who are waiting and suffering, once they reach that maximum safe time, we pay for them to go anywhere. And the same with the premiums. We could copy Switzerland or Australia or Holland,

Holland and pay their, or subsidize their premiums for private options. We do that, that is done to an extent, as I said, with what we call extended health benefits. It's really private insurance for all of the things that arts on government monopoly doesn't cover. Yeah, I think like you said, we just need more flexibility in the system. Unlock the productivity that's bottled up just because people aren't getting paid. enough to want to work so they're not getting injured people back to work to you know increase the tax base it's to some extent kind of circular and as you were saying you know when I was a Mayo I remember a lady came down from Toronto I

think she paid over a hundred thousand dollars US had her operation skip the whole lineup had top tier healthcare she's not waiting like she she as as idealic and idealist as any Canadian wants to be she does not have to wait one to two years in any system and it is just it is what it is but rather than her taking the hundred thousand dollars to the USA she probably could have kept that in Canada and that might have funded you know one or two ORs for someone else so there are we need the flexibility and we have to stop just comparing ourselves ourselves to the USA we're bigger than the USA there are other models to compare ourselves too yeah that's that's good stuff you guys are both a wealth of

knowledge. Like I said before, you know, half in jest, one of the things we do on this show, we often talk to people who are uncredentialed as a sort of intentional outcome for the interviews, want to get the average, you know, person's perspective on this. But I think because this affects so many of those average people, it's important to get experts on here who are in the field, working on making things better for people. And, you know, in some respect, it's come at great personal financial costs, all these different things, right? And people need to realize that there are pros out there with skin in the game, trying to make things better and improve the system, you know, true upstream swimming level stuff, especially in healthcare.

So I want to thank you both for what you've done and thank you for your time tonight. Tell people, Dr. Dale, I'll start with you, where they can find more about you, follow your work. The floor is all yours. Well, they could buy my book. Could do that, yeah. I'll put a link to the book in the show notes as well. For me, you know. By the way, you make about 10 cents on a book.

I mean, you do not make money by buying, by writing books unless it's a best-selling novel or something. That's right. No, no, no one's going to make a movie on my book. No, the romantic, the romantic dragon books are really, you know, feathering your nest. But Dr. Day's book, my fight for Canadian healthcare on Amazon, you can grab that. I'll put a link in the description. Well, for me, I basically have no real presence on social media. You told me to look up my Twitter, and I think I opened this up 10 years ago.

I thought I would shut down, but I actually, apparently it still exists. So if you want to see the lamest Twitter account, you can go to DCMD spine. I guess I'll start using it again. But other than that, I think, I mean, most of my practices in Hamilton Health Sciences, and then other than that, I'm, like I said, I'm booting up the spine surgical system with a clear point in Toronto and went back. Outstanding. Thanks for listening and watching everyone.

We will see you next time.