Dr. Martin pushes private medicine, but not even Reformers appear to be listening

Charlotte Gray

CMAJ 2000;162:1610

So why is he doing it? Why did the 39-year-old MP from British Columbia, who still does the occasional stint in a BC emergency room, decide to enter the race for the leadership of the Canadian Reform Conservative Alliance, which is replacing the Reform Party? Particularly when 3 of the other 4 candidates in the race have political machines behind them that are so powerful that they keep knocking Martin's tired old jalopy off the track.

But Martin insists that he is in the race to win. "I'm a pragmatist. I recognize that other machines are bigger than mine, but this is a marathon, not a sprint, and things may look quite different after a 2-and-a-half month campaign."

Few observers believe that Martin, who had raised only $100 000 by late April, can overtake his opponents. But they are taking a serious look at the centrepiece of his electoral platform, which makes him a more policy-oriented candidate than his rivals. Martin is pressing for health care reforms that would allow physicians to develop private practices as long as they commit 30 to 40 hours a week to the publicly funded system. He insists that if doctors' hours were regulated this way, medicare would not become the home of second-rate medicine.

In recent appearances before editorial boards, he argued that only dramatic structural change can save the existing system. "A parallel system will free up resources within the public system. Without this reform, we're going to slam into a brick wall."

Martin is convinced that his campaign has already had an impact in 2 provinces: Alberta Premier Ralph Klein has introduced legislation to permit private hospitals, and Saskatchewan Premier Roy Romanow has called for a national dialogue on what services medicare should provide. "Premier Romanow is even using the same language as me, about slamming into a brick wall if we don't make changes," says Martin.

But it is doubtful that either premier actually took their cue from the little-known Alliance candidate — their solutions for the funding crisis are quite different from those proposed by Martin. However, he is not discouraged because he sees the medicare debate finally breaking out of the old boundaries. "All the 'politically incorrect' stuff I've been saying for months about a parallel private system is now becoming part of the mainstream. Everyone else is getting beyond the idea that more money from Ottawa can fix our current system."

If Martin is elected leader of the Canadian Alliance, he would be the first physician to head a federal party since Sir Charles Tupper led the Conservatives in 1896. He would also give his own party a very different image from that presented by the other contenders. Martin does not share the fundamentalist religious views of his Alberta rivals, Stockwell Day and Preston Manning, and he does not have the go-for-the-jugular instinct of his Ontario competitor, Tom Long.

Most important, a Martin-led Alliance would offer Canadians a real choice in terms of what health care system they want. But if the recent noisy demonstrations in Alberta are any indication, his is a choice resoundingly rejected by most Canadians. In fact, his policy platform reflects how out of touch he is with both voters and his own party.

Talking to Martin, it quickly emerges that he defines his constituency somewhat differently from his competitors. He talks of attracting "disaffected Liberals and New Democrats, who want to see government living within its means, but who also want strong social programs." Meanwhile, his Alliance competitors want to attract Ontario Tories and deliver Canada's largest province to the new party. And strategic thinkers among their supporters know that Martin's health care proposals may be interesting, but they won't sell politically. "He's talking about a totally private system, privately funded, where the rich people can go off and do their own thing and, [with] poorer people left with poorer doctors and poorer facilities," says Bob Mills, the Alliance health critic. "I could not sell that politically — I wouldn't even try."

At his campaign Web site, Martin invites visitors to support his proposals. "It takes brave Canadians to stand up to the status quo and support brave new ideas for the Confederation." By mid-campaign, Martin had a scattering of supporters across the country, but he had not gathered much momentum because none of his fellow Alliance MPs had endorsed him. Meanwhile, whoever does emerge as leader of the Canadian Alliance will never adopt Martin's proposals for medicare reform. Politically, they're too dangerous.

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