In a landmark decision, the Canadian Medical Association is now backing a private, for-profit health system.

At a CMA convention in Edmonton Wednesday, delegates decided by a two-to-one margin that patients should be able to look for care elsewhere, if they can't find it quickly enough within the boundaries of the public health-care plan.

Until now, the association has strongly supported a public health care system.

But many doctors now say long waiting lists have become a critical problem and that the health system needs help from the private sector.

Dr. John Slater of Comox, B.C. says: "I have stopped believing in Santa Claus and I have stopped believing the government will ever fix the monopoly system."

He adds that governments have had 40 years to get the monopoly system right but have failed; meanwhile, the casualties are piling up.

"One of them has been my wife,'' says Slater.

CMA president-elect Dr. Ruth Collins-Nakai says patients "need to have alternatives" if the public system fails them; but she stresses that doctors in Canada are still concerned with providing timely access to health care based on need -- not the ability to pay.

Collins-Nakai says Wednesday's vote merely reflects a recent Supreme Court decision, which upheld the right of Quebecers to turn to private health insurance if the public system fails them.

Among the steps doctors have taken to reduce wait times, says Nakai, is the adoption of a list of "benchmark wait times."

The list limits how long patients have to wait for key medical services such as cardiac care, cancer treatment or MRIs.

Two-tier warning

One of the voices opposed to a private health insurance system belongs to Dr. Ben Hoyt of the Canadian Association of Interns and Residents.

He describes a private system as one in which "the haves will be able to buy their way to the front of the line while the have-nots suffer in inappropriately long queues."

Hoy says Wednesday's motion also flies in the face of one of the CMA's basic principles -- that access should be based on need, not the ability to pay.

Harvey Voogd, of the Alberta group Friends of Medicare, said the doctors group has now clearly "embraced" private health care.

"To say otherwise, I think, is a fallacy. It's like saying, 'I support marriage, but I'm not against adultery.'"

With files from The Canadian Press