Call your dermatologist. Ask for an appointment. You'll quickly be advised that since you haven't seen the good doctor in six months, you must get a new referral from your general practitioner. That process will cost the Affordable, Transportable, Universal and Unmanageable Medical Services Plan $26 Canadian tax dollars. You're one of, let's say, 10,000 Canadians who will have the same experience this morning trying to see a specialist. Cost? $260,000. That's today. Multiply by 300 working days, and we've just racked up $78 million in unnecessary, repetitive charges. And that's just one of at least a hundred similar inefficiencies in our total health care system: $8 billion a year for nothing. Now, the doctors and their unions will explain that the dermatologist, psychiatrist, podiatrist, palm reader will bill the system $130 visit and we can't just have riff-raff calling up at all hours of the day and night looking for expensive treatment. And the GPs who have left their private practices for the supermarket check-out system known as The Walk-In Clinic will bill MSP the $26 for the ten or more misguided folk they see per hour and tell the poor slobs that for real advice they had better also see their family doctor, because, after all, he knows them better than I do. Real cost: $52. Glove and money Argument: Hospitals buy rubber gloves at a dollar a pair. Why, when you can buy rubber gloves at Costco for 79 cents? And to make matters worse, hospitals buy rubber gloves and cotton swabs and dishtowels and plastic cups and bedpans by the railway car. Why are they paying top dollar? Counter-argument: The rubber gloves we buy at the hospital are guaranteed leak-proof, which is so important when you're piercing body cavities on a regular and horrifying and life-endangering basis; the gloves at the supermarket have no guarantee and they're often substandard or rejects or seconds, take your scary pick. Counter-counter-argument: The rubber gloves and sponges and cleaning supplies and tissues and diapers are all bought from our friendly and familiar agent who does the hospital rounds with his order book and his good cheer and hockey tickets and bottle of Merlot and occasional cruises to Dominica. It's business. That's how it's done, mate. What exactly is your problem? Counter-counter-counter-argument: You know how anybody can buy a nut or bolt at Home Hardware for 59 cents? And how the same miraculous little piece of metal always costs the Canadian Armed Forces or Canadian Coast Guard or Canada Post $3.50? Same deal. 'The worried well' In modern psychiatric practice, the darkest industry secret is known as "the worried well." They are the middle-class neurotics who want someone to listen. As a nursing friend said recently, "Why not? Why see a schizophrenic, who smells, when you can see an attractive, well-groomed female patient in her forties, who has marital troubles and sexual problems?" Heck, it's only $145 an hour. And under our current system, they can do exactly that twice a week! Forever! You see, the devil is in the details. And a thousand little inefficiencies will never make one good photo-op. Politicians like photo-ops. Politicians like The Big Answer. Something sweeping, Something grand, something I can hang my hat on. Show me handing over that cheque for a billion new health dollars to some disabled kid, that's the ticket. Politicians are not prepared to go through the sock drawer with a fine toothed comb. It's too…well, messy, too time-consuming. For godssake, it has no story line! Get out the scalpels Which is funny, because the provincial government here in B.C., for example, is very keen on Public-Private Partnerships. They want very badly to get in bed with the private sector. Think Coquahalla, think Ravco, think B.C. Rail. And the great modern specialty of the private sector has been for some time now cutting away at the dross and counter-productive. Jack Welch of G.E. fame is the most admired CEO in recent memory. And Mr. Welch's singular skill has been taking fat, inefficient corporations and trimming their sails. Unprofitable divisions, gone. High-priced and redundant vice-presidents, gone. Aging workers with expensive benefits, gone. But will we try the same approach in public policy? Not in our lifetimes. In Alberta, Ralph Klein threatened some real reform. During the national election campaign, Mr. Klein boasted he'd open more private clinics and begin a tax deduction based on income to raise more revenue. He did neither. Instead he threw another $700 Million into the pot and offered a "health invoice" to everyone in the province so that they can see how much they're costing the system. While the rest of Canada was being Romanowed-to-death, Klein commissioned his own study. The Graydon report concluded that it didn't matter how many clean-ups you did. The simple fact is health care needs more money and it always will. Yikes! Now we're talking user fees. Imagine that! Paying for something when you use it! What'll they think of next? Of course, any reasonable Canadian will be wary of a slippery slope that might make us America Lite, with 20 percent of the population uninsured. But should that make us terrified and unwilling to let the ortho surgeon do what your local blood clinic is already doing, namely operating a private business that serves the system at a reasonable cost? Colin Hansen and every health minister across the land should be challenged to find accord with Ottawa and get on with the messy and tedious and necessary job of cleaning up a system that can work so much better for all of us - if only we have the will. David Berner is a radio talk show host on CKNW in Vancouver.