What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Saturday, April 08, 2006

Alberta's Pathetic Leadership Hopefulls

It really is pathetic. The Alberta provincial conservative premier “wannabes” are taking exactly the same approach as the federal politicians have during the last four elections. The greatest phony would seem to be Jim Dinning. As provincial finance minister, he cut health spending and services and started the problems in our public health care system in Alberta. He was the big “Poo-Bah” of the Calgary regional Health Authority for several years (and during that time was always over budget and going to the provincial government for more money). He, of all people knows first hand the present system is not sustainable. Yet, he has the unmitigated gall to declare that he will be the guardian of the present health care system, and will squelch any aspect of the “third way” that will come in conflict with the Canada Health Act. Sounds exactly like Mr. Paul Martin and Mr. Chrétien before him, and for that matter, Mr. Harper in the last election. It would seem that the best thing to do as a politician is keep the Medicare system in a state of crises, and declare before each and every election that you are going to “fix” it. Quite frankly, it makes me sick, no pun intended.
Let us review once again some of the issues:
1) Some people say that waiting times for cataracts have not gotten shorter since they have been moved to the community and out of the hospitals and therefore “private clinics” won’t shorten waiting lists. Perhaps what they don’t know, or don’t want to know, is that the Region will only agree to contract out a certain number of cataract surgeries per year. So if 1000 cataract surgeries will be needed in 2006, and the region only agrees to contract out 750, then it follows that 250 people will be put on a waiting list. After two years, there will be 500 people on a waiting list, and so on. New ophthalmologists coming to town won’t help the problem because the region only contracts out a fixed number of cataracts, always less than the needed number, to save money.
2) Orthopedic surgeons in the Calgary Area are not working to capacity. This is because they are limited to a certain number of hours of operating room time. This is necessary, not only because there are limited hours available in our operating rooms, but there also are limited beds to put patients in after they have been operated on. Contracting out surgeries will only help if the number of surgeries in total for a year equals the demand for that year. As with cataracts, contracting out procedures costs money and money can be saved by building up a waiting list. It’s that simple.
3) Has anyone actually seen the exact process that has been put forward in orthopedics as being the salvation of hip and knee replacement surgeries? My understanding is some money can be saved by stream lining the procedures preoperatively, operatively, and postoperatively, and that seems reasonable. But what I understand is that this is a pilot project (in other words this is being done on a small scale in a specific area), and I have heard that in excess of twenty million dollars was put into the project to “kick start it”, and a similar amount of money has been granted for its continuation for the next year. I certainly have not seen a cost accounting of the procedures done, the age of the patients, their risk status, etc. If this small pilot project requires 20,000,000.oo dollars a year to operate, how many hundreds of millions of dollars are required to apply this one orthopedic program to the entire province and what is the cost, and the cost savings. Further, can the public system afford to do this? From what I can see this is tinkering, and not a solution. The bottom line is it will require billions of dollars to shorten wait times (risk times) in our health care systems and politicians don’t want to take the money from other priorities. So they fiddle (they call it innovation for the last twelve years) and lie to the public.
4) Guaranteed wait times sound good, but will be an administrative nightmare. What are you going to do if your wait time extends beyond the recommended wait time, sue the government? Sounds like a “make work project for the legal profession.
5) The wait times recommended by the C.M.A. and others that I have heard are attempts to entice the governments to move forward on this issue, but have no bearing on the medical facts, that I can tell. The recommended wait (risk) time suggested for a patient with a fractured hip to wait before having surgery is given at 48 hours. In the last year, an excellent article was published clearly showing increased morbidity and mortality in this group of patients if they wait longer than 24 hours to have their hip repaired. So where did this 48 hour figure come from? I suspect the other wait times similarly are not backed by medical evidence.
6) Doctors, particularly surgeons, MUST be allowed to work in both the public and private health care systems. At present, some orthopedic surgeons are working at 60% capacity in the public system. What would we think of a company that had millions of dollars of expensive equipment standing idle 40% of the time, but was not meeting the demand of their customers? Probably we would suggest it deserved to go out of business. Frankly, forcing physicians to work in one sector or the other is micromanagement and just plain stupid.
Why in heavens name do we keep voting in the politicians who know the state of health care in Canada, and basically guarantee the status quo? Where is our indignation? Where is our courage? And perhaps more to the point, are there no leaders with the courage to come out, say what the situation is, and have the courage to do something about it? Klein talked the talk, but was afraid to walk the walk. Our new “wannabes” are even afraid to talk the talk.


Blogger Lanny said...

I would say that it is because the public is clueless to the real problems going on in healthcare. That's why this blog is so important. Add to that the propaganda spewed by the media, friends of medicare, ndp, former governments, etc and any talk or walk is instant political suicide. So, thanks to this propaganda, people are dying, the system is failing, and there is no hope for change.

I have noticed some shifts in public perception as they encounter the system and its problems but they still don't know why those problems are there. Again, the media etc point their uneducated fingers in the wrong direction and support more propaganda. We need people like you to shout loudly and bring some common sense and information into the picture instead of propaganda.

8/4/06 10:23 AM  
Blogger Al said...

The basic problem is the shortage of physicians and the shortage stems from two basic problems:
1) Decreased training positions in medical schools in the late 80's, and this problem continues today.
2) A sense on the part of physicians that they are not valued. This "valued thing" can be broken down further:
Governments have viewed us as the problem, not the solution, and have treated us accordingly; consequently
a) We feel "managed" and are.
b) Physicians have left Canada in huge numbers
c) Relative to dentists, veteranarians, etc, our fee schedule is low and the demands high ---fewer men entering the profession---women now comprise over 50% of medical graduates---- but women physicians put in 10 to 20% fewer hours than men in their practices and tend to see fewer people in an hour.
If it wasn't for foreign doctors the crises would be incredible----and the foreign reserve is drying up, and the population is aging.
Canadians worry about global warming in the next 100 years. Your right, they have no idea of the problems they face in the next twenty years in medicine. And our leaders say what the public wants to hear and the news media lets them get away with it.

9/4/06 11:35 AM  

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