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?

Monday, April 17, 2006

Debunking, Strike One

Have you ever tried to untangle a real mess of string or rope that is hopelessly intertwined? I kind of feel like that when I’m reading the booklet, “The Bottom Line”. You take a piece of the string and follow it to see were it goes (in the hopes of teasing it out to an end) and it disappears in a whole lump of other parts of the ball of string. One is tempted to cut off each small piece of string that one can isolate and then try to tie each small piece together, but that would be a horrendous job, and at the end of it you probably would be left with nothing useful. Or maybe in exasperation, throw the whole thing in the garbage. But I promised to look at all aspects of this health-care thing, so here goes, we have to start somewhere.
One of the things that is disconcerting in this booklet, is the tendency to put forward opinions that are controversial, as though they are facts (I note the subtitle of the booklet is “The truth behind private insurance in Canada”). Throughout the book, quotations are taken from people who had bad experiences financially, prior to Medicare, in the health care field. These quotations date back to the nineteen thirties and forties, and many of them from Quebec and Ontario. No one said things were perfect then, but I know that supporters of the present system cry foul (for good reason) when the news media present “the disaster of the day” in our present system. Intelligent discussion cannot come about by citing case scenarios for affect. We can look at each case and learn from it, but deliberately creating a negative attitude is self serving. Testimonials do not facts make!
In the introduction, Shirley Douglas (not entirely impartial) is quoted as saying “You either want a single payer system in this country, or you want an American style system. And don’t kid yourself that there’s anything in between”. Well, in fact, everything else is in between. Canada and Cuba are the only two Health Care systems that have a “One payer System” (possibly also North Korea). The U.S. has 48,000,000 people without health care coverage (about 20% of the population). Are there any industrialized nations of the world that don’t fall between these extremes?
Gillian Steward is quoted as saying:” Medicare is as Canadian as hockey or Mackintosh apples”. Does this imply that Canada was the first or only country to bring in a one payer system? Or are they implying that, it in some way, with its thirty seven year history, Medicare is part of our Canadian Heritage? What is the relevance from a rational perspective?
The authors claim their main thrust is to debunk some myths with hard reality. In doing this, the first myth they debunk is “Private insurance is a “new” model for health care”. Is there really anyone that puts that idea forward or uses it as an argument? I certainly never have! This is like saying “They said two and two is five, when no-one ever said that”, just to discredit the opposition. They say the reality is: “Albertans and Canadians have already experimented with, and rejected private insurance and for-profit delivery in favor of the universal public single-payer system. No, the reality is that Canadians, especially Albertans, were bribed by the federal government to abandon their previous well functioning system, and experimented with the new proposed universal public single payer system. Most of my patients in 1969 could not understand why the system was being changed. I had to explain to them that the Alberta government stood to gain 50% of the cost of provincial health care from the federal government if they joined Medicare. The authors point this out in a subsequent chapter so why cloud the issue? The opposition parties and main stream news media railed against Premier Ernest Manning in the 1960s for even contemplating foregoing this federal windfall, as the authors point out in their booklet. The truth of the matter was many of the European countries, including England, had already gone down the “one payer system” road and lost many physicians to Canada as a result of it. It was however, a “vote getter”, and popular with Unions (government’s programs and personnel, are highly Unionized), and politicians are always looking for votes. As Canada was attempting to embrace this “new” Medicare experiment thirty seven years ago, the European countries began contemplating ways and means of extracting themselves (as we are now), because they were finding the costs escalating beyond their expectations (as we are now). Strike one on “debunking”!

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