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?

Wednesday, April 19, 2006

Strike Three, Over and Out, Thank Heavens

To go on in the booklet “The Bottom Line” attests to my inherent tendency to be masochistic; but I must proceed since I’m at a point of no return. In the interests of brevity (and because the topics seem to be intertwined like the tangle of string I mentioned), I shall deal with the next three topics all at once (sigh of relief).
Myth 3: Private insurance will be cheaper for individuals
The booklets reality: Expanding private insurance is a downloading of costs onto individuals, workers and businesses.
WAKE UP! All this so called innovation over the last fifteen years has been downloading the sick and unfortunate into the community, where their care is virtually invisible and the cost HAS been borne by patients and their loved ones. The system has conscripted the loved ones of the patient, and the community beds (they call it home care), to care for patients that previously were hospitalized. This has forced people to assume a large part of the care, and where possible, try to get insurance for such care (which often is not available). The authors of this booklet acknowledge this huge downloading effect (as do I), and then in a subsequent chapter show that the cost of hospitals, and doctor’s fees has not really increased more than expected, considering inflation and population growth.
Astounding! In Calgary twelve years ago we had 3.3 hospital beds per one thousand population, and 56 long term care beds per one thousand people over the age of 65 years. The last figures that I heard was that Calgary had 1.7 hospital beds per one thousand people, and under 50 long term care beds per thousand people over 65 years of age. No wonder hospital costs haven’t sky rocketed; we have half the number of beds per capita. Doctors fees have only kept up with inflation 10 to eleven times over the last thirty seven years, little wonder doctor’s fees are not responsible for the huge growth in health care costs.
In spite of all this down-loading, the 9% increase in Alberta’s annual spending on health care is not enough (Calgary Health Region was looking for an 11% increase). How do we blame insurance for the above scenario and at the same time say the present Medicare system is sustainable?
An insurance system is designed to pay money for assuming the cost of certain risks. They do not provide care. Their job would be to find a high quality provider in the event of an “incident”, not take on the care of the patient. If we are looking at costs, we must compare “provider costs”. A monopoly has the advantage of having no marketing costs, no competition, and centralized administration. Its disadvantage, financially, is it is heavily unionized. Not only may union workers in health care be paid more, but the union may determine how the workers are utilized (a nurse may not be allowed to porter a patient to the X-ray department). A private facility may have some advantages financially because they are non-unionized, but they need to compete for the patient through service, quality, and reputation. This, advertising, and separate administrations of competing companies, may increase costs. In our clinics, our costs for providing approximately the same services as the Calgary Regions 8th and 8th clinic and South of Anderson Road Clinic, was 50% lower than these clinics. Other private services such as abortions and cataract surgeries are cheaper done in the community because the procedures don’t need the expensive facility (Real Estate and equipment) of a full fledged acute care hospital.
Having an alternative private system may overall, be more expensive, BUT, it will be supported primarily by the wealthiest in our society, not the average tax payer. To make it work, there will need to be availability of private facilities, and there will have to be a benefit for the premium payer. By offering quicker access for elective procedures, we will “unload” our public acute care facilities and free up beds in the public system, resulting in shorter public waiting times without increased “public sector” funding.
The authors claim the fourth myth is that we are moving to a European System. They claim the reality is that we are moving towards an American system. The real truth is the Americans are attempting to introduce a system that is more oriented to looking after people who are incapable of providing their own health care needs; Canada and Europe are looking for ways of providing care for those who are unable to provide their own health care needs, while allowing those who are able, to seek their own and other alternatives. We (and Europe) are moving from being “everything to everybody” (which is usurping our resources and impairing our ability to care for the poor, the chronically ill and the frail elderly) to being “there” for the people within our societies who, for what ever reason, are not able to provide for themselves. The Americans are still on the journey of providing for the poor, the chronically ill, and the frail elderly (many are the 48,000,000 that do not have medical coverage).
The claim that our present health system is “unsustainable”, is put forward as their fifth “Myth”. They go on to show a graph that confirms that hospital costs and physicians costs are reasonable, and therefore the system is sustainable. They do this after spending considerable time in previous chapters and acknowledging that costs have been continuously downloaded on the patient, insurance carriers, and the community resources.
The sixth “myth” that they debunk is that the private system (they seem to want to call it private insurance) will save the public system money. They say the reality is that it may actually cost the public system money. Well, I think we have already gone around that post several times. If we find, through private schemes or programs, sick people, or people that need medical interventions, and these people rightly fall into the category of poor, chronically ill, or frail elderly, then I it may cost the public system more money; that is what we as a just society want from our health care system (as opposed to forcibly providing for the wealthy that can care for themselves).
We have a huge reservoir of medical needs in our society that are not being addressed. Waiting (risk) lists are just the most obvious. Before we can get on with true reform, we need to decide what a medical need is, and whether the intent of Medicare is to control the population (building a health care corral instead of a fence), or develop an atmosphere of, and system for, “choice with compassion”. Strike three, and thank goodness! Over and OUT!

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