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?

Thursday, November 23, 2006

Dave Hancock, a Lawyer's Perspective on Healthcare

The first thing we have to understand about Dave Hancock is that he has been in politics since 1974. The second thing we need to understand about Dave is that he is a lawyer. The first thing that crossed my mind when I read his “bio” was “Why doesn’t Dave, who has been in politics since his youth and all of his adult life, held many important portfolios in the Alberta conservative government, have more support from the Conservative caucus and Alberta Conservatives in general? The answer, I believe, can be found on his web site while reading about health care issues.
First you will have to take many hours out of your day (as I have) to read the reams of material. Secondly, when you are finished you will probably not know what he said, but will have a distinctly uncomfortable feeling if you are a conservative. Perhaps it is all the “buzz” words and phrases that he uses (that I have heard over the last fifteen years while I wasted my time on numerous committees). Words like collaborate, focus, comprehensive, innovate, guarantee, ensure, teams, commitment, maximize, effective, coordinating, and on and on and on------. Phrases like cost effective, medically necessary, assessed need, social and mental well being, root causes, province wide strategy, and more recently “Full Capacity Protocol” are driving me crazy! If only “coining a phrase” could solve a problem, Mr. Dave Hancock and our political medical planners over the past 15 years would have solved everything years ago.
I certainly don’t intend to comment on all of his material, but rather, try to determine where he stands on critical issues in health care (You of course, are invited to review all of his material, and point out the errors of my conclusions).
1) On private Health care-----Dave states that it is a difficult question (yes, we know that). He also states it plays a significant role now (We know that too). Should we have a public system?----he says we should; all Albertans must have timely access to quality care regardless of ability to pay. We are all in agreement with that, Dave, but you see, they don’t have that NOW! He states there has been too much discussion on Public verses Private already. Wow, I missed that part. When did it happen? Then he gets on to prevention. Healthy life styles, etc, etc, etc. The same old mantra. Mind you, in another section we will look at his “healthy life styles” solutions.
2) Doctors remuneration-----There is no easy answer to this is Dave’s response. He reports that technologies have benefited some physicians but not others and physicians should be rewarded for their time, expertise, and responsibility. Well you have been in Cabinet for the many years that these disparities have been occurring and family physicians providing comprehensive care have been disappearing. We, the public, and I, the family physician, wanted to know how you were going to address the problem. Stating how things “should” be doesn’t “Git-er-done”.
3) Health funding------Dave’s Response: “New and innovative thinking, spur innovation and competition, standardized performance measures, engage leaders, create a Health Care Policy Coordinating Council, and focus on being well (There you have it folks, that’s how you fund our public health care system. Need I say more?). When asked under this same topic about funding issues such as Fort McMurray, aging populations, etc, he states there needs to be flexibility. Duh! But how do you propose to actually install the flexibility feature? Oh, yes, you again mention healthier life styles.
This review would not be fair without looking at Dave’s 21st Century plan for Health and Healthcare. His commitment is based on the following:
1) No Albertan will be denied access to medically necessary health services because of inability to pay. (The problem, Dave, is that we are being denied access already, and have been for some time. The Supreme Court of Canada says that access to a waiting list is not access to health care. And could you please define “a medically necessary service”. I’ve never seen that done before, so maybe you know something that I, and the rest of Albertans, would like to know).
2) Every Albertan will have access to the resources, education, and support necessary to achieve and maintain his or her best possible physical, social, and mental well being (This will be a true Utopia. I can hardly wait. The only trouble is, Dave, we first have to IDENTIFY the people at risk, and then we have to MOTIVATE them to access the resources, etc, etc. Then you have to PROVIDE the resources, keeping in mind that access to a waiting list is not an access to a resource; have we got the money for that? See funding---dealt with earlier).
3) All Albertans will have access to a high performing health care system that compares with the best health care systems in the world. (Now remember, Dave, access to a waiting list is not access to health care. And although our health care system compares to the best healthcare systems in the world, it does NOT compare favorably, as you well know from other dissertations on your web site. Further this has occurred largely under your watch. I think the question is how you are going to change this situation for the better).
Before winding this up, I should deal with two more innovative ideas that Dave Hancock seems to be fond of, that have not been mentioned in the news media to reduce emergency department waiting times.
1) I believe he supports the idea of a low intensity medical clinic near an emergency department to prevent “inappropriate” attendance to emergency departments by patients. My answer to this is three-fold. a) The number of inappropriate visits to our emergency departments have been steadily going down, and at present take up little time and resources in the emergency departments of Calgary. b) You would have to take resources from the community (doctors, nurses, etc) to staff these units. c) If there were adequate resources in the communities, patients would not go to the emergency departments and face six hour waits.
2) He definitely supports the “Full Capacity Protocol” that requires, within two hours or less, all stable admitted patients waiting in the ER for transfer to an in-hospital bed, should be transferred out of the emergency department to the appropriate ward, after a decision to admit has been made. Perfect; if only we had the “appropriate” beds required on the “appropriate” floor, and the appropriate” staff on the “appropriate” floor, to look after the patient “appropriately”. Come on, Dave. You and I both know that although this relieves congestion in the emergency department, more times than not, the transfers to in-patient beds will be “inappropriate”. This is the old “shell” game that I have referred to in the past that challenges the public and news media to find out (or guess) where our health care needs are being hidden. Already patients are being transferred to inappropriate beds by our “first bed available policy” and even when there is no bed available, end up being cared for in hallways. There is, as well, a small matter of having a physician attached and responsible for each and every patient admitted to an in-patient bed (and bringing in more nurses for the additional patient load). Very often our patients are in an emergency department bed, under the care of an emergency physician, because there are no hospital “staff” doctors to take on the care of the patient. On occasion our intensive care patients already “spill” into our medical ward beds “inappropriately” because we have run out of intensive care and/or cardiac care beds. So, please, Dave, don’t use the term “appropriate” when referring to our present Health Care System.
3) Since Dave Hancock suggests eliminating healthcare premiums (along with several other candidates) and recapturing the nearly one billion dollars derived there-from by increasing taxation in general, I should perhaps comment on this approach. There is no doubt that health care premiums are just another form of taxation, but it does continually inform the public that “health care” is not free. Since Mr. Hancock is in favor of “incentives” for healthy life styles (suggests tax-credits), I’m surprised he didn’t suggest eliminating premiums for those people and families with healthy life styles, and charging premiums for those with unhealthy life styles. Tax credits primarily benefit the wealthy. The bottom line is that Albertans are going to pay for their health services one way or the other, so it is a non issue.
I think, on the other hand, that it is “appropriate” to end here. If you want to delve deeper into Mr. Dave Hancock’s thoughts on Health care, he has much more on his web site. But I do advise you to approach it as you would a contract (If Dave gets to be premier, you’re going to be stuck with him), so read ALL the fine print.

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