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 09, 2006

Health Region Needs Help Quickly

“Negotiation” is an interesting process. If one looks up this process on Wikipedia we can find information on the a) process, b) tactics, c) the win/win approach d) the advocates approach, and e) a whole lot of information. So why haven’t we (meaning the various levels of government) done a better job of managing the growth and corresponding needs of the Fort McMurray area, recognizing they were and are in a negotiating position with the large international oil companies wishing to be involved in the tar sands? If they didn’t know how to do this, they could have always gone to the internet!
The most interesting aspect of the Wikipedia information, from my perspective, is the reference to the 2005 published material called “Beyond Reason: Using Emotions as You Negotiate” and in particular the five “core concerns”, namely: autonomy, affiliation, appreciation, status, and role.
To simplify this where governments and large multinational companies are concerned, we probably have to primarily talk about money; the large corporations because of their year end profit margins and accountability to their shareholders, and governments because of their continual immediate need for money to buy the votes of special interest and special “needs” groups.
At an international level, some people obviously think that, Radical Islam extremists and the Western World can’t negotiate. This is obviously wrong since these negotiations are going on continuously as a world dynamic. Knowing our regard for life, free speech, equal rights, etc, the question is being asked of us “ How many lives are you prepared to sacrifice, how much abuse of equality, and how much abuse of your free speech are you prepared to give up, in return for granting us what we want, namely, autonomy (leave us alone), affiliation (we can buy and sell what ever we want to whoever we want), appreciation (our values are equal or superior to yours), status (we reject and resent the U.S. as being recognized as a world power), and role (we will determine world order------including the annihilation of Israel and infidels)? But let's get back to the problems in Fort McMurray.
At a national and provincial level, negotiations are going on continuously between various levels of government: who has the right to tax what, whose portfolio is in whose jurisdiction, etc. Saskatchewan and Alberta demonstrate the differences in negotiations that have occurred in provincial negotiations with various groups, including the large multinational companies and the various labor unions, and others. Both provinces are rich in resources, but the development of those resources has lagged far behind in Saskatchewan. Time will tell us which approach was most beneficial to its citizens; the freer hand given to companies to develop resources in Alberta, or the more controlling policies of the Saskatchewan governments.
My criticism of all the provincial governments in dealing with development in Canada is primarily in the areas and responsibilities having to do with infrastructure. For these discussions I include the provision of adequate medical care in the category of infrastructure, since we have a monopolistic health care environment in Canada.
Over the last few years, while traveling in the U.S.A. I have been amazed at the infrastructure development that is done in advance of demand. Overpasses and freeways are built long before housing has created the demand. Just west of Phoenix, Arizona, is an area called “Green Valley” with many miles of four lane highway, turning lanes, an overpass, and hundreds of acres of land with no housing activity at present. In one area about twenty miles from Phoenix we found a beautiful golf course and a large school with no houses for miles around. On asking in the club house about the school, we were told that in order to have the golf course and the large corresponding housing development, the developer was required to build the school. In another area west of Phoenix, a very large school was built and has been completed, and the developer is now proceeding with a golf course and 10,000 homes. Apparently some negotiations went on that falls into the win/win category for both the municipalities and the developers.
There has been much talk about “stopping” the oil sands development of late. The reasons given are many; lack of housing, lack of infrastructure, environment, and in today’s’ Calgary Herald article “Strained health region needs help quickly”, lack of medical resources. Is it really possible, that everyone, in the various responsible levels of government, didn’t see this coming? Or are they simply inept or irresponsible in “negotiating”?
It would seem, from the article, that the recent proposal by Imperial (Kearl oilsands project) includes its own “medical centre”, staffed by a nurse practitioner and support staff. Good grief! What kind of “medical center” is that? How about a hospital with the required staff? Sorry, I got carried away. In Canada we don’t allow “private medicine”!
It would also seem to me that negotiating things, such as the above, are hampered by the fact that the large oil companies and developers in Canada know that our governments cherish their monopolies, and their control of both the education system and the health care system. At a time when there are big dollars for the International Oil Companies and their shareholders in our oilsands, one would think that better concessions could be obtained and still end up with a win/win situation for the tax payers in our province. At one time, oil companies had "Company" doctors. Now all their health care needs are carried by the public system.
As for the loss of physicians and other medical personnel from Canada, one has only to look at the negotiations that have occurred over the last twenty five years between governments and their associations. The five principles in negotiating a win/win situation have basically been ignored, and governments have adhered to the win/ loose scenario that existed prior to the 1970’s. Let us consider the core principles as they have been applied to health care:
1) Autonomy.
A one payer system has been imposed and physicians have been forced to practice in the system or out of it.
2) Affiliation.
Hospitals and practitioners have been grouped into regions, and physicians were basically forced to practice in certain hospitals, or give up their hospital work altogether.
3) Appreciation
Family physicians were considered expendable in hospital care, and doctors in general were considered to be the cause of escalating health care costs. As a result, the positions in medical schools were slashed, and very few family physicians are doing hospital care in our major cities.
4) Status
Many years ago doctors, nurses, teachers, etc, were potential role models. The entertainment area has largely taken over this societal position.
5) Role.
In years gone by, the physician was the patients advocate. At present, most physicians have become dependant on, and as a consequence, advocates of the system.
The bottom line is that I am tired of having various governments and their agencies complain about their difficulties, even during prosperity and high taxation, because of their poor negotiating skills with the multinational giants, and their win/loose approach to the medical services professions. They should now accept the heat, or get out of the kitchen!


Blogger Lanny said...

Excellent point. I hadn't thought about how the healthcare monopoly would deter corporate investment in expanding healthcare.

The negotiation analogy shows why socialism doesn't work.

10/11/06 7:06 AM  
Blogger Al said...

Just as our determination to have TOTAL freedom of speach can be used against us in a democracy, our emotional attachment to "Universal Public Health Care" can carry baggage. There has been a continuous downloading of health care costs to the public system. Even insurance companies have downloaded to the public system and negotiate an "annual global settlement" (at least that is my understanding).
One of the arguments in the U.S. for having a universal public system in the U.S. is that their companies are at a disadvantage vis a vis companies locating in Canada. We are in a tremendous advantageous position since we already have the public system and could "negotiate" with the companies to do cost sharing as part of their "permit to develope". The governments have that responsibility on behalf of the taxpayers of Canada.
Workmens' Compensation has access to the private system to improve return to work times-----a strictly financial consideration and blatantly unfair to the rest of us. The Alberta government should negotiate with the large multi-national oil companies to improve their provision of health services to accommodate the workers they bring in(this should apply to other infrastructure as well as environment). These policies need to be introduced slowly on a win/win type negotiating position, not the all or nothing win/loose policy the government has imposed on the medical profession.

10/11/06 10:14 AM  

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