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, November 20, 2006

Mr. Dinning, A Polished Politician's View on Healthcare

Knowing Jim Dinning somewhat through his and my committee work in the Calgary Region while he was the C.E.O. of the region, puts me at a bit of an advantage (and disadvantage, because I like the guy), in commenting on him as a prospective Alberta premier. There is no question that Mr. Jim Dinning is personable, charismatic, intelligent, and the consummate politician. In fact he is by far, in my opinion, the best politician of the “premiers to be”. The question is “Do Albertans want a politician as the next premier of Alberta?”.
I know, its a strange question, but I will elaborate. To win friends and influence people, tell them what they want to hear, and tell them what they already know. Don’t presume (in their presence) that you know more than they do. A good example of this is Mr. Dinning’s speech to the Calgary and area physicians. His opening statements to the group included: “Thanks for the opportunity to be here tonight and listen to a group---, and while I have some comments to make I’d prefer to hear some from you about health care----“. Then he carefully shows that he is not a neophyte in Healthcare, by stating that he was the Chair of the Board of the Health Region, and states that since then he has been a keen observer of the changes that have taken place in the health care arena. Brilliantly, he then goes on to tell the doctors what they already know:
1) In spite of numerous reports (Kirby, Mazankowski, Romanow) little has been actually done
2) I have learned that “healthcare reform has been more about talk and much less about action (actually, the efforts at reform that have taken place have devastated our previous well-functioning system)
3) Discussions about reform are almost impossible to have (because politicians need to get elected)
4) We’re quicker to come up with new plans than following through with what we started
5) The best ideas for what needs to be done to improve access come from people who actually work in the system (but have been consistently ignored because they have been viewed as a special interest group)
6) That people actually care deeply about health care
Wow, I want to vote for him right now. He certainly has insight, right? Well, maybe we should wait and see what else he has to say on the subject. You have to be careful with politicians. They have a habit of coming on as your best friend, but are nowhere to be found when you need them (mostly I’ve needed them to leave me alone!).
In his speech to the doctors he outlines five “plot lines”.
a) Get serious about health: Under this heading he raises the issue of preventative health, healthy life styles, etc. Nothing new here! We have been trying to do that for forty years. He does talk about establishing a Heritage Foundation to address issues in the first ten years of children’s lives (who can be against that?), but doesn’t say exactly how it would work. He talks about giving children a healthy start (sure sounds good, but will he be taking kids out of homes where people are poor?). After all, it seems less that 50% of these children are up to date on their immunizations. Will we have mandated nutritional classes for families with obese children, or home care nurses doing the grocery shopping for people on welfare? How much “child control” and “parent supervision” are we looking at here? Frankly I would have preferred a policy of taxing junk food, and taking junk food out of schools.
b) Forget about big plans----pick a few priorities and stick to them. (For sure, that is how to get things done). His choices for these priorities are primary health care delivery, an electronic health record, and new models of care for chronic illness. Now, how can you disagree with those three priorities, they lack the substance and detail as to how these priorities with decrease the cost of our publicly funded health care system, shorten wait times, or improve the quality of care, -----all thing that the average person is deeply concerned, but man they sound good! So far, efforts at primary health care reform have seriously shorted the availability of family doctors and primary care givers. What will you do differently? Although the electronic health record may improve some aspects of care and enable “tracking” of chronic disease, the cost of this system in the short term is increasing, and will continue to rise. Any benefits from tracking diseases will be far down the road and may be worth while, but it certainly is not a “here and now” cost benefit.
c) New models for care for chronic diseases. This, of course, means nothing to any of us. Although it has potential, as I have blogged, pertaining to the detection, registration, and targeting of people at risk, research in this area is in its early stages and is a long way from implementation.
3) Innovation----infusing more of it into our publicly funded health system
I think if I hear the word “innovation” one more time coming out of a politician’s mouth, I will be physically sick! The downturn in our health system in Canada, and the slipping of our world standings in health outcomes, started 15 years ago with the idea “we don’t need more money, we simply need more innovative ideas on how to use the money more wisely”. What in the world makes us think that our “innovative” ideas are any better now than they were 15 years ago? Statistics show that only a small percentage of innovative ideas are practical. On Mr. Dinning web site he mentions the success of the “Bone and Joint” pilot project. Jim, to my knowledge, millions of dollars were put into this project, which only underscores the fact that huge amounts of money are going to be needed to shorten our long waiting lists. How does that address our concerns about the sustainability of our publicly funded healthcare system?
4) Increase our supply of health care providers and get them to where they are needed.
On Mr. Dinning’s web site he addresses this issue by first stating that there is this crises in health care workers(again, a fact that we all appreciate) but then sings the same old tired tune of training more, bringing in more foreign doctors and assisting in student loans. Not a very exciting solution; in fact it is no solution at all. Jim, first you have to recruit students into the health care fields, then after you train them, you have to KEEP them. How do you propose that we prevent them from going to the U.S. after graduation? We have been actively recruiting qualified foreign physicians. In spite of half of Sask. physicians being foreign trained, we are still falling far behind----but you know all this, don’t you! Try to focus, as you suggest we all do, and actually suggest a PLAN as you recommend.
5) Find practical ways of containing cost increases (now we have arrived at the crux of the problem, sustainability). Mr. Dinning’s only suggestions in this area are: a) Micromanagement, and b) Examine the use of an independent, arm’s length body to review and assess new treatments and services as part of the process for adding these to the list of things under public health care. Well, to me micromanagement usually means more money to administration, and less to patient care. The “arms length” review body to assess appropriateness for healthcare coverage is nothing new; but what in heavens name does “arms length” mean? Does this mean lawyers, accountants, and politicians? I made a similar suggestion to Mr. Don Ford, Health Care Policy adviser to the Klein government, in a presentation submitted in Feb/1998, but I suggested a “hands-on” group consisting of doctors, nurses, pharmacists, chiropractors, physiotherapists, and tax payers. The “arms length” group, Price Waterhouse, suggested in the 1990s that all the hospital boards in the Calgary Region be brought under one “Arms Length Board” which agreed to their proposal to sell the Grace and Rockyview Hospitals, and blow up the General Hospital. Can Calgary survive another “arms length” provincial body looking at health care?
I have always said and still maintain that no government can provide infinite services without having infinite resources, and the reality is, that in spite of very ingenious tax methodologies, governments do, in fact, have limited resources.
So, that’s it folks. Mr. Dinning, like Mr. Oberg, has more knowledge of our health care system than the other candidates, but I’m afraid has no new solutions. In fact, by not thinking outside of the “Canada Health Care Box”, Mr. Dinning takes away many potential alternatives. On the other hand, keep in mind I have stated that Mr. Dinning is an extremely “bright” guy, and the most “polished” of the candidates (I apologize for the attempt at humor in such a serious dissertation), and it certainly wouldn’t be the first time that a political candidate vaulted themselves into office by supporting our “Universal Health Care System”. Could this why he is pushing the status quo? Perhaps I’m just being paranoid. Pass me my haldol.


Blogger michie said...

I completely agree with you- It's all about the votes.

Whenever real change is suggested, the public has a conniption fit. Not good for getting votes at all. Nope.

25/11/06 5:04 PM  

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