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?

Friday, December 29, 2006

Good Health, and Good-Bye

There seems to be a consensus that Friday the thirteenth is a bad day. For our family, Wednesday, December the thirteenth, has been the worst day of our lives. A telephone call that morning told us that the biopsy of a small lump under the skin of my beloved wife and my children’s’ incredible mother, was diagnosed as cancer. Furthermore, it was a cancer that had its origin in some other part of the body. Subsequent diagnostic imaging has revealed that the origin is the lung and that surgery of any kind is not an option. We are all devastated.
It is indeed strange that someone such as I, dealing with death frequently, still finds this reality totally unexpected and totally unacceptable. I guess we look at the life expectancy of a woman at 65 to be another nineteen years and do not expect anything less for the person we love. How do we face the reality of loosing your soul mate of the last forty four years? She is so incredibly brave she breaks my heart. One hour after being told the terrible news, she turned to me with tears streaming down her face and said “You know, I’m really not afraid of dying. It’s just that I’m going to miss you and the kids so terribly”.
I would like to thank my physician friends that helped Lea and I reach the diagnosis and plot a course of action quickly. I can’t imagine people waiting for weeks for necessary imaging and attention when a cancer diagnosis raises the distinct possibility of an early death.
It has been one year since I started this blog, and this will be my last blog entry for a long, long time. My priorities lie elsewhere. I extend a sincere thank you to those that have read my dissertations, rambling as many were; and a particular thank you to those that have commented. Good health in 2007 to all, and may the world marvel at your good fortune.

Saturday, December 23, 2006

Wal-Mart One, Stelmach Zero

I love Wal-Mart. Whoever they have running their ship knows how to keep ahead of the crowd. In the last year, some left leaning groups (various unions and their leaders, the competition, and at least two democratic senators), have been bad-mouthing Wal-Mart for not providing their employees with medical benefits. Recently, a plan has been devised by this terrible capitalist entity that I think has significant merit, and may revolutionize primary health care.
It is common knowledge that 50,000,000 Americans do not have health coverage and many, many Canadians cannot find family doctors. Emergency wait times are many hours long and even walk-in clinics in Canada cannot keep up to the demand, with many of them limiting their hours because of staff shortages. Recently, governments in Canada have been in discussions with pharmaceutical associations in Canada, and physician Colleges, to allow pharmacists to prescribe medications for minor conditions. The medical associations have concerns about pharmacists diagnosing, but, what if the pharmacist could work closely with a doctor------closely, as with “ connected electronically”?
Recently my daughter had a rash. She not only told me about the rash, but also E-Mailed me a colored picture of it. Apparently Wal-Mart is looking at electronically providing some primary medical care to it’s workers and its customers. These customers could talk to the pharmacist, the pharmacist would E-Mail a doctor the complaints, a proforma questionnaire would be E-mailed back to the patient (or the pharmacies could have them on hand), they would be filled out by the patient, with comments/pictures added by the pharmacist (or nurse/pharmacy practitioner, and a collaborative decision as to a course of action would be made. The physician could charge half as much (no overhead to speak of), and the pharmacy would get the business from a pharmaceutical and other business perspective. My understanding is that a few physicians would service all of the Wal-Mart stores in a state or province (or health region). Moneys would be collected by Wal-mart and the physicians would be paid by Walmart. The result would be a significant decrease in the cost of a large portion of primary care, and partly subsidizes by Wal-Mart.
Now, to be fair, I’m not sure if the above is precisely what Wal-Mart is proposing, but from what I have heard, it comes close. Many pharmacies have already expanded their services to include health promotion. To facilitate this, the provinces in Canada should allow and encourage health savings accounts; a tax deductible account similar to an RRSP.
The bottom line is this: I don’t think our governments will ever solve our health care dilemma in Canada. Mr. Stelmach got elected recently in Alberta because, at least in part, he promised nothing. Moving forward generates criticism, doing nothing keeps the politician under the radar screen. So be prepared for “nothing” in terms of health care reform in Alberta in the foreseeable future.
In business, maintaining the status quo is a death knell. As demand increases, solutions must be found, or the competition passes you by. My prediction for 2007 and beyond: “Big business will help us find solutions to healthcare, the demand is there, governments simply have to unlock the door”.

Tuesday, December 19, 2006

Suffering, a Canadian Value

“In a society where instant gratification is barely fast enough, Canadian’s fierce defense of their right to queue for medical treatment is anomalous. Yet, for some, publicly funded health care defines who we are”.
The above statements were the lead statements in today’s editorial of the Calgary herald. The part that caught my eye was not the part of how bizarre it was for a society to tolerate waiting for weeks and months, in a system that pertains to life or death, but, then won’t tolerate minutes and hours to purchase junk food. The part that amazes me is the fact that some Canadians would define themselves by identifying with our Canadian Health Care System.
Let’s take a few practical examples:
1) A 20 year old patient sees a doctor because she is having some double vision for the past two weeks. She sees her family doctor and relates that three months ago she had a weird sensation in her left leg that lasted six weeks and seems to be stumbling more. She relates that she had an aunt who had similar symptoms ten years ago, has been diagnosed with Multiple Sclerosis, and is now in a nursing home at the age of thirty five. Her doctor examines her and says that MS is a possibility but she would have to see a neurologist, an ophthalmologist, and have a CAT scan to confirm the diagnosis. The patient now is faced with, weeks at the best, and several months at the worst, to have the following questions answered: a) Do I have multiple sclerosis? b) Will I end up like my aunt? c) Can it be treated better than my aunts was? d) What can I do to help?
2) You have just been diagnosed with heart disease that requires by-pass surgery. You have been put on an urgent waiting list. You have been told that survival is far better if you have the surgery, and that the waiting time for this surgery could be up to one month. You realize that your life is at risk while you wait for the surgery; you have trouble sleeping, eating, concentrating, etc.
3) You have had a cough for about a month, see your doctor, and a chest X-ray is done. Your doctor tells you that you have a suspicious area on your lung and need a CT scan of your chest and a bronchoscopy. You think “cancer”. You wait three weeks for the CAT scan and it confirms a “serious problem”. You wait another two weeks to see a chest specialist and another ten days for the broncoschopy. Your thinking “Its taking too long. I’m going to die”. The bronchoscopy and biopsy are done and it takes ten days to get the results. You are told that you have adenocarcinoma of the lung. You are referred to the cancer clinic and see a “team” of specialists. You are told that you need a head and body scan to insure that the lesion is operable. A bone scan is booked to insure that you are a surgical candidate. All the while you wonder “will I live or will I die? If I am going to die, how long have I got to live? Will I die in pain? You have a million other questions.
So tell me again why we Canadians identify ourselves by our public health system? People on waiting lists experience the same basic fears as hostages captured by terrorist; will I live or die, if I am going to die, how long have I got to live and will I die in pain. Many are in pain while they wait for decisions. In short they are under an incredible degree of suffering, and their loved ones suffer with them. Ordinarily, we would call a situation like this cruel and inhumane. Our government calls it difficult, complex, but still keeps the gates to freedom locked. The aged, the poor and the chronically ill have no alternatives but to stay imprisoned in this, our public health care system. The wealthy can pay and escape. They see the specialist, have the CAT scans, bone scans, the surgeon, the radiation oncologist, and the medical oncologist in a matter of days and a course is plotted. They know what lies ahead and what they must do, and they can get it done.
To a large extent, much of the suffering is in “not knowing” and thus, not being able to intervene. Waiting lists are lists of suffering people. What kind of society would take pride in this abuse of the most vulnerable? What kind of society identifies itself by this kind of torture? Depraved dictatorships?
No, it would seem to be our Canadian society; led by the advocates of our universal, monopolistic, and immoral, healthcare system. Each day I would leave work, feeling I had let my patients down. Each day patients were put on lists that were too long; lists where, I knew, in spite of my best efforts, they would suffer much longer than needed. Human rights advocates, where are you when thousands of Canadians need you? We need to be rescued from this “Canadian value”.

Sunday, December 17, 2006

NDP/Friends of Medicare Celebrate Hancock as Health Minister

So Mr. Dave Hancock is Alberta’s new Healthcare Minister. That figures; he said twice as much about health care on his home page leading up to the leadership elections as all of the other candidates combined, and at the same time, said the least. Have you ever noticed that when people go on and on about a subject that they may be treading water. I wrote pages and pages in an exam in medical school and got a 67%. The professor stated that I either knew the material very well, but was unable to express myself, or, I had a very tenuous grasp of the subject matter. I think Mr. Dave Hancock, as a professional politician and lawyer, likely has no trouble expressing himself. His solution to everything is “healthy life styles” and innovation.
Let’s review the key innovative and preventive movements by the Alberta government, and in particular, the Calgary health Region in the past 17 years, so we can get an idea how things are going.
1) Increasing health care costs brought in the innovative idea of decreasing medical school enrolment (if there are fewer doctors, there will be fewer tests ordered and fewer people will be admitted to hospitals). Sick people don’t generate costs, doctors do. This attitude alienated thousands of Canadian doctors and was responsible for the significant loss of physicians to other countries.
2) Increase the training time for a nurse from three years to four years.
3) Hire an accounting firm to set healthcare on a “business model”. This resulted in two hospitals in Calgary being sold, and one blown up. We went from 3.3 acute treatment beds per thousand population in Calgary, to the present 1.7 beds per thousand population.
4) During this downsizing in the province thousands of nurses were let go. These were the recent graduates because the Nurses Union gave privilege to the oldest nurses. Now we have an acute shortage of nurses and an alarming average age (approaching retirement).
5) Walk in clinics were looked at as a way of relieving pressure on emergency departments, but few, if any, took on preventative ongoing care. Income for walk-in clinic docs is much better than traditional family care, so fewer new docs are doing traditional family practice, and fewer docs, overall, are practicing preventative medicine.
6) Private laboratory services were largely taken over by the Calgary Region and more than 50% of small laboratory outlets were closed. This practice continues and patients often wait an hour or more for a simple blood test.
7) As a result of (6.) many small X-Ray outlets also closed and many small medical clinics in Calgary followed suit. Now the government is trying to re-establish similar clinics (8th and 8th, etc) at twice the cost. Little if any preventative medicine is practiced by the physicians that work in these clinics.
8) The region brought in “hospitalists” (physicians who specifically look after hospital patients), and paid them more than the physicians received for looking after their own patients in hospital. This precipitated a flood of family doctors giving up their hospital privileges.
9) Doctors were left out of the decision making process because they were deemed to be a special interest group (I suppose they thought the doctors would only give advice that was self serving). We are told this attitude no longer exists, however it should be noted that our new premier, Mr. Stelmach did not appoint Dr. Oberg as Health Minister (nor did Ralph Klein). The suggestion was that he did not want someone that was “too close” to the medical profession. Interestingly enough, Mr. Knight was appointed as Energy Minister (his background in energy services is seen as an asset), and the fact that Mr. Groeneveld was a farmer seemed to be a plus for his appointment as Agriculture minister.
So much for trying to solicit the help of the medical profession. Could it possibly be that Mr. Stelmach simply needed the “tried and true” rhetoric of “we will save healthcare with innovation and prevention” (and Mr. Dave Hancock can sure preach that sermon), to get elected in the next provincial election. Every prime minister and premier for the last thirty years has been elected with the same song and dance, so why not Mr. Stelmach? And while they fiddle with their innovations and grandiose plans of addressing the “determinants of health”, people die while they wait in “risk” lines.
I note that the NDP are quite happy with the appointment of Mr. Hancock to the Healthcare portfolio, and why shouldn’t they be; he’s their man.
And lastly, the great innovative idea of a health system that is “cost effective” and “patient focused”. I have in previous entries talked of the many pit falls of our cost effective policies. In my next entry I will discuss the “patient focused” part. And if you wish to read more on our new Health Minister, I refer you to my entry “Dave Hancock, a Lawyer’s perspective on Healthcare.

Wednesday, December 13, 2006

Calgary City Council Solves Healthcare Crises

Recently Calgary City Council passed a by-law that pertained to the behavior of its citizens; then, they quickly demonstrated that they meant business by fining a homeless person $100 for spiting in a garbage can. Now, from my perspective, he should have been given a medal. If everyone in Calgary spit and discarded what they didn’t want in a garbage can, Calgary would be an example for the “World Model City ( The Calgary Flames games should rake in tens of thousands of dollars each game!).
Now, I’m not saying I approve of spitting in public, or cursing, or putting your feet on park benches, etc, but how did they come up with fining behavior anyway? Just in the past year the fines for traffic violations increased two or three fold. I thought punishment didn’t work. That’s what we are always told about car theft, vandalizing, assault, and even murder. Perhaps it is only when the behavior punishment has a “cost” component, does punishment work. If that be the case, Calgary city hall has just solved the health care crises in Alberta.
If they were responsible for healthcare, I’m quite sure they would put in the following:
1) Fine each person $500.oo per year per point that their BMI exceeds 30.
2) Fine each person $100.oo per year per point that their blood pressure is over the recommended level.
3) Fine each person $10.oo per 1% that their cholesterol levels are over the optimum level
4) Fine each person $500.oo per year who doesn’t have a membership in an exercise club, with corroborating signature of attendance and “clock punching” evidence of time spent.
5) Fine physicians $100.oo dollars per patient that do not reach the above goals.
6) Increase taxes on cigarettes (or add a fine for smoking).
7) Ration junk food (as butter and some foods were rationed during WWII) and fine anyone going over their ration.
8) Tax all foods that are deemed to be “unhealthy” (in addition to the GST).
Some of you, I’m sure, are being critical of these suggestions; but think about it. The city is fining people for behaviors that they (someone) deems offensive, but is any true harm being done? The traffic “fines” are for the peoples’ and public good, to protect from injury and so on. I assure you, healthy life styles and compliance with recognized treatments would decrease morbidity and mortality from strokes, heart attacks, diabetes, and save the system hundreds of millions of dollars in healthcare costs. Furthermore, if we consider the average life style of Canadians, there would be hundreds of millions of dollars derived from these fines. Not only would there be enough money to fund healthcare, but enough left over for education, infrastructure, welfare, and a host of other worthy causes. Control with fines; yes, even homeless people. After all we don’t uphold the law based on a persons address!
The world has gone mad!

Thursday, December 07, 2006

Gay Marriage

Since today is the day our federal parliamentarians vote on the definition of marriage, I may as well add my two bits to the discussion, and since I am posting after the vote has taken place, the entry is only for purposes of discussion. I, quite frankly, have never understood exactly how a group that supposedly takes “pride” in their sexual orientation, would want to “marry” into an institution that already would appear to be going down hill. With the introduction of gay marriage, the definition of marriage would necessarily have to be changed to the “union of two persons” which gives no specificity or “special ness” to their sexual orientation. What happened to the “pride” part?
As we have progressed over the years, the more advanced societies and science itself, have continued to make an effort to define things precisely so as to better analyze and study for the purposes of advancement. In biology we look at the kingdom, phyla, family, genus, species, and so on so as to identify and learn more. This is done, as I understand it, based on its characteristics and function. In society, we have institutions, organizations and the like, each one bringing something special to the table; each one having certain characteristics. The more precise those characteristics and the definition, the more able a civilization can study societal benefits and contributions.
As an individual, I am not against gay marriage or polygamy (as long as the latter abide by, and protect the rights of the individuals within that union). As a scientific member of our society, I feel that it will make it more difficult to analyze and assess positives and negatives of this initiative, in what is already an emotionally hot issue. As a heterosexual, who is partly defined by my involvement in this institution (I am married to a woman), I feel my identity and the identity of the institution have been somewhat obscured. If the claim of genetic influence is appropriate in determining sexual orientation (and I believe it likely is), then why can this not be reflected in a unique institutional name, one that the participants can be proud of and is defining? If all the rights and privileges of these various groups are equal, how is the charter of rights and freedoms being denied?
Out of interest one day, I telephoned the Canadian Legion to see if I could join. I was told that I could have a social membership but would not be allowed to vote and would not be a “full” member. Quite frankly, this annoyed me. Obviously, since the number of people who have been in the military has been declining, the social aspects of the Legion have been on a downslide. As a remedy for this, they introduced a “social” membership; but in an effort to appease the members that are identified by their service in the military, they have allowed those, that have not defined themselves in a similar way, to join, but not vote. My feeling was that you either meet the criteria or you don’t. Allowing “social” members has, in a very small way, taken away from the identity of the other members; and it was done for financial and political reasons.
I think when an organization loses its defining characteristics, it eventually fades and will cease to exist. This seems to be the case in countries that have had “same sex marriage” for the last number of years. Marriage rates have been going down. In North America divorce rates have been going up. This will have the net effect of fewer people belonging to the institution of marriage. I also think marriage helps to a small degree (but certainly not the only factor) in both having children (necessary to sustain a society), and providing a stable environment for raising children. Do we really want it to slowly fade and die? And this is not to say that gay couples unions are not stable; I simply think they should call the union something else and promote it with pride, rather that attaching to some other union name and broadening the definition.
The next big question and “hot” topic surrounding this issue is “Should the church bless same sex unions”? Recently a minister friend asked me this question. He never asked me if the state should allow civil unions with all the rights and privileges of “marriage” because I think he would know the answer would be “absolutely”. I think he also knew that I felt same sex unions should not be called “Marriage” but likely for different reasons than his. The question was simply a religious one; “Should a Christian religion BLESS a state recognized same sex union”?
The first statement that I wish to make is that there is general consensus and recognition that there should be freedom of religion, and that there should be separation of church and state. Put another way, there is no obligation on the part of any religion to condone, yet alone bless the actions of government, or a government to enforce the beliefs of any one nation.
The second point to be made is that there are many kinds of love. Some people love their work, some people love their pets, and some people love nature and the great outdoors. To my knowledge, the bible recognizes these various loves but also puts a different emphasis and characteristics to these different states of love. It mentions the love of a brother for a brother, a child for a parent, and a parent for a child; it mentions the love we should have for God, and the love that a man should have for his wife, and a woman should have for her husband. My understanding is that he “blesses” all these types of love within their context.
The third point that needs to be made is that Christ loves and blesses the sinner but not the sin.
The fourth and final point is that the love between a man and a woman in the “Marriage” sense, and/or, a “Civil Union” sense between same sex couples, is undeniably meant to be a sexual union. There is consensus that if a sexual event does not take place within a union, the marriage is deemed not to have been “consummated” and therefore can be annulled (regarded as not to have taken place).
With the above points in mind, I find the question of blessing same sex unions a relatively simple one, and the question simply becomes “Does Christ consider sexual activity between people of the same sex a sin, or an activity worthy of being “blessed”, since the activity within the relationship defines both the type of love and the relationship.
And now I await my condemnation as a homophobe.

Wednesday, December 06, 2006

Weyburn Mental Hospital Project, The Precursor to Universal Public Healthcare

I’m not sure what the T.V. program “Weyburn Mental Hospital Project” was intended to do, but it brought back some good memories for me.. I watched the entire program, and as someone that worked there in the summer of 1958, I felt the presentation dwelt on the negatives and gave short shift to the positives; most of which, in the program, were attached to the architectural aspect of the physical facility. They mentioned the grounds to some degree, but not truly in the context of the patients. They did show some tomato plants growing, mentioned vegetable gardens, and mentioned the dairy farm, but for the most part dwelt on the supposed “atrocities” that occurred within the walls of the building. Granted, there are many things about institutional living that most of us would find offensive, but I think the Weyburn Mental Hospital was, in fact, a step in the progress of our society (almost like a huge societal experiment), to address the issue of “What do we do, as a humane society, to look after those who are unable, for whatever reason, to look after themselves?” From my perspective, the major problem with the endeavor was that the scope of what they were attempting to do, with the facility and staff they had, was simply “over-reaching”. Apparently at one point, the facility housed and cared for over 2000 patients, when it was originally designed to look after approximately one thousand.
Much of the T.V. program showed the dark underbelly of the facility, the bed on bed overcrowding, and the fact that the facility was greatly understaffed. Some of the primitive treatments were shown (Insulin and electroshock therapy) that, to the average person, would appear to be inhumane. Mention was made of the use of leg and wrist restraints for violent patients, and the use of the drug epecac to induce severe vomiting. (Unfortunately, the person that mentioned it suggested it was a form of punishment when in fact it was used to cause exhaustion through repeated vomiting in an effort to prevent self-mutilation). Mention was made several times of the fact that our modern anti-psychotics and anti-depressants were not available in those days, but not enough was said as to what would happen to the patients if there was no intervention. Suicides were mentioned, but there was almost the inference that these occurred because of the terrible living conditions rather than their mental health condition. In those days, the Weyburn Mental Hospital “housed” all the people that had no where else to go.
I look back to my summer of work at the Weyburn Mental hospital quite fondly. I had visited the grounds many years before, and being a farm kid, thought it was great. The dairy farm was incredible, clean and well kept. The grounds were immaculate. Many of the patients had gardens of their own, in which they grew a variety of fresh vegetables. As a summer student employee in the summer of 1958, (of which there were many), I had only on rare occasions, been on the wards. My job was to be in charge of the grounds crew of some 11 to 13 patients. This included looking after the green house (beautiful), some weeding, picking up papers, watering flower beds, occasionally digging and planting, etc. My patients had “grounds privileges” (as many other patients did), and would be at the garden shed as the sun was rising. I can still see the old timers sitting around the shed, smoking their pipes, savoring the warmth of the morning sun.
I enjoyed my work there; and in particular I enjoyed the patients. Since my job was one of supervision, and their jobs were more for the purpose of giving them purpose, I had plenty of time to visit with them and get to know them. Most of the patients in my crew suffered from some sort of organic brain disease, although there was “King George”, who was quite psychotic and delusional, and “Two Step” (who was mentioned in the program), who had had a severe psychotic breakdown after his family had been destroyed in a house fire. Poor Two Step; He would take three steps forward and two steps back where ever he went. Naturally he was very late for his meals, for getting his gardening tools, for getting to the work site, etc, but it really didn’t matter because he could be relied upon to get there eventually. Whatever had happened to his family (I was not privileged to his record because I was a student), his pacing was continuous and in cadence with “Burn their heads, burn their bones, burn their goddamn heads, burn their goddamn bones, burn their heads, and so on. As the summer progressed, because I continually engaged them in conversation, I became familiar and friends with almost all of them. One day “The Millionaire” approached me and told me he had decided to leave all his money to me in his will. I, of course, thanked him and enquired as to whether I could use the money however I wished, even on wine, women, and song. He drew himself up to his full height and exclaimed “Then you aren’t god anymore”. Later I reassured him that I wouldn’t waste his money on wine, women and song, much to his relief.
One of the female patients that had ground privileges was about forty and her name was Sadie (not sure if that was her real name). I had been forewarned about a few of the other patients (with ground privileges) and Sadie was on that list. In addition she had signs put up in her own print (stuck to trees, etc) that stated plainly “Tail, Ten Cents”. Now Sadie was quite a smoker so on occasion I would chat with her and see if she was “firm” on her price. She would giggle and tell me secretly’ on occasion, a cigarette was sufficient. I would tease her and admonish her about being too “easy” and she would get a big laugh out of it.
One very large lady (about thee hundred pounds) was quite fond of men and would occasionally try to catch one. One day I heard screaming from around the side of the hospital. I rushed around the building to find the screaming coming from a window cleaner twenty feet in the air on a ladder. Our hefty lady was giggling and about half way up the ladder to “capture” him. She was reluctantly “talked down” the ladder; much to the window cleaner’s relief.
The only patient that really caused me and my crew a problem was a twelve year old girl who had been admitted for psychiatric evaluation because she was actively soliciting sex. I really didn’t know much about her situation, but during her “ground privilege” times she would hang around my crew and “display herself”; sort of like the recent “Brittany Spears thing (I guess if you’re older that’s allowed). The agitation level of some of the patients rose considerably and I had to report her to her nurse. I never saw her after that.
The program mentioned that between 1964 and 1966 they threw the doors open to many of the previous “closed” wards of the hospital, and from time to time patients would be scattered all over the city and country side. My parents reported two naked ladies walking down highway thirty nine on a hot July day. The hospital was quickly, over this time, downsized to approximately 300 people from 2000 people. Many were discharged to relatives, foster homes, etc, but many ended up on the street or in other institutions (nursing homes). One has to wonder if these people are better off on the street or in an institution, no matter what the institution is called. Are we more humane leaving them sleep out in minus 20 degree weather and foraging for their food in dumpsters? Or for that matter bussing them to a warm “sleep-over” and then back to the minus 20 temperatures through the day? How will the generations 50 years from now judge us on our treatment of this group of people who seem unable to live with dignity? And I wonder what ever happened to Two Step, the Millionaire, and Sadie.
Isn’t it always just about money. Is it not possible that if the Weyburn Mental Hospital had continued with the 1000 occupants it was designed for, kept the staffing and programs up, and with the advent of mental health treatments we have today, would have been a facility that would be a mental health gem? Someone made the decision that these mentally afflicted people could make decisions for themselves and make out on their own, at about the same time the government was deciding to put in place a monopolistic health care system that basically declared that the people with all their faculties were not able to responsibly arrange their own healthcare coverage. In our present Universal Public monopolistic health care system, have we not abandoned those very people that need societies help while depriving capable people the right to insure and provide for themselves? As time goes on, the present system has become increasingly burdened with those people who could fend for themselves, with too few caregivers and crowding in our facilities. Meanwhile, the people that really should be cared for and protected wait on long “risk lists”, and are not specifically targeted with intervention and preventative programs. Have we really not just expanded the Weyburn Mental Hospital situation into a National Monopolistic Universal “Healthcare” project? Has our Universal Public Healthcare system become the Weyburn Mental Hospital without walls? Think about it; the Weyburn hospital simply and inappropriately tried to do too much for too many people with too few resources and at some point, rather than being more discriminative in their “coverage “ of their dependant patients, simply threw the doors open (more to the point, pulled the rug out from beneath them), and left most of them fend for themselves. As costs rise in our public healthcare system and the needs outstrip the capacity, will the government at some point, suddenly throw their hands up and declare that we can all look after ourselves? Wouldn’t it to be appropriate (and sensible) to encourage those that are able and wish to provide for themselves through insurance programs and a private system, the opportunity to do so?

Friday, December 01, 2006

Lies, Damn Lies, and Politics

Does anyone actually know how this equalization thing works? I’ve tried to get information on the process, but the general consensus of the powers that be is that if someone told us, we would be too stupid to understand it, so why tell us. This afternoon, while half-heartedly listening to Mr. Dinning on some talk-show, I thought I heard him say something to the effect that Albertans shouldn’t be concerned about equalization payments, and how the formula was calculated because it wasn’t actually Alberta’s money that went into equalization, it was federal money.
Silly me, I’ve always thought that the feds didn’t really have any money except yours and mine, and of course taxes from corporations, which we basically pay anyway because we are the consumers that provide that profit.
So, this is my understanding to date, please enlighten me if I’m wrong:
1) The system was set up to ensure all provinces of certain basic social services that are deemed to be part of the “social fiber” of Canada (Is child care in Quebec included?).
2) At present the formula (???? Which contains some natural resources ???), is based on the “wealth” of the five provinces in the middle (not the wealthiest and not the poorest).
3) The federal government then decides what level of transfer payments (monies), is necessary to level the playing field of societal niceties (they may call it essential services to make it sound better----who knows what it entails?).
4) The supposedly “poor provinces” get the lions share; the “rich provinces” get much less.
5) So the feds take tax money from all taxpayers and redistribute it. In Alberta’s case, much of our tax money going out, and little of it coming back in. But, Mr. Dinning, isn’t my tax money still my money when it ends up in the hands of the federal government? Isn’t it sort of a mandated contribution?
So let us see what happens if a different formula is used, including all provinces and natural resources. I think the intent would be to take some of the burden off of the industrial provinces (Ontario) and bring the total redistribution pot up, thus putting more money “earmarked” for redistribution. It is true, it doesn’t change the amount of taxation money in the federal coffers; it just buys justification for more discriminatory distribution of money for the purpose of gaining votes (Man that sounds paranoid. I must be forgetting to take my haldol again!). So, Mr. Dinning, you have either misrepresented the system to us entirely, don’t understand it yourself, or believe that making large areas of Canada dependent on federal handouts is a noble cause. Which is it? In any case, you sound more and more like a Liberal Lite, as per Ted Morton. Who would think Alberta would have a Paul Martin as their premier. Times are a-changing.

Dinning Will Win, Alberta Will Lose

It continually amazes me that politicians continue to vault themselves into office by declaring they are a “moderate” by supporting our Universal, publicly funded, monopolistic healthcare system. Is that the proper term for supposedly intelligent people, who have the privilege of tracking and analyzing a healthcare system over a period of thirty nine years, witness an exorbitant increase in cost during that time, witness a corresponding decrease in health outcomes during that same period of time, still claim nothing needs fixing and the status quo “rules”. Einstein had a different word to describe it.
Perhaps I am being too idealistic and severe in my criticism and these fellows are simply being politically astute, and the public misinformed; but whatever the case, once again the strategy will work, even in a more independent Alberta. I will predict Jim Dinning will win the Leadership of the Conservative party of Alberta and be Alberta’s next Premier.
Having reviewed how the voting tabulated last Saturday, and taking region by region candidate placement, it becomes apparent how tomorrows vote will go. By adding the first and second placements of Jim Dinning, we arrive at a figure of 76. If we do the same for Ted Morton we get 48, and with Ed Stelmach we get 13. Now I know that this is a region by region perspective, and that the leadership will be determined by the total number of votes for each candidate, but from what I can see, unless there is some unforeseen occurrence, Jim Dinning will be a shoe-in.
And that is too bad for three reasons:
1) If Mr. Dinning has so little understanding and “vision”, of solutions in healthcare, of which he has had considerable exposure, how can we have confidence in his abilities to deal with infrastructure, incredible growth, environment, Ottawa, etc? On the other hand, if he took his “status quo” position on healthcare just to get elected, what does that say about his honesty, integrity, and character?
2) It will indicate that the people of Alberta are no longer prepared to stand up for Alberta. It will mean we have lost the ability to shrug off criticism and to try new things; in short we, who have been the most independent and innovative in Canada, have bought into the philosophy that we should be followers and not leaders. We have become a province and people that believe conflict should be avoided at all cost, and that principle should give way to the common good.
3) Strong leadership on the right could seriously split the conservative part in Alberta. Like many Albertans during the run up to the last election, I considered voting for the Alliance Party, but did not feel the candidates and their leader were of sufficient experience or strength to be credible. Although I voted conservative, many conservatives simply abstained. In Thursday night’s debate, it became apparent that, as Ted Morton stated, Mr. Dinning seemed to have little tolerance for the views of Ted and his followers. The primary ingredient of a “big tent” organization is that each member has respect for each others views. Referring to those views in negative terms such as regressive or scary is not endearing. If the Alliance party were to find credible candidates and convince a Ted Morton to lead it, the conservative vote in Alberta would be split so significantly, the Liberals would likely win the next provincial election.
So there it is folks. I predict a Dinning win and big trouble ahead for the Conservative Party of Alberta.

Private/Public Healthcare, A Synergistic System

I think the first thing we should deal with in our discussion as to how a private parallel healthcare system would work in Canada, is to look at the idea of guaranteed wait times, since some politicians are suggesting this, as some sort of solution to our long “risk lists” in our health care system. Let us take a case where I need a hip replacement. I am in pain and am developing a stoop because of contractures developing in my hip. I relate to my family doctor that the pain pills he has prescribed are no longer effective and I wish to have a hip replacement. He agrees and refers me to an orthopedic surgeon. I am informed that the waiting time to see an orthopedic surgeon in Alberta (any surgeon who does hip replacements) is six months. The provincial guaranteed waiting time in the province for a hip replacement has been set at three months. Does the time I am waiting to see the orthopedic surgeon count as time “put in”, waiting for my hip replacement? I have already acknowledged, and my family doctor and physiotherapist agree, that I need a hip replacement. So the “system will probably say “No, we only count the time after you see the orthopedic surgeon”. Fine, I take my morphine and stumble around for the six months, finally see the orthopod months later, and he concurs; I need a hip replacement. I am then put on another waiting list, waiting for a slot in the operating room, that is again estimated at several months. What happens when the three months are up on my new waiting list and I have not had my surgery? Do I get sent to the U.S.? India? another province in Canada? Or will I be booked at night on an emergency basis and “bump” someone else who is waiting? If we have that capacity, why don’t we just extend the operating room hours now? What if nothing is done? Who forces the government to honor their guaranteed wait time? Can you imagine the hassle trying to deal with the government bureaucracy?
At the same time I have my problem, my neighbor sees his doctor with a similar problem, but is not sure he is ready for surgery. An appointment is made with the surgeon, as in my case, six months down the road. Is he put on a wait list? He sees the surgeon and is told the pros and cons of surgery but the decision is his. He wants to think about it. Is he put on the waiting list then or two months later when he decides to go for the surgery and signs the papers?
The point is that guaranteed wait times cannot work without a recognized process for the many people that will not fall within the agreed upon parameters, and without a treatment resource outside of the existing public system. If this were not true, we already would have appropriate wait times. A private system would enable negotiations between the government and the private system, to agree upon a price and the conditions to be met, and the protocol to be followed to access the private system when the public system has not met their guaranteed wait time, in advance of the situation. All parties, including the public, would be aware of those terms and conditions and the protocol to be followed. My suggestion would be that the orthopedic surgeon involved could approve the move to the private system if the wait time guarantee cannot be met.
When a parallel private system is allowed in Alberta, it is imperative that companies providing health insurance, be invited to be active in Alberta. These companies would offer full coverage comparable to the public plan, or they may offer coverage that the patient could pick and choose from similar to a “menu” of services. People could review this menu and the cost of coverage and choose the coverage that suits them personally. What would likely happen is that as people get older they would insure for joint replacements if the public system wait times were long, and tend not to insure if the wait times were reasonable. This would automatically, to some extent, control the wait times and cost to the public system. Some people would choose to wait in the public system so their premiums would not go up, some would change their life styles to bring premiums down and within their reach. Patients, as taxpayers with insurance, would always have the right to the public system, or the private system, at their option. The better the public system works, the fewer people will take out insurance.
Timing is critical with this next issue. Although our present physicians must be allowed to work in both systems, it is extremely important for the government to do their homework in advance. A search should be undertaken for physicians who have left Canada and set up practices elsewhere. They should be invited to return to Canada, practice in the public system, the private system, or both. Obviously, the private system will try to attract good physicians into their programs, but they will be looking at physicians in Canada and abroad. The government should focus on those who have left Canada for reasons related to restrictions in practice. Properly approached, many of our native sons and daughters would return. It has always amazed me that we Canadians are so supportive of diversity in our culture, but stick stubbornly to a monopolistic healthcare system. And why do we press for ways of bringing in foreign doctors, instead of looking at ways to recruit back our own sons and daughters who left Canada because of our narrow minded perspectives on health care?
Which brings us to the next point; by having a private system, the public system, its administrators, and the government, will have their feet held to the fire. People will investigate and educate themselves as to what is covered, and what is not covered in the public system, and whether they have a need for additional insurance. People will realize that there are choices to make, and that they cannot be, and should not be, wholly dependant on a government system that has not defined exactly what it is, what it is not prepared to finance, and how it is going to do it.. The importance of life styles is underscored in a private system, adding to patient awareness.
Our existing government leaders in health care continually mention “preventative” medicine, and that this is the answer to sustainability in our Canadian system. Unfortunately, any benefits derived from altering life styles (quitting smoking, exercising, loosing weight, etc) will be many years down the road, presuming there will be enough patient compliance to make a difference. Presently healthcare costs are sky-rocketing, and waiting lists are getting longer, or have not changed. Programs of long term societal changes, to be effective, will necessarily be costly and long term. How will the transition from ever increasing intervention costs and these significant prevention costs be bridged? As previously stated, cost benefit will not be realized for years.
Once again, interim private insurance can bridge the gap. From my perspective, the government’s primary responsibility should be public health with all of its implication. They should be primarily responsible in the areas of pandemics, epidemics, life style issues and preventative health, immunization, neonatal care issues, poverty, food safety, pharmaceuticals, etc; the list can go on and on. The next priority of government and closely associated with the first should be to address the issues that have to do with chronic disease such as diabetes, hypertension, cancer, etc. The last responsibility in healthcare, of governments, should be, on a province by province basis, to provide a safety net for unforeseen medical events for its citizens who are unable to fend for themselves. The idea that we, who are able to fend for ourselves, should be excluded from doing so, is insulting, offensive, and undemocratic. There is absolutely no reason why the private and public systems cannot work together in the “intervention” area of health care.
Finally the issue of healthcare premiums should be addressed. As long as low income people are exempted it is not really an issue. Basically, it is simply another taxation measure. It would be nice if a little ingenuity were used in the administration of this tax. What if rates varied somewhat with life styles? What if those paying the tax (premiums) actually got to pick and choose some health care benefits specific to them and their needs (travel coverage, ambulance coverage, additional drug coverage etc). With the drive to a computerized health record, it would be a piece of cake to implement. But I’m sure someone would find some inequities in such a system. Lord help us if we show some true innovation that may not be 100% inclusive.
The above is a rough draft of how a private health system could be utilized in our present system. It should NOT be considered, in any way, a replacement for our existing public system, as the doom-sayers screech, but an add-on; a tool to be used by those who choose to use it, and by the system, to shorten wait times and give people more control of their lives. Too bad none of the candidates or for that matter, Iris Evens previously, took the time to introduce the subject rationally and objectively. But then again, who is listening?