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, February 21, 2008

An Obama They Are Not

Well, that was embarrassing! We in Alberta can only hope not many other Canadians (or people from other countries, for that mater) were watching Alberta’s great leadership/election debate. A Mr. Obama we don’t have, either from the perspective of an orator, or any kind of a message of hope----particularly in Healthcare. Mr. Mason basically is saying they could do better, and suggested salaried doctors, seemingly oblivious of the fact that a salaried family doctor typically sees fewer patients than a fee for service family doctor (how will that get more people a family doctor?), Mr. Stelmach says they have everything under control, and Mr. Taft simply whines that we are where we are because the conservative government got us here, conveniently forgetting that the other provinces in Canada face the same or worse scenarios. Mr. Hyndman raised the issue of “the money following the patient” which is a principle that has been bantered about for the past fifteen years and has never gained traction.
The entire program could have been a five minute program and could have been limited to their 45 second summaries. Mr. Mason will look after you from the sperm to the worm, Mr. Stelmach states that they are doing a great job; Mr. Taft whines that it isn’t fair that the Liberals haven’t had a chance to rule in Alberta, and Mr. Hyndman states that if we want change we should get back to a policy of “survival of the fittest”.
At the same time the Great Alberta Debate was on, I noticed the program “Lost” was on another channel. Dutifully, as a responsible citizen, I watched Alberta’s Great Debate. Unfortunately it turned out to be just another version, and I might add, an inferior version, of “Lost”.

Wednesday, February 20, 2008

Quebec, Our Healthcare Saviour

Wow, healthcare in Calgary, Alberta, has made the headlines of the Calgary Herald two days in a row. Today it reported that the system was stretched to the limit and that patients were waiting in the emergency department for as long as twenty four hours for an admission bed. I thought there was some kind of rule in place specifying (mandating) a much shorter time, I guess somebody found out that when the beds are full, and the hallways and sunrooms are full, they stack up in the emergency department and the rule can go to -----. Come to think of it, the article does say that 17 patients were in hallways waiting to be seen by physicians while paramedics “medi-sat” them. Keep in mind, the city budget pays for the paramedics.
It would seem that once more the Calgary region is short of money, 115 million dollars, to be exact (er---sort of exact). In the same paper the Region blames the province, the province blames the Region, and they all blame the increasing population (the patients), and nowhere in the newspaper or on the campaign trail are solutions being offered. Some MLAs are lashing out with accusations that the Royalty increases have killed the economy, while also in section “A” of the same addition a headline reads “Alberta’s 4.2 billion dollar budget surplus larger than expected”. The health Minister, the Honorable Mr. Hancock states firmly that he will not recommend covering the shortfall because it may encourage the Health Region to spend more money, but assures those of us that are gullible that patients will be cared for (even if he has to do it himself????).
Finally, national columnist Don Martin offers some hope on page 10. He points out that Quebec is moving towards solutions that are a threat to Medicare by virtue of a report released by Liberal Cabinet Minister Claude Castonguay. He points out that for political reasons the feds will stay quiet on the issue and if enacted, the report will “turn Quebec into an unfettered health delivery revolutionary” (personally I love the “unfettered” part of the statement). He goes on to say that if that happens, no other province will accept federal consequences or penalties for becoming a rogue state of privatized health care. He then sort of summarizes and buys into the stupidity of the last twenty years with the statement “The Canada Health Act will be dead----and two tiered healthcare very much alive.
The Canada Health Act will never be dead, Mr. Don Martin; it needs to change and will change, but die it certainly will not. As for the “Two Tier Boogy Man”, anyone who has the barest knowledge of our present day Healthcare System is fully cognizant of the fact that it already has many tiers. I say Viva La Quebec!!!

Tuesday, February 19, 2008

Healthcare Top Issue, Canada and USA

“Doctor Shortage Makes Health Top Election Issue”; this is the headline in Today’s Calgary Herald (Feb 19/08).
So I read the article, thinking I would encounter some thought stimulating innovative platforms from Alberta’s political parties on Alberta’s Healthcare system. Unfortunately, the only ideas put forward by all four parties are the same ones that we have heard over the past twenty five years (promises) and that got us to this present day state; or ideas that are totally irrelevant or counterproductive such as eliminating healthcare premiums. Would someone please tell me how decreasing the government’s revenue stream is going to help provide more family physicians to the citizens of Alberta? Now, if they had said they would increase the threshold of annual income before paying premiums and increase premiums for high risk life styles, at least some discussion would be precipitated.
All four parties claim they will increase long term beds, increase the numbers of graduating docs, etc, etc, etc. Haven’t we heard this a thousand times before? If the number of graduating docs that choose family medicine continues to shrink, how in heaven is graduating more plastic surgeons, dermatologists, etc, going to help? And if we can’t retain in Canada the physicians we in Canada graduate in the various specialties including family medicine, are we not simply providing well trained physicians (at the tax-payers expense) for the United States, Australia, New Zealand, etc?
The reason none of the political parties want to get into the healthcare issue is that they all realize that at present in Canada and Alberta, healthcare costs are being controlled through rationalization of services; not through legislated restrictions, which would be politically onerous, not through direct fees that would be politically onerous, not through private insurance options that are PERCEIVED to be politically onerous, but through restricted access to healthcare personnel and technology by virtue of scarcity, the politicians greatest ally in our present system in controlling costs.
The article in today’s Herald states that “the experts” say there is no simple solution for what ails the health care system, and Dr Glenn Comm, President of the Calgary and Area Physicians Association says “there are no quick fixes” and “We got into this mess over a long period of time”, but my question is: How about some quick STARTS to fixes, how about at least looking at some options other than those that “Got us into this mess over a long period of time”, how about some real discussions without special interest groups trying to STOP discussion. Any solution has to address increasing costs and at the same time offer the population better access. It would have been nice to see at least one of the political parties identify itself as real change (an opportunity for the Alliance Party)
in the area of healthcare, a party willing to look at options on both the left and the right of the political spectrum. A simple example would be to bring in a registry system with intensive intervention in the area of chronic disease (an idea that many would think intrusive and too “left-thinking”), coupled with private insurance availability and facilities for those that can shop the market for the best coverage (an idea that is strongly rejected by the “left” and considered to be “right wing”).
Alas, all the parties avoid any open discussion of healthcare like the plague. Perhaps they all agree with one of Canada’s somewhat notorious Prime Ministers when she stated that an election is not the time to discuss substantive issues. Mind you, she was voted out resoundingly in that election.