Dr. Merrilee Fullerton on Healthcare

Lots of talk about fiscal restraint by Ontario's Liberals. Too little, too late. When Smitherman was setting up his expensive Family Health Teams and spending oodles and oodles of cash to transform Ontario's health care system into a consultant-happy- bigger black hole than it was, people said "we can't afford not to do it!"--- A dangerous sign of things to come.

Our politicians stand before us and tell us that now is the time for difficult decisions (that time was long ago) but it is difficult to make difficult and possibly initially unpopular but necessary decisions when one's political life depends on telling people what they want to hear.

I will acknowledge that the Ontario Liberals are caught between a rock and a hard place and no matter what they do they will hear complaining from one camp or another. But at some point, it is important to do what is necessary. That doesn't look like it is coming any time soon since Dwight Duncan tells us recently that continued spending increases will occur in health care. Strange thing that comment since rapidly rising health care expenditures are what is driving spending in other necessary areas to be cut.

Alas, we are tied to the mast of the health ship that is taking every other sector down with it while politicians hold hands and will leap just as the going gets rough, just as they always do. 

Definitely, I am sounding cynical today. The public is led to believe that health care is their God given right and they are soon to find out the repercussions of such thinking.

The leadership vacuum persists. There is no independent body to speak to the public with cold hard fact. Health Council of Canada does little if anything except spout the political health care dogma of the day persistently. Nope, no leadership there either. The OMA seems bound to government so tightly it can't breathe a breath of fresh air into the whole mess either. The CMA tries but will have difficult times ahead as its soon to come leadership may turn out to be regressive.

The media fails because of its largely left wing tilt and because it sees more payment and responsibility for individual health as evil--apparently better to keep us all dependent. But new media sources are coming on stream and the traditional private care hating journalists have probably had their day in the union sun.

At least in Alberta, politicians are trying to tell it like it is but the public denial may turn out to be too strong.

Perhaps the real catalyst for change will be a dose of reality, delivered to the public from non-health care related sectors.

Some facts, if you didn't already see them in the headlines today:

* Ontario deficit to hit 25 Billion-up sharply from $14.1 Billion in March

* Action plan to be revealed in 2010 (doesn't sound like action to me)

* Leaner and more efficient provider of quality public service to come (!!)

* Ontario is spending 4.8 Billion more this year than predicted

* Tax revenues falling dramatically- about 6 Billion less that predicted last spring

* Corporate tax revenue is about one third lower than predictions-2.65 Billion less (a hefty drop)

* Ontario's massive deficit is heightened by the growing size of the health care sector, expected to account for half the budget as early as 2015-Pascal Gauthier, TD Economics

*deficit budgets for years to come

* projected deficit of $21.1 Billion in 2010-2011

* projected deficit of $19.4 Billion the following year (wanna bet it will be more?)

*and how 'bout that eHealth spending, and hiding Tepper', McLeod's and Sapsford's funding deep in hospital budgets to top it all off?

The public may have to find out for themselves the hard way...just like my teenagers.

Not so long ago, I think ELB asked for a new topic.....was it on "prospective" payment for physicians a la New England Journal of Medicine article? Let me know ELB and we can fit that one in somewhere along our conversation route.

But it gets me to thinking, that we are in a new world of health literacy not only for physicians just to understand what prospective payment means but for the public and patients to understand their role in their own health care.

Granted, not everyone will be able to become literate in their own health care but I hazard an educated guess that the majority will. Trouble is, many physicians, politicians, health policy types and administrators tend to see patients as illiterate or pretty close. This is all very unfortunate since people are going to need to become more aware of how to manage their health care.

This starts with health literacy.

Empowering and educating patients in their own care will require an understanding of health terms and how to use the system including medical social networking sites and mhealth. Forget Michael Decter's book on how to navigate the Canadian health care system-that was obsolete before it was published. Just look at the ease with which anybody under the age of 75 manages a mobile phone, sends photos electronically and surfs the internet.

The majority of the public can do this and those who can't will need government support. Fine, but to think that government can spend billions and billions on failed eHealth strategies because of the government centralized one-size-fits-all-especially-the-consultants approach, well, we would be doomed to fall and fail endlessly.

Social networking sites are likely to take on a significant new role in health care but establishing reliable sites guided by the medical profession or another respected source will be the real catch.

How long will it take for the health care leadership in Ontario or Canada to figure this one out.

By the way, I hear that an auditor's report on the federal version of Ontario's eHealth, Canada Health Infoway, will be out in early November. It should be interesting.

I'll post some links in the comment section and don't forget to visit the twitter link if this sort of thing interests you.

Welcome to our newcomers and thanks for the fascinating contributions from all of you.

To be honest, I am getting tired of seeing Sarah Kramer's photo beside every article on eHealth and its lack of accountability. She may have been sharing the helm but the rot goes much deeper than that. I suppose her name will forever be associated with the scandal and others will slink away only to surface in another government agency or as some kind of consultant.

And lo and behold, we see Gail Paech mentioned again...and again...and again.

What is it about government bureaucracy that allows the same old, same old to keep being recycled? A little new blood is a good thing from time to time but government should attract them before they are thoroughly brainwashed and banging their heads relentlessly against the same health care wall or health care bible depending on how you look at it.

I provide a link below to an article in the Toronto Star today. Go for it!

When we talk about health care, we talk in the billions, and in some cases trillions, of dollars and in time spans of decades and in physicians and nurses per 100,000 population. Numbers are really, really big in health care-- REALLY big.

Planning that utilizes statistics both past and present and then attempts to extrapolate this information to the future is tried, but with significant error, because the world isn't static and neither is science or technology or the economy.

Just a year or two ago, there were suggestions and even insistence that growth in Canada's GDP would be sufficient to offset the rising costs of health care. A great deal has changed since then and no matter how we wish things could be different, we really do need to face reality.

An excellent article recently in the National Post by Terence Corcoran pointed out some significant facts:

* The federal deficit (not debt) for this year, originally estimated at $50 billion is now pegged at $55 billion

* According to Finance Minister Jim Flaherty, by the year 2015, the series of deficits expected over the next few years will run up the national debt (not deficit) by $170 billion

* Ottawa's total net debt will rise to $628 billion meaning about $19,000 per capita which isn't much different from 1997, the peak year for federal debt.

* Provinces and local governments are also running deficit budgets.

*Ontario is heading for a deficit of $18 billion this year with deficit budgets likely for years to come.

* BC, Alberta, Quebec, New Brunswick and Newfoundland....all riding deficits....to the tune of about $31 billion this year alone.

* Canada's provinces are likely to add close to $100 billion in total new debt over the next five years.

* Added to the provinces' net debt of $274 billion as of the end of 2008, this additional $100 billion will bring the provincial net debt to $375 billion by the end of 2015.

* Add $375 billion in provincial net debt to the projected federal net debt of $628 billion by 2015 and you  are looking at $ 1 trillion (TRILLION) in debt...about $30,000 per man, woman and child.

So...the message is likely that to turn this trend around, cuts to government spending will be needed and possibly more taxation. Either one on its own is painful. Together they are even more concerning.

With health care being the biggest portion of all provincial budgets and with federal funding for health care already having been dished out fairly lavishly to the tune of billions and billions only back in 2004 (remember, the "fix for a generation" by Paul Martin) one wonders where anybody gets the idea that   we are going to get the funding to shorten wait times, add a national pharmacare program or adopt new and increasingly expensive diagnostics and treatments let alone contribute to improved education programs and environmental initiatives or to withstand the economic blast of a serious pandemic.

No doubt about it: The public is going to have to be more self-reliant when it comes to their health care whether through monitoring their own chronic illnesses, using social networking sites to connect with others who share the same illness or through funding their own procedures or preventative care.

Once again, I'd like to thank all of you regular contributors that keep this blog going despite my occasional respite. Of all the health care blogs and even non-health care blogs I've visited, this one has the most ongoing contributions. Kudos to all of you for the great input.

The readership continues to grow and I'll be looking at additional ways of bringing more opinion to us. Welcome to Dazzo and a welcome back to Lurker. We all look forward to hearing more from you as well as from our very informed regulars.

Recently I've been struck by the emotional and divided response to President Obama's call for health care refrom in the US. Various individuals and groups on both sides of the discussion have been vilified from time to time and it just doesn't seem like a very tolerant way to go about debating or advancing improvements in health care.

Can't we just get along and allow individuals who want to spend on their own health care to do so whether through health savings accounts, tax free savings accounts, or transgenerational insurance or other?

Can't we just agree to disagree and then let individuals find what works best for them? We've done this in many areas. Why not in health care?

One of the biggest criticisms of Canadian health care recently is that there isn't enough government money spent on prevention and wellness--we are disease oriented in terms of providing health care. That's a fair criticism but look a bit deeper and it may be surprising to find that prevention won't save health care dollars which is why there are discussions about health care reform in the first place. If there were sufficient funds to cover everything for everybody, there would be no debate or even need for reform.

As much as there are many people devoting much time and energy to the promotion of better health and health outcomes, we need to be honest about the cost of such programs. It seems that the underlying premise is that more prevention will save health care dollars. But such may not be the case.

We should first mention that there is a difference between individuals being in charge of their own prevention and taking responsibility for their actions or inactions versus  government funded health prevention programs that take into consideration mass screening, large amounts of pharmaceutical use, and a large scale push toward incentives and pay for performance for providers.

As much as prevention would seem to offer up cost savings, the potential outcome of more government organized screenings and primary care prevention at the provider level (and here  I  make the distinction that the latter should be seen as separate from public health type policies that allow for clean water, improved sanitary conditions and clean air and environmental awareness) to cost more, not less, is quite real.

I will post the link to the Congressional Budget Office and its information on overall cost savings on prevention in health care and also the link to the letter that is mentioned.

Now some of you reading will think that I am a real dope and that I don't believe in prevention. That is not the case. I do believe in prevention. It's just that I don't believe prevention will save the health care system in Canada any money. It will cost MORE. Let me repeat that. Prevention will cost MORE.

On an individual level, better prevention of all kinds will provide improved quality of life. However, costs of health care prevention measures must be weighed against the need for improved education for Canadians as well as the need for more social programs such as adequate housing for dependent individuals amongst other important and urgently needed public health improvements.

The idea that more prevention will keep down health care costs is just wrong. It certainly deserves its place but preventative health care needs to be seen for what it is...an individual decision requiring individual responsibility.

Thanks for reading and for your most enlightening contributions as always. I am most grateful for your support.