The complexity of health care never ceases to amaze me. It's like a contrarian puzzle--as more pieces are added, the more complicated it becomes with completion made impossible. To put it concisely, it is a "head banger".
Before I go any further, I'd like to take a moment to show my gratitude for the excellent contributors to this blog. Over the years I am continually appreciative of your insight, dedication to shining the light, and persistence.
More than ever, we need common sense voices to be heard above the din of political posturing and above the vocal groups with union backing.
The posts from the past few days on debt, end of life care, executive salaries, OMA-MOHLTC negotiations, inequality theories, are all connected. The difficult issues surrounding these areas have developed in significant part from a single payer health care system that has been overcome by harsh realities of an aging population, a sluggish economy likely to go on for decades and attempts at political distraction.
First, Ontario has a debt of approximately 300 Billion and growing even as Premier Kathleen Wynne talks deficit reduction. Her calls for federal collaboration really mean, "give Ontario more money" but her Liberal party has not spent judiciously. You all know the various scandals and overspending from ehealth, to gas plant scandals to smart meters, to failed energy policy. Even the Canadian Medical Association has got into the act calling for a National Seniors Strategy aka more federal funding for health care. In fact, there is more federal money being transferred to Ontario but it can't go on.
The price of Canadian oil has dropped precipitously and while customers at the pump might be rejoicing, there will be an impact on federal coffers. We should be grateful that Canada, at least federally, is in a reasonable situation to withstand another economic shock but for political or health care leaders to think that the answer to medical service delivery issues is to go back to the federal pot is undisciplined and indulgent.
I note that Health Quality Ontario is calling for more palliative care support. I can't deny the need for this. How will it be paid for? As we add more layers of care whether it is patient navigators, preventative measures, more palliative care, caregiver support or more pharmacare, there needs to be an understanding that it all costs more...somewhere the tab gets tallied and somebody has to pay unless, of course, cuts can be made elsewhere.
Lo and behold, I am hearing more and more from people who tell me that their aging family member, friend or acquaintance is being denied care. It is typically a patient into their 80s or 90s whose family is told that the hospital bed or resources are finite and that spending on the dialysis or other life saving procedure would not be best use of the public resources. It is both stunning but predictable.
The patient whose family members are able to advocate for medical services that should be legally available to them survive to fight another day. Those who can't are denied care. I thought Ageism was illegal in Ontario but apparently it is being practiced on an ongoing basis led by physicians who believe they are doing the right thing by sacrificing the patient in the name of the system. Even though the courts have upheld the rights of families to determine when to cease life prolonging medical intervention, MDs are taking it upon themselves and their representative organizations are pushing to create a health care environment where some people's lives are seen as undeserving of resources. It is disconcerting to say the least.
The discrimination is occurring quietly but it speaks volumes of a society that is losing its values. The modern medical profession that was once considered a life saving and life preserving entity is now participating actively in denial of care and is in a serious conflict of interest as it is driven by politicians to control costs. This kind of comanagement is not ultimately helpful. It simply pushes costs further out, where they collect insurmountably.
The calls for poverty reduction, more money for social determinants of health, more palliative care, more, more, more go on and on. Today I read Dr Eric Hoskins, Ontario's current health minister, discussing the need for a National Pharmacare program touting the benefits of being able to negotiate better generic prices. I acknowledge the need for more ways to fund much needed medication but a National Pharmacare program cannot be had until a Hybrid system for medically necessary care is created. Tax payers and fee payers cannot continute to add more and more services that must be funded by a relatively smaller tax base. The reality of demographics stands in its way. A National Pharmacare dialogue is a clever distraction from what ails Ontario's health care system but let's be realistic about how it can be funded. Driving up debt at both provincial and federal levels is not the way to a properous country that can provide opportunity for the next generation.
Oil, Ageism, Pharmacare...they are connected. In a complex world with our complex health care system, we can begin to take measures to create flexibility for patients and in funding of health care. It will require trade offs and a Hybrid medical system that combines a robust public system with private options. We have until 2025.