B.C. Courts will bring into Focus the Hard Questions about Canada’s Health Care System
Thursday, September 8, 2016 at 09:01PM
Canada’s health care system has been called many things including a “jewel” and “the very essence of what Canada is all about”. It has also been called “sclerotic”, “archaic” and for politicians it has become “a sacred cow”. For many Canadians, our health care system has become a mirage. Aside from the illusory notion that our health care is “free”, many cannot explain how it works and how it is financially sustained. Many cannot access the care they need.
However, this mirage is going to be drawn into clear focus in the weeks and months ahead as the B.C. Court is hearing a case put forward by surgeons and patients that accuse the B.C. government of denying them their rights to timely medical care.
Perhaps the B.C. case will allow Canadians to begin the necessary discussions about how our health care must change to address the serious systemic shortfalls within it. We have a strained health care system due to an increasingly aging population, more pharmaceutical options, more medical technology with associated potential interventions, and emerging science that requires more medical research and money.
For people waiting for care, or denied care, or whose disease is treatable elsewhere but not here, the limitations of our current system have become numbingly clear. We should walk a mile in patients’ shoes to understand the importance of the B.C. Charter Challenge for those who have been denied timely care. While the outcome of the case is important at an individual level, it will also resonate at a societal level – throughout our country.
Some people choose to frame the case as a “private vs public” health care battle and foresee the destruction of Medicare if B.C.’s provincial health care service loses the case. However, at a foundational level, the case is a challenge about the rights of Canadian patients in a system that denies timely care. What rights does a patient have? What recourse should a patient have? What suffering can the government health insurance plan fairly impose on an individual patient, if any? (In a country that has recently witnessed the Supreme Court of Canada rule in favour of an individual’s right to die, one might expect that it would also rule in favour of an individual’s right to live.)
Now is the time to ask the difficult questions about what we want from our health care system that was designed for another era and which, despite transformation, is a laggard in the developed world. Many of us who have been part of the on-going debate about patients’ rights and the short-comings of the system recognize that we can and must preserve what is fair and equitable about Canada’s health care system and move forward to improve what is not.
There are some important questions that must be fully discussed.
Must we pit patient against the system? What is more important, the patient or the system? Can we not all agree the system must exist for patients? So, the question then becomes “How to provide more care to more patients?” In that context, how is it ethical to preserve a system that cannot meet patient demand despite almost fifty years of trying?
How comprehensive a system can we afford? Do Canadians want modern health care that keeps up with change, or do they want an archaic system designed for fifty years ago? As pharmaceuticals become more and more prominent in treatment options, many Canadians want to include pharmacare in our country. However, the cost of Canada’s government funded system makes it difficult to move forward in publicly funding other areas of care such as eye care, dental care, and newer pharmaceuticals for cancer and other previously untreatable diseases. How can a better balance of services be achieved that will meet our expectations for an advanced health care system?
There’s the important issue of “Universality”. Do Canadians want universal health care coverage in theory or in reality? The term “universal” does not mean “government funded”. It simply means coverage for everyone. There are many ways to provide coverage for everyone in a truly universal system that creates access instead of imposed rationing. Many other countries have hybrid systems for medically necessary care and manage to achieve universality at lower cost and with better outcomes. Why aren’t we looking at and learning from other better performing systems? And, what of portability of care in Canada? Do Canadians want a system that provides similar services across the country, or do they want the system to be determined simply by the degree of rationing required in each province?
What is to be done about the under-utilized infrastructure and medical workforce? What do Canadians want, more government rationing of care or more ways for more patients to access care? Canada has less than the average number of physicians per capita compared to many developed countries yet we cannot fully employ our medical workforce due to costs associated with utilization of government funded services. Operating rooms and surgeons sit idle, hospital beds may exist but are “unfunded”. Hybrid systems of other developed countries have more providers, more hospital beds, and better access to medically necessary care at lower cost than Canada’s health care system.
Canadians must have this honest and difficult discussion about our health care system if we are to create a truly universal system with quality health care that addresses patient need. I believe the B.C. Charter Challenge will help in this dialogue. Contrary to rhetoric about the case being an attack on Medicare, it is not. Given the history of our country, Medicare will continue, but we must acknowledge its faults. A more robust health care system is needed, one that is truly universal, comprehensive, and accessible and not so negatively impacted by government short comings both in funding and in vision.
The B.C. case will bring our health care system into much clearer focus. It will drill to the core of the debate. If we are to give patients the dignity and respect they deserve, then we must acknowledge that they are part of the solution and give them the necessary freedoms that are currently lacking.
Reader Comments (556)
http://www.ottawacitizen.com/news/national/mulgrew+groundbreaking+suit+threatens+universal+medicare/12187934/story.html
"Saving the sales tax will be nice, of course. But the government still has to pay for all those hospitals and schools, so it’s going to have to get that money from somewhere else. As any economist will tell you, across-the-board cuts (subsidies) to energy costs are always a sop to the rich, since the well-off consume a greater share of power to run their 4,000 square-foot McMansions. This plan is expected to drain $1-billion from provincial coffers. It’s a shell game they’re playing. It’s still your pocket that’s being picked."
http://www.theglobeandmail.com/opinion/wynnes-way-rob-the-poor-help-the-rich/article31835620/
Closing Time by Semisonic (1998) from the album Feeling Strangely Fine.
https://www.youtube.com/watch?v=3xzDm5v7lXI
Appropos tune! Well done DITP.
Health,frozen,with hospitals being advised to squeeze more.
Most life insurance companies can calculate cost of waiting lists/no treatment. It is how they help adjust their rates.
Now we're getting somewhere! Time to unmask and reveal the depth of corruption in this government.
This has me thinking, maybe the trade-off of losing corporation and small business privileges would be offset by the benefits of unionization. I don't particularly care to run an office or hire /fire staff anyway, let us all be government lifers, I think I might learn to love big brother!
Resurrecting old skills is very difficult ....the Soviets , with collectivization, team based collective and state farms, destroyed the small landholders, the small farmers and destroyed their voluntary cooperatives.
Agriculture collapsed, the USSR / Ukraine which had been the bread basket of the world , became , instead, a net importer of grain and food, with mass starvation , the Homodor...murder by starvation of 7-10,000,000 not to mention the deportation to Siberia of so many more.
The skills and knowledge of the murdered / deported peasant farmers was lost...the remaining teams of Soviet agricultural bureaucrats were completely out of their depth, blundering about incompetently with disastrous results and declining productivity.
Two decades after the happy collapse of the Soviet block, the agricultural decline has not recovered....perhaps it is bottoming.
Modern day Russia is hoping to attract back to Russia the ancestors of the Old Believers once exiled with their skills ( learned over a 1000 years) in sustainable forms of agriculture, with their ability to survive in harsh conditions and ability to live in harmony with nature....to recolonize the very lands , now lying abandoned and fallow, that they were removed from.
There were 15-20, 000,000 prior to 1917....perhaps there are some 5,000,000 surviving now world wide , living in the USA, Canada , Australia, New Zealand , Brazil, Uruguay and Argentina.
Solo / Small group FPs resemble the Old Believers in many way...however their skills will die with them.
Bill 210 will get passed so that local boards determine terms and conditions of where and how one can do medicine in their area. Only the conformers will be accepted.
Central will spend the next 2 years,focusing on "high billers".It has no solutions to health care, so can only focus of those whom they can blame for health cares woes. Healthcare is not working because of "high billers". By applying "social justice" policies, and bringing the "high billers" under control, all will be fine.
Those top 2000 are about to be demonized.
No surprise here. Every government rediscovers and finds it a short term response but not a solution.
From
JULY 1, 1992 CAN MED ASSOC J 1992; 147 (1) 33
Toward integrated medical resource policies
for Canada: 6. Remuneration of physicians
and global expenditure policy
Greg L. Stoddart, PhD; Morris L. Barer, PhD
"We do not find individual income thresholds a
particularly appealing policy option, except as a "last
best" (or perhaps "first but temporary") instrument
to stimulate a more constructive and collaborative
development of other policies to manage physician
resources. If quality of care is an issue, then an
improved system of continuing competence assessment
seems to us a preferable policy. If proliferation
of services is a concern, then decreased reliance on
the fee-for-service method seems preferable. We
share the widely held concerns about the current
levels and distribution of physicians' incomes; however,
we also share concerns that thresholds, unless
carefully designed, may "penalize the good guys."
An integrated set of revisions to quality assurance,
remuneration method and physician supply policies
should be the objective here."
Central just needs a short term strategy and tactic, to divert attention from solving an insolvable ideological dilemna.
Diversion is - in plain fact - Central's ONLY tactic.
http://www.thestarphoenix.com/news/national/mulgrew+chicken+little+arrives+complex+medicare+trial/12194155/story.html
"The real issue in this case is about data — are medical waiting lists so bad that people are dying or suffering physical and psychological damage to an extent that court intervention is required to stop harmful consequences of a fine-sounding government policy?"
The issue is - can government prohibit access to medically necessary treatment while failing to provide it? If so, under what circumstances?
- From the star Phoenix link above, wow. My main take home point is that I need to use the term "audacious scofflaw" more often in my day to day conversations!
,
Er medicine is tough and we all make the rare bad decision (in retrospect) at 0300. I like sleeping at night so generally error on the side of caution. We don't often get a second crack at the patient and are relying on follow up in the community or not at all so we probably over investigate. That will not change.
A written referral letter faxed or given to the patient is much appreciated. Often the doc that takes the call (if they do call) is not the same one who sees the patient.
"It’s become abundantly clear that the appropriate processes in place are not working for thousands of Ontario patients like Mayor Macmillan,” she said. “The Minister of Health cannot continue to wash his hands of Ontario patients who are falling through the cracks.”
http://www.torontosun.com/2016/09/15/cancer-stricken-mayor-hec-says-onatrio-health-system-rigged
Electricity has knocked health care and the physician services agreement to a spot after the morning Dilbert comic strip. And no one reads Dilbert anymore!
What lessons are there for the OMA?
P.S. The government is going to lose a billion dollars in tax revenue by eliminating the provincial portion of the HST.
Where do you think the offset is going to come from? Anyone, anyone?
Buehler?
Hydro has been on my radar and that of many others for quite some time. Clearly the SRR by-election loss was a wake-up call for KW.
ELB, are you suggesting there is another catalyst?
N Engl J Med 2016; 375:1011-1013September 15, 2016DOI: 10.1056/NEJMp1608289
"The hospitalist model has provided such putative benefits as reductions in length of stay, cost of hospitalization, and readmission rates — but these metrics are all defined by the boundaries of the hospital. What we don’t yet know sufficiently well is the impact of the rise of hospital medicine on overall health status, total costs, and the well-being of patients and physicians."
...
"As patient care becomes increasingly fragmented, many physicians find it more and more difficult to provide truly integrated care. Physicians whose practices rest on a clear separation between inpatient and outpatient care or manifest a shift-work mentality are more likely to respond to requests from patients and colleagues with, “Sorry, but that’s not in my job description.”
Power generation is a huge national and provincial issue, and its impact on the economy is now being realized. The transition to renewable energy sources, and off carbon generation, is going to be expensive and painful, and that reality is hitting. It is going to require a lot of public money, and lots of people on limited incomes, particularly in rural areas are being advisedly affected. The HST cut isn't going to solve this.
As for the doctors, that is done. Pot of money defined, deal with it, or leave.
We accept that waiting lists exist,and services are not available,representing our "health poverty".
Energy poverty: we will not solve this with "power outages" or refusal to power certain devices.
Watch carefully the job announcements. The backroom subsidies in tax reduction,and energy at reduced cots are impressive.
You state "now" being realized. I find the premise that the impact of power generation done well or badly could not have been seen as having an impact on the economy.
I'm restraining my reaction to this kind of statement.
Leadership cannot be about doing grandiose, egocentric manoeuvers following the "big hairy audacious goals" mantra of various self-appointed gurus who are not in position to either understand the complexity of the real world or who spend their time publishing what their fantasy world look like. Leadership must be both pragmatic and visionary. Wishful thinking doesn't cut it.
Ultimately, the tax payer and all the "fee" payers get hit by this. It creates uncertainty, resentment and a tightening of the purse strings.
Oh my.
On another note, I attended an event in Ottawa yesterday where Kathleen Wynne and entourage showed up. Some people left. Another called her out on an issue. People were avoiding getting in the photo op.
And....despite this, several retired teachers and several others still voiced their approval and support of the Wynne government. They are comfortable. No problem with their hydro costs they say and as far as they are concerned, Wynne is doing a wonderful job in health care....this despite one Wynne supporter lamenting that he cannot find affordable care for his relative with dementia......just keep those rose coloured glasses on for a little longer and keep stumbling along.
The impact of power realignment was recognized years ago,but no long-term planning was allowed to be developed,because it would honest about future changes to lifestyles.
Best example to watch is the transit mess in the GTA. Huge political decsions that will affect the population in massive ways, which can not be discussed,because winners and losers are being picked.
Same as the OMA mess, huge shift in the winners and loser groups will occur.
The struggle between transnational progressives and the nativists is painful to watch!
So everything is done according to short term expediency and damn the long term consequences a la Keynes " after all, in the long term we are all dead" attitude.
Ontario is doomed.
Ontario health care is doomed if short term expediency is really ruling the roost....has the supposed long term health care planning , involving so many people , so much time and so many $'s , been only a cover story all the time?....seemingly the only long term planning underway revolves around reelection in 2018....after that , who cares, " apres nous le deluge".
" Transnational progressivists"....the post nationalist global citizenship crowd? Those advocating green energy/ global warming crowd? Those advocating the needs of the LGBT crowd? Those advocating the importation of unvetted Islamic refugees from the Middle East asylum ?
So there are two wings in the Ontario Liberal government split along those lines?
Generalization,but a reasonable explanation of the widening polarization. Those who want ,first,to save the world,on the back of the population it gathers tax from,versus those whom want to govern the local population,as its first goal, and support global efforts with what is left over,once the local needs are reasonably addressed.
" A liberal is a man too broad minded to take his own side in a quarrel" ( Robert Frost).
Once you do that,you then must review the proposed OMA contract,and how it will influence your future.That isthe sole offer.It will not change.
It is important that the government and its collaborative quislings own the inevitable negative outcomes.....the OMA and allied professional organizations will do their best to give their master cover and blame their own memberships for whatever negative events occur...but the feet of the government will have to be kept to the fire.
http://shawnwhatley.com/distract-doctors/
First pass,Bill 210.Then deliver the social justice package of physicians as state controlled widgets. Most will comply for the income security. 60% of the practices need the each OHIP deposit to get delivered.
From one section email sent today to OMA President Dr. Walley:
"In addition, the new, special communication tool that you have noted does not "guarantee that emails will go out, unedited and unreviewed, within 24 hours.” In fact, the email preamble to the new communication tool very clearly stated that communications will be reviewed, and its utilization would require our Section to sign a multipage contract before utilizing the service. We are not going a sign a multipage legal contract just for the ‘privilege’ of communicating with our members. Our ability to communicate with our membership is a right. Setting all that aside, you have told us point blank that this alternate communications network is vastly incomplete as many members have unsubscribed. In effect then the only way to communicate with our full membership is to go through the regular OMA channels that for ten years has held-up, blocked, edited, and censored our communications."