Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 






Oil, Ageism, and Pharmacare

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.

Thank You!

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.





Ebola "Terror"?- Not Quite

I have hesitated to wade in with this blog on the subject of the Ebola epidemic in West Africa for a number of reasons.

First, it is getting plenty of media attention elsewhere.

Second, concerns can become overdone and exagerated to the point that the public turns away. If the public turns off then there is a real possibility that politicians back away from providing much needed resources for countries significantly affected and lacking the resources to control outbreaks.

Third, there are plenty of other challenges that we face to our way of life here in Canada. A thoughtful perspective is needed to see that several slowly moving issues such as the demographic shift and homegrown terrorism have greater potential to create severe societal problems here than more acute and immediately horrific events happening elsewhere.

Fourth, when drastic measures such as travel bans to control the spread of Ebola to other countries are raised, the authors are accused of fear-mongering and exagerated response that is harmful to economies and to populations.

BUT, is there really terror in Canada over the Ebola crisis unfolding in West Africa? 

I don`t think so.

Terror or panic is not helpful but I don't think that is what we've got. What there seems to be is concern for what might happen should Ebola go unbridled in West Africa or what happens when it is transported to North America. There is a fascination about this macabre disease and all things morbid.

There ought to be a deeper understanding of what happens to people and economies when we fail to act collectively to hit Ebola type outbreaks hard and fast at the source and when we fail to take necessary measures to stop its spread to other countries. There ought to be an understanding of what happens when public health organizations are starved for funding and seen as acute care`s quiet little cousin. It`s possible that North America`s contact with Ebola has done this.

What we`ve seen initially in the Ebola cases that did arrive in the US, was a degree of calm response bordering on complacency and supported by the concept that what happened in West Africa could not happen in North America. The Ebola infected missionaries returned for care and recovered. North America`s health care system would not allow bad things to happen. Unfortunately, things did go wrong with that approach. North Americans were infected despite best efforts. There have been lessons learned. Terror, no.

While reassurance has its place, it should not be a substitute for taking significant precautions to prevent the spread of serious disease with potential for human and economic damage. There is a time to overdo some measures and to over respond. Some people believe that is fear-mongering. I do not.

While the Ebola cases in the US appear to have been contained and the CDC is now ramping up guidelines for improved protection of health providers, we should not be complacent about risks of emerging disease. They exist. They may pop up when we least expect them and false reassurance and complacency should have no place in our medical armamentarium. Currently, we are not prepared.

Reality is that the slow moving demographic shift and instability grown in other countries and transplanted here pose a much greater risk to Canadian way of life than Ebola even though it is a horrific disease.

We are not "terrorized" by the thought of an economy that can't manage under the weight of expectations or global uncertainties. We don't seem to be "terrorized" by the thought of politicians encouraging euthanasia as a way to deal with rising numbers of frail elderly or people with diseases we can't fix. We don't seem to be "terrorized" by jihadists mowing down soldiers in parking lots. Perhaps we should be. Maybe then we would take our collective heads out of the sand and respond in a meaningful way to the real threats that are more insidious, less immediate, but even more harmful to society and to individuals.





Medical Tourism in Ontario

There could be real innovation in Ontario health care if the "Anti-change" groups would stop their obstructing. Most recently, the cries from Ontario nursing unions and Canadian Doctors for Medicare have resulted in response to new funding streams being generated from medical tourism efforts at Toronto area hospitals.

Both the CMAJ and the Toronto Sun had recent articles on this. The Globe and Mail reported on this earlier in the year. I will post the links in the Comments section.

Let's face it. Ontario is strapped for cash. Thousands and thousands of Ontario patients are waiting in queues while ORs sit idle for weeks every year and while beds exist on wards but are neither staffed nor funded. Medical tourism could contribute to helping hospitals provide more services and care to Ontario patients.

Doris Grinspun, as usual, speaks against any such option. Apparently, she would rather see patients wait in  queues than get the publicly funded services they need. The fact that hospitals are finding their budgets squeezed by Ontario's financial circumstances seems to be completely missed by her. Medical tourism has the potential to provide more income to the hospital thereby allowing it to provide more services to Ontario patients through the public system. It should be a Win-Win situation but somebody did not invite Ms Grinspun to the decision-making party. She is not happy.

Patients coming from abroad would provide income to hospitals who will use idle infrastructure and unused specialist time to provide the care. Ontario patients would not be "bumped" because of medical tourism. On the contrary, the additional revenue stream from medical tourism would be advantageous to Ontario patients. This new funding stream does not necessarily fit with Doris Grinspun's rigid ideology but it is a necessary step in a new and innovative direction.

Canadian Doctors for Medicare appears to be fixated on a single payer system at some level of unattainable purity. Dr. Dutt suggests that allowing medical tourism would cause specialists and surgeons to work "part time". She appears to avoid the harsh reality that despite less than developed world per capita physician average, Ontario is unable to employ 16% of graduating specialists in their area of expertise.

Dr Dutt should be reminded that surgeons train many years to hone their skills. They need operating room time to preserve them and can use medical tourism opportunities to continue to serve patients. The revenue provided by medical tourism could also assist more Ontario patients to benefit from the skills of these same physicians lessening wait times and creating a more productive population.

The Ontario public needs to understand how medical tourism can be helpful in making more services available to them.  Nursing unions and Canadian Doctors for Medicare should get a grip on reality or get out of the way. Patients are waiting.






Ontario Election 2014

I must admit that it is somewhat mindboggling how the Liberals might still be in power June 13....but it will be Friday The 13th by the time the scandal-riddled-Liberals limp over the finish line with a little bit of doping from the Unions. If they manage a minority then let them wear their mud a little longer. If they manage a majority then the unwitting public is in for a big painful surprise as credit rating agencies begin to flex their muscles. The Liberals won't be looking very fresh at that point.

For the PCs, a win  will be a double-edged sword. The loud mouth unions will be out in full force at every turn. If the garbage truck is late, it will be Tim Hudak's fault. If a storm knocks out the electrical grid, that will be Hudak's fault too and if the growing ranks of people with acute on chronic disease show up in droves at the ER, that will be Tim's fault too...

It almost makes me think that a couple more years of the Wynne government would be worthwhile only if it is to show what a terrible muddle she and her big spending government have created. The downside is that Ontario will be driven further into debt and further hardship for Ontarians will be the result and I have difficulty supporting that.

What is striking in this election is the level of disengagement of the electorate. Advance poll numbers were down by about 6%..and with the first game of the FIFA World Cup on the tele I expect many areas of Toronto and Ottawa will have low voter turn-out numbers.

What kind of society do we create when the Union propaganda successfully deceives and the self-indulgence weakens the electorate?

What kind of society believes that the best election platforms are the ones that promise it goodies without any trade-offs?

Somehow, a culture of complacent, non-voters has been created. Their usual excuse is that it doesn't matter which party takes over, the result is the same. Why bother? 

How wrong they are.

I hope you manage(d) to vote today or in the advance polls and I thank you for your ongoing support!



Courageous People Changing Health Care

While union backed protesters decry the end of the Health Council of Canada and complain that the federal health transfers are not sufficient to provide the provinces with what they need to fulfill their political promises, other people are working hard to create more sustainable change.

I'm not talking about the individuals who are entrenched in more bureaucratic and systemic convolutions that add to the cost of care by creating expensive and more complex coordination such as Family Health Teams and Health Links.  I'm talking about people like Dr. Robert Bell of the University Health Network in Toronto and Dr. Brian Day of the Cambie Surgical Centre in Vancouver.

Dr. Bell has  recently been appointed as Deputy Health Minister in Ontario and is leaving a hospital network that encourages medical tourism, allowing patients from other countries to be treated at UHN by paying for their own care. This makes a lot of sense. Currently there are unemployed and underemployed specialists to the tune of approximately 16% of all new graduates. There are operating rooms that must close for weeks at a time to allow hospitals to balance their budgets to meet provincial accountability agreements and hundreds of thousands of patients across Canada waiting in queues.

The revenue generated by having out of country patients pay for procedures and care at the UHN allows hospitals to spend resources on patients who are not paying. This has a certain symbiosis that could be a win/win/win, for out of country patients, for Canadian patients and for employment at many levels for Canadians. Despite this, various groups are already lining up to request that this service be stopped. Not only should it NOT be stopped, I believe it should be made available to Canadians as well so that both health human resources and infrastructure can be used maximally as well as creating a source of revenue for hospitals and even for government, not to mention the primary goal of allowing more patients to get the care they need.

Dr. Brian Day is another health care expert who is courageous in his attempts to advocate for vulnerable patients forced to wait in Canada's failing single payer system. He is bringing a legal challenge to the laws that prohibit individuals from paying for medically necessary care. You can find more information at the following site:

  Charter Health

 As our aging population requires more services and more care and with relatively fewer workers to provide the tax base in the future, we need to be open minded about how to allow more people to access more care in ways that are acceptable to them.

There are times when the unions and the media and the "entrenched" drown out reasonable voices on health care change. I hope that the voices of Dr. Bell and Dr. Day will be heard at many levels, and that change will occur to support sustainability of a Hybrid health care system that combines a robust public system with private options for medically necessary care.

It is challenging to stand out from the crowd to say and do what is necessary. Please support sustainable change where you can. Thank you.