“Hi, I’ll have a double-double and a double-bypass, please.”

British Columbia’s health care system put the exclamation point on the word broken today, with the scandalous news that hospital staff in New Westminster had to use a Tim Hortons as a triage station. The temporary beds had to be set up in the closed coffee shop after the hospital was overrun with 100 patients between 11:45 p.m. and 12:45 a.m.

B.C. Health Minister Colin Hansen, meanwhile, was just peachy about it. In the typical manner that the BC Liberal party squeezes manure into diamonds, Hansen said that it was evidence the system works:

“It does happen from time to time that emergency rooms are under tremendous stress because of the number of patients presenting themselves on that day,” Hansen said.

“They had all the ambulances lined up outside waiting to unload passengers,” he said. “Today we have protocols in place where the patients are brought inside, they’re cared for, they get the attention of medical staff.”

Apparently the Timmys is actually a legitimate “designated overflow area” to be used in extreme high-volume situations. I don’t know whether that’s supposed to impress me or people just arriving here from Burkina Faso.

Maybe it’s just me, but I don’t really like the idea of a donut shop being the waiting area for those awaiting emergency health treatment. Something about seriously ill people being in a place where people ordinarily eat… that kind of sounds like a health violation. I could be wrong.

And what are 100 people doing in an emergency room at midnight on a Monday night? Are we currently being invaded by Chilliwack? Is there a war I don’t know about? Or is it more likely that people are using emergency care as a substitute for the nation’s shameful doctor shortage? Questions, questions.

Of course I guess the Timmys is slightly better than their last temporary overcrowding area: the parking lot.

I’ve got an idea. Let’s charge people a nominal fee for visiting the emergency room. $20 should do it. Let’s see how many of these people are actually in a life-threatening situation and how many are taking advantage of the unlimited health care bill.

You might have seen this little blurb in the Toronto Star about Tommy Douglas’s daughter claiming that Stephen Harper is eroding the health care system. She reportedly said that while Harper would never admit he’s against the system, the evidence shows that the system is “being starved to death.”

First of all, let’s get some facts straight on this story. Total spending on health care in Canada reached roughly $191.6 billion in 2010, up by $9.5 billion (5.2 per cent) from 2009, according the Canadian Institute for Health Information. This represented a year-over-year increase of $216 per Canadian, bringing total health expenditure per capita to an estimated $5,614. As recently as 2008, Canada was fifth in the OECD for health care spending per capita.

When Tommy Douglas’s vision of Medicare was brought into being in 1962 by Woodrow Lloyd, the federal government offered a plan to fund 50 per cent of hospital costs. By 1966 that became a 50-50 arrangement between the federal government and the provinces. Since that time, and most notably during the Liberal majority governments during the 90s, health care transfer payments has dropped to about 16 per cent.

Spending as a per cent of GDP increased most between 1975 and 1992, rising from seven to 10 per cent in that time. Liberal cutbacks and changes to provincial transfer payments, particularly with the creation of the confusing Canada Health and Social Transfer system in 1996, resulted in a decline in spending.

Put into historical perspective, Pierre Trudeau’s Liberal government in 1975 spent $12.2 billion on health care, or roughly $527 per person. In Brian Mulroney’s second year in office that number had increased to $49.8 billion ($1,541.70). At the Liberal handover of power in 2005, total health care spending was $140 billion ($4,333.30). So in just four years the Harper government has increased year-over-year spending by $10.32 billion, or an additional $1,280.70 for every man, woman and child in Canada.

I’m far from one to defend Stephen Harper’s spending habits, but it would seem to me that 27 per cent increase to the total health care spending in Canada over five years is a rather significant improvement, and far from being “starved to death.” Starving the system would have been to increase spending by a nominal increase in the inflationary adjustments.

Let’s not forget that the Canada Health Act is very clear in keeping health care a provincial jurisdiction. How the provinces manage their money is entirely up to the financial responsibility of the provincial leadership at the time. In 2007, the largest cost of health care spending was in hospital costs, eating 28.6 per cent of the whole; physician salaries took up 13.1 per cent; and prescription drugs accounted for 16.5 per cent.

According to the 2010 federal budget, $24.8 billion went to the provinces in the form of health transfer payments, second only to social security. An additional $2.9 billion was transferred in provincial program expenses. (It might be worthy to note that Canada spent $20.9 billion on national defence).

Health care spending accounts for between 37 per cent to 50 per cent of provincial budgets now, and that number continues to rise as the provinces depend on larger transfer payments from Ottawa. The logical solution, then, would be to amend the Canada Health Act to allow for a more flexible delivery of health care at the provincial level and remove the dependence on the federal government to control the problem.

Photograph by: Richard Lam, PNG

For many refugees, reaching Canada truly is like arriving in the promised land. As a part of our generous policies for processing refugees, they are afforded free, immediate and unlimited health care, dental care, welfare, lawyer and translation services and sometimes even transportation.

But the freebies don’t end there. Although most Canadians are used to paying for their own prescription drugs, according to a CBC report, Quebec pharmacists have been supplying drugs to refugees on taxpayer dime for years. And because it often takes so long to get reimbursed for the drugs, they’re now putting a foot down.

A Quebec association is urging the 1,734 pharmacists it represents across the province to refuse supplying prescription drugs unless paid up front, saying it can take up to three years for Citizenship and Immigration Canada to reimburse them under the Interim Federal Health Program.

Hm, wouldn’t it be nice to get in on that program? Sadly, if you’re a Canadian citizen you’re out of luck.

According to the article, a refugee worker argued it makes sense to financially inconvenience pharmacists rather than have refugees not take their medication, resulting in hospitalization that will end up costing everybody more anyway.

Interesting how social services are always used as a weapon when justifying the exorbitant and unjustifiable costs of something. For instance, if you criticize a government program that spends taxpayer money to distribute heroin needles to drug addicts, the argument is always that it’ll save money in the long run from fewer transmitted diseases. It never seems to occur to people that the single-payer health system is the problem.

Not that refugees have to pay for health care costs or premiums either, since they’re not legally entitled to work. Emphasis on the word “legally.” Most of them wind up working under the table while waiting the three or four years before their case is approved or rejected, all the while accumulating the best social services your money can buy.

A family of three people or more earning $30,000 or greater in British Columbia are required to pay $121 per month for medical services premiums, an added health care expense of $1,452 each year or a 4.8 per cent health surtax. That’s a lot of money for three people trying to survive on $30,000. Many people have to forgo prescription drugs because they don’t have a plan that covers them.

None of these problems are faced by refugees who have everything provided for them up front. The average refugee claim incurs $29,000 in processing costs and social benefits according to the immigration minister himself. That means the taxpayer bill for the MV Sun Sea Tamil ship is roughly $14.2 million.

With a median family income of $68,860 (2008), that’s enough money to sustain 206 Canadian families for one year. And using the 2010 Low-income Cutoff (LICO) for four people in Canada ($39,455 according to Statistic Canada), it’s enough to sustain 360 low-income families in Canada for one year. That $14.2 million would provide a $2,000 subsidy to 7,100 families in Canada.

It’s time for the government to get its priorities straight. And they begin with Canadian citizens.

A must-read from, gasp, Publius:

Medicare Malpractice

More from the P-Man.

Mark
Ottawa

André Picard, the public health reporter at the Globe and Mail is getting very sensibly realistic–beginning really to see the light?

Canada’s health care system is coming apart at the seams, torn between a desire to uphold a monumental principle and the staggering challenge of delivering on that promise.

Equity – the notion that healthcare should be provided to all without regard to income – is medicare’s defining feature.

But the lofty principle loses its meaning if the care provided is not prompt, high-quality, co-ordinated and affordable…

Other countries with universal health systems – notably those in Europe, which are consistently ranked as the most equitable and cost-effective – have not made Canada’s mistake of confusing equity with sameness.

Rather, European countries have done what Ottawa and the provinces know they need to do: Adopt a model that pragmatically mixes public and private elements both in funding and delivery while staying true to values…

…an oft-illogical patchwork…has left Canadians – and to a large extent policy-makers themselves – perplexed. To wit: Physician visits are covered by medicare but the drugs they prescribe are not – unless the patient is over 65; physicians cannot bill patients but they can refer them to imaging clinics and laboratories that do; private clinics can offer knee surgery but not heart surgery; a citizen cannot jump the queue for care unless they were hurt on the job and they are the responsibility of Worker’s Compensation [there's a whole second tier right there]; homecare nursing is provided by private companies but hospital nursing is not…

Canadian health care is unusual in that the system is bifurcated. There is virtually no private insurance or private delivery in some areas (like physician services – which are 98 per cent public) and in other areas there is virtually no publicly insured or delivered care (like dentistry – which is only five per cent publicly-funded).

By comparison, in European countries, there is almost always a private option for consumers and, at the same time, there is greater public funding and regulation for every aspect of the health system. For example, in France, only 74 per cent of physician services are paid from the public purse and, in Germany, 68 per cent of dental care is covered by public funding.

This approach, generally speaking, has resulted in lower per capita health costs and better outcomes…

First and foremost, we need to throw off the shackles of the Canada Health Act, a well-meaning law that has become an impediment to reform.

The CHA, in its current form, perpetuates a fundamental absurdity of medicare: The universal single-payer model applies only to “medically necessary” physician and hospital services. Focusing on doctors and hospitals made sense in 1960 but not does not in 2010; and leaving the term “medically necessary” undefined suggests that medicare must provide all care to all people – an unrealistic expectation that has driven costs through the roof…

…delivering affordable, timely care in practice is much more important than merely doing so in principle.

Amen.  An earlier glimpse of the light, and the poor realities of our system, by M. Picard is here. As for the reality of the “lofty principle“:

One-tier health care in action: Emergency, schmergency

Update: Liberal M.P. Keith Martin is getting really “radical” (in Canadian terms) and specific–take a look at this. The true key to any meaningful, and affordable for the public, reform is allowing private insurance to be bought for “medically necessary” services that are provided in private facilities. As has always been the case in the UK after the National Health Service, on which our one-tier system was modelled, was created. Take a look at BUPA.

Mark
Ottawa

Read this Washington Post story and see who ain’t there:

Wariness abroad of new order in U.S.

“Canada’s National” whatever is certainly running up the wariness flag as fast as it can:

With new Congress, Canada can expect trade, border flare-ups

But wasn’t it the Democrats who were trying to block the planned new pipeline for Alberta oil sands crude, besides hammering the sands themselves? So why the Globe’s instant wariness?  Creating more “news” to suit their agenda?  And Postmedia News is no better with a piece that really has very little to do with trade, and in which Jumpin’ Jack Layton tells a real porkie:

Republican tide likely to hit Canadian trade
Obama also ditches plan to legislate carbon cap-and-trade system
…
NDP leader Jack Layton said he suspects trade relations will continue to dog the Canada-U.S. relationship…

He predicted Canada-U.S. trade will emerge as an issue in the run up to the presidential election in 2012, as it did during the campaign that ended with Obama’s election two years ago…

What blinking balderdash. If Canada-U.S. trade (as opposed to Mexico and NAFTA) was an issue in 2008 not one American in a thousand knew it. Canadians really need to get a grip on reality instead of stupidly navel gazing.

Otherwise some sense from Norman Spector about the Americans needing fewer Canadian pols:

Dumbest Canada-U.S. initiative ever
…
In short, can we now agree that it’s a good idea for Canadian politicians to stay out of U.S. partisan politics entirely — however tempting it might be to curry favour back home by being seen to stand up for our values in the United States?

Mark
Ottawa

But it’s a sacred trust and the best system in world, right?  Note the desperate spin in the Ottawa Citizen’s headline:

Waiting lists for certain surgeries drop dramatically
ER still lacking much-needed beds, regional health chief reports
…
According to the most recent data released by the Champlain LHIN, nine of 10 ER patients who need to be admitted wait up to 33 hours before they get beds in Eastern Ontario hospitals…

Golly gee, look what we see on the Champlain LHIN’s website:

…
The Excellent Care for All Act, 2010

The Excellent Care for All Act puts patients first by improving the quality and value of the patient experience through the application of evidence-based health care. It will improve health care while ensuring that the system we rely on today is there for future generations…

Saying something doesn’t make it so. But governments increasingly seem to believe in words, not deeds, and work more and more by mere propaganda. Hurl.

As for that “sacred trust“:

Publius: “…it’s socialized health care, with Saskatchewanian characteristics.”

Mark
Ottawa

Lovely, Brian Mulroney starting to see the light:

A Sacred Trust Revisited

Earlier:

Tommy Douglas not rolling in his grave enough/Ministers of cults [me]

The Writing On The Hospital Wall [Adrian]

Mark
Ottawa

Earlier:

Minimum Max a conservative leader?

Note that small “c”; let the provinces be provinces, let the feds be feds, and let the voters know who is truly responsible for what–so they can at least have the opportunity to decide intelligently. Now from Paul at Celestial Junk:

More Max … floating trial balloons for the boss … or going roque?

Maverick Max went rogue again in a Toronto speech on Wednesday by advocating Ottawa get out of transfer payments to provinces while giving legislatures more tax room to finance the health, social welfare and education services they are constitutionally obliged to deliver.

For Jim Flaherty, who rolled out a blueprint on Tuesday showing continued growth in the social transfer envelope well into the next government’s mandate, the notion of surrendering $40 billion worth of fiscal clout over the provinces is a severely alien concept.

… and who can forget this … or this.

And this is a very good piece:

Stop giving $36B a year to the provinces

Plus a news story, note the implicit opening towards private health care (see: “Tommy Douglas not rolling in his grave enough/Ministers of cults”):

Tory MP suggests scrapping Canada Health Transfer

Conservative MP Maxime Bernier (pictured) on Wednesday proposed scrapping the Canada Health Transfer and giving the provinces dramatically more flexibility in how they deliver services — ideas quickly condemned by critics as a possible trial balloon revealing Prime Minister Stephen Harper’s “real vision” for health care.
Photograph by: Francis Vachon, Postmedia News

If only.

Update thought: Even if these transfers were cut equalization payments would remain:

…the Government of Canada’s transfer program for addressing fiscal disparities among provinces. Equalization payments enable less prosperous provincial governments to provide their residents with public services that are reasonably comparable to those in other provinces, at reasonably comparable levels of taxation…

So M. Bernier’s transfer of taxation take from the feds to the provinces should not affect the latter’s inherent abilitily to provide services.

Mark
Ottawa

That policy remains: all Canadian Forces out next year.  Yet in August 2009 the Liberal, very left, Toronto Star editorialized:

…
Subject to Parliament’s approval, Canadian troops and police might still play a useful role mentoring their Afghan counterparts, with a view to working themselves out of a job. We can protect aid projects. And perhaps provide transport aircraft and helicopters, as well as surveillance drones, to assist our allies…

Over the last few months the Liberals have indicated a willingness to consider a post-2011 role in Afstan for the CF (e.g. a non-combat mission training the Afghan National Security Forces). So why the Conservatives’ so obdurate insistence on “troops out” next year?

Perhaps because, against all hopes, they are a little party, a silly party (scroll down here to “T.E. Lawrence: So long as…”; ignore for current purposes the “barbarous, and cruel”).   Are the Conservatives now a party mainly interested in (and overly accustomed to) the accoutrements of political power rather than one actually trying to achieve concrete, changing, things domestically?  For example, health care.  And a party utterly averse to taking real risks to achieve something serious elsewhere?

Continuing the good fight abroad, at home, even a little bit?  Hah!  Rather cutters and runners when the going gets tough and the kitchen gets hot.  All hat, no helmet.  And no skillet neither.

Update: The post is in the National Post’s “Full Comment“:

Upperdate: Also in the Spotlight on Military News and International Affairs:

…
Canadian Commentary
…

Mark Collins — National Post
When the going gets tough – More
…

Mark
Ottawa