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

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

Further to the mild tone of optimism in a recent post of mine (with a major reservation), Publius looks to Alberta and describes a dark side:

…
This is not talk of freeing the market for health care – perish the radical thought – but allowing private entities to offer care with public funds. The hope is that by contracting out, the services will be delivered more efficiently, while keeping the provincial governments as paymasters. The latter part is suppose to reassure the electorate in some deeply mystical way. Because the government is paying for it, it will be good and humane. Repeat until numb.

Since this is government-run health care by other means, there is little to cheer about. Its main advantage is circumventing the militant health care unions. Its disadvantage is that, in the Left hands, it can be used to discredit further reforms in the direction of the market. Just regulate privately delivered care in such a way as make it even worse than the purely public system, and wait for the Toronto Star – and its sisters across the Dominion – to denounce it as capitalism run amok…

As I’ve often said in this space, Medicare isn’t a government program, it’s a cult…

…Any sort of health care financing scheme will have to rely on the principle of putting a bit in and using as needed, something akin to insurance. The overwhelmingly majority of Canadians can afford private insurance premiums, if they could not the tax base would not exist to support the current system. Like with food and housing, those who could not afford the premiums would be subsidized. Such a system would have its abuses, as any system does, but it will allow the great majority of Canadians access to health care on their own terms, rather than those of the Minister of Health. It would also ensure that even the poor could get quality health care, since they would be just another customer of the hospital or clinic. While such an approach would be logical, it would challenge the sanctity of government delivered care. The Cult of Medicare is not interested in quality health care, it is interested in preserving state health care…

Cult. Quite. We have ministers, not of health but of cults.

Mark
Ottawa

A ray of reason in our mindlessly ideological health care “debate”:

Tasha Kheiriddin: Private health care comes to…. Saskatchewan

From the cradle of Medicare, hope for health care reform.   The Saskatchewan government announced this week that it will be contracting out dental and knee surgery to a private surgical facility.  While the public purse will foot the bill, the operations will be performed by the Omni Surgery Centre instead of a public hospital.

According to provincial health minister Don McMorris,

“the move will help shorten wait times for some day surgeries and the setting will be more convenient for patients.”

The move will not only save time, but money.  Surgeries done at the Omni Surgery Centre cost less than the same procedures done at a hospital. According to provincial officials, knee surgeries will cost $1,500, $179 or 11 per cent less per procedure. Dental surgeries, at $965, will be cheaper by $76 or seven per cent…

Paying for “one-tier” health care, Part 2

Update thought: As for the current federal government’s even touching on the private funding issue…hah!  Even private provision probably beyond their possibilities given their political pusillanimity (despite the hideously dictatorial habits of a certain prime minister). Ain’t alliteration and assonance awesome? Unless overdone, ça va sans dire.

Mark
Ottawa

Socialized and unionized health care at, er, work.  From Paul at Celestial Junk:

How about cash cow for “insider” scheduling. This is a result of healthcare for the employees, instead of healthcare for the sick…

Not exactly “one-tier” working conditions.

Mark
Ottawa

Yesterday:

Paying for “one-tier” health care

Today the clear answer in a National Post editorial: get rid of that “one-tier”:

…
The CMA has its own list of proposals, which include a reexamination and modernization of the five founding principles of the Health Act, and the creation of a “Charter for Patientcentred Care.”

A better solution, we think, would be simply to bring Canada in line with virtually every other OECD nation, and create a hybrid system that permits private health-funding options in parallel with a publicly-funded universal health system. As others have noted many times, Canada is the only country in the world, outside of Cuba and North Korea, where garden-variety private health insurance for essential health needs is illegal.

It is all well and good that the CMA is critiquing the fine points of Canada’s single-payer health model. But until our politicians tear down its Soviet-style proscription of private options, everything else is palliative care.

As I wrote at Daimnation! in 2005:

…
So once private health insurance for essential services is allowed across Canada (it already is in several provinces, and the Supreme Court decision said it should be allowed in Quebec), then we can have a European-style two-tier system, with the private clinics (hospitals, imaging centres, etc.) existing parallel to the public system as long as they receive no payments from the public system. (A full two-tier system will not be possible if it relies on cash payments–very expensive for major procedures–rather than payments through insurance: see the UK’s BUPA.)…

Remember that even the UK, despite the sainted National Health Service, has always allowed “two-tier” health care via private insurance such as provided by BUPA. Insurance that almost certainly saved my father-in-law’s life when he required rapid major surgery a few years ago.

Update thought: We’re sure making progess in dealing with health care funding, eh?  The CMA itself has backtracked badly.  And there’s been no there there from the currently governing party:

Conservatives kiss health care reform good-bye

Mark
Ottawa

Maybe, as Spector Vision sees it, the…

CMA speaks with forked tongue

Perusing my morning read, I see that the CMA is out with a new report that is quite critical of our existing health care system. And that the organization is calling “for five major changes to help improve the state of the system, and the health of Canadians.”

How to pay for all this? — you may ask yourself. As a former federal and provincial public servant, I certainly asked that question after reading the Globe article — not to speak of the big, honking headline on the front page of the Star...

…you’d think that the medical profession might have some thoughts to offer Canadians as we make that decision.

Indeed, turning to the CMA report itself, I find that the CMA actually salutes the recent Québec budget:

“Quebec has been the first among the provinces and territories to acknowledge that the current approach to funding health care is neither sustainable in the long term nor fair to future generations…”

One of the favourite dodges of politicians in our country is to say one thing in English and another in French. However, if we can’t count on doctors to give us the straight goods when it comes to health care, on whom can we count?

Earlier, in my province:

The joys of one-tier health care, Ontario style

Mark
Ottawa

Don’t you just love socialized medicine?

Ottawa Hospital turns away sex assault victim
…
A 21-year-old Ottawa woman who had been sexually assaulted was refused immediate treatment at the Ottawa Hospital over the weekend, the Sun has learned.

The woman was taken to the Civic hospital early Sunday [July 4] morning to have a rape kit completed but Ottawa police were told there were no sexual assault nurses available.

The victim was given three options: Lie in a bed until Monday morning when a nurse would be available — but she wouldn’t be able to shower — or go to either Cornwall or Renfrew hospitals.

She ended up being taken to Renfrew [some 100 km, pop. 10,000] to get treatment…

The hospital is going through staffing shortages with their specialized sex assault nurses said Mike Tierney, vice-president of clinical programs.

“We have had some challenges recently in staffing this specialized program and that has resulted in us not always being able to provide service in as a timely manner as we would like,” said Tierney, who declined to comment on the specific incident.

He said the staffing shortage was due to illness and happened about three weeks ago [emphasis added]…

Ah, those beloved “challenges”.  Welcome to the … (your ordinal) world.

Mark
Ottawa