Navonim - The Ramblings of Garnel Ironheart

Navonim - The Ramblings of Garnel Ironheart

Sunday, 3 June 2012

The Real Reason for the Health Care Crisis

A word of warning: this is a rant.
Now let's begin.
For my non-Canadian reader(s), it is important to begin by explaining how the Canadian Health Care system works.
Under the terms of the Canada Health Care act, all citizens and permanent residents of Canada are entitled to free, basic health care.  This includes visits to doctors and hospitals, operations and procedures and other medically necessary services.  Health care is technically a provincial responsibility under our constitution but the federal government works to ensure that the provisions of the Health Care act including unlimited access to physicians and hospitals is upheld by each province except Quebec.
As a result we are rapidly reaching a crisis point in Canada where health care is becoming the second biggest item in most provincial budgets, the largest item being payments on accumulated debt.  As the population grows and ages, along with increasingly expensive technology becoming the standard of care in hospitals and clinics, the cost of delivering free and unlimited health care is accelerated year after year.  It was not so long ago that the province of Ontario's entire annual budget was smaller than just the health care component today.
Here's the other thing you have to know about Canada's health care system.  Other countries pride themselves on their geography, history, architecture and other grand concepts.  We're boring.  Our pride is centred on our health care.  Never mind that most European countries have better outcomes at less cost than us.  Never mind that our "public payer only" system is shared by just two other countries: North Korea and Cuba.  Our health care system is what makes us Canadian or, more specifically, not America.  Any attempt to tamper with the system, except to make it even more generous, is seen as trying to Americanize it which is kind like trying to force a cheder boy to eat pork.  It elicits a whole lot of struggling, screaming and cries of "Sheigitz!"
Because the system is rapidly becoming unaffordable the various provincial governments are struggling with attempts to contain costs.  Nursing positions are cut.  Doctor fees are cut.  Hospital positions and OR times are cut.  And still the system costs more and governments desperately cast around looking for someone to blame so they can either then absolve themselves of responsibility or acquire a new target to cut.
But in all the kerfuffle, one factor is never, ever mentioned: the patient.
Intuitively this should be obvious.  After all, doctors rarely generate their own business.  Unlike lawyers who invent laws and then make is necessary for us to hire them to get around those law, we don't seek out business.  It comes to us.  When I'm working in the emergency room, I have no need to call up folks and ask if they'd like to see a doctor today or if they want to take advantage of our "have one enema, get the second free" deal.  They just walk in day and night demanding to be seen.  That leads to hospital charges to the government and doctor charges to the government.  We didn't initiate those charges, we just pass them along.
But what's frustrating about this lack of willingness to mention the patient is that the reasons patients incur these charges to the system are often quite stupid.  See, one of the drawbacks of a free "use it as much as you want" system is that people will use it as much as they want and more.
What has happened after over a generation of free health care is a combined sense of dependency and entitlement that has hobbled the populace and rendered it incapable of even the most minor common sense judgements.  Why try to figure out how to handle that minor injury when the ER will check it out for you and give you a free bandage to boot?  Why stop smoking, eat a nutritious diet and exercise when your heart attack and/or stroke will be paid for by the taxpayer?  Imagine a non-stop onslaught of people who refuse to take care of themselves and demand someone else fix up their messes because that's what defines them as Canadian.  That's the system I work in.
And that's the real reason costs are spiralling out of control, not the desire by every hospital to have that brand new second generation PET scanner.  It's the guy who comes it at 3 am with a plugged feeling in his ears and wants them syringed out on the spot.  It's the lady who brings her kid to the ER because his fibre-free diet has rendered him constipated and who brings him back six hours later because the laxative the first ER doctor gave her hasn't produced anything yet and she's worried.  It's the endless "I know this is just a cold but..." and "I know I shouldn't have had 7 beers and 2 shots o' tequila before trying to drive him..." that are driving the system to the point of no-return.
The sad part is how dependency and entitlement entrench themselves into a society like a tick feasting on a horse's buttock.  Once in place there is no arguing with the entitled and certainly no political points to be made from telling them to start taking responsibility for themselves. 
But eventually the system will crash from this overburdening and none of us, even the ones who take care of ourselves, will have where to turn to and once again government will deflect the blame.


E-Man said...

Excellent point, but the American system is also untenable. I don't know what the future holds for healthcare anywhere, but it is not looking good.

BTW, I think I am going for pathology in the end of the day. What do you think about that field of medicine?

Anonymous said...

First Step: promise the moon

Second Step create smokescreen to renege on the promise

Mighty Garnel Ironheart said...

E-man, on one hand pathology wasn't seen as the sexiest of specialties when I was in school. On the other hand, our pathology lecturers were the most relaxed and fun speakers of the bunch. From what I've seen, they're quite happy with their choice.

JRKmommy said...

Do we have any evidence that people who obviously don't care about their own health are motivated to change by a private health care system? People don't seem to be less overweight or drink less in the United States.

At most, I think that you could have a policy of (gasp!) user fees if a triage nurse at the ER or at Telehealth informs a patient that the matter doesn't require an ER visit and can be handled via an after-hours clinic or telephone consult or with the regular doctor the next day. A patient who still wanted to wait at the ER would be billed a modest amount (maybe $20?), which would be waived if a genuine emergency was discovered. Someone who wanted 24/7 service may choose to pay, while others would make the effort to find the best alternative.

Another area for potential cutbacks is multiple referrals. We've encountered a few family doctors who will send a patient to several doctors in the same subspecialty, for 2nd, 3rd and 4th opinions, without informing the specialists of the other referrals.

Adam Zur said...

I think that there was a period in which the KGB did a lot to influence America. This seems to me to be obvious. Why would courses in universities about the political basis for America have readings in Hobbes and Roseau and Hegel but not John Locke. There was a KGB agent that defected to the West and he was on the Canadian broadcast. He said that about 84% of the resources of the KGB were spent on disinformation and the attempt to radicalize and dis-stabilize the west in general and American society in particular. The KGB eventually discovered his identity and killed him. The effects of this effort from the USSR to dis -stabilize America seems to be to be bearing fruit until this very day.
My point is this did effect Canadian and America politics.

Garnel Ironheart said...

JKRMommy, here's the problem with user fees in the ER. People will complain bitterly: But I didn't know it was just a cold! I thought I had pneumonia and that's an emergency so I'm not paying.
Or this will happen: single welfare mom down to her last 10 bucks and her child has a fever. She chooses to buy cigarettes and stay home instead of go to the ER and pay the user fee. Kid dies of meningitis. No one is going to say "Idiot mom killed child". They'll say "User fees killed child".

Adam Zur, that's why calling someon a Nazi is a real insult but calling them a Communist isn't. Our culture has been subtly warped to hide the extent of Communist evil.

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