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.