Monday, April 11, 2011

Six Percent Doesn't Solve Health Care Crisis

Six percent. I hear on the news that the two thick doors of this federal election are going to guarantee six percent increases in health care funding for some number of years, not quite sure how many, but it will be perpetual, or long-term in campaigning-party speak. Consider me unmoved. Unimpressed.

Medicare Canadian-style won't be debated in this election. The parties are too afraid of the firestorm if they do. But they don't debate it when in power either. Oh sure, they've commissioned their studies. But like the shut-door Liberals before them, the Conservatives have pretty much done nada. And chucking money at the problem is only going to drain our coffers.

Oh yes, the system needs money. But it needs courage and wisdom more.

I don't know about those receiving medical care, but the public in general -- and their cowardly representatives in Parliament and Legislatures -- seem to think that medicare must both fund and run the hospitals and clinics. Well, as a too-frequent user of the health care system, I don't give a rat's ass who runs the place I go to, as long as OHIP pays and the services I receive are competent. At the moment, OHIP is paying for less and less -- nothing like showing up at a privately-run lab and being told to cough up $80, not because the lab is private but because OHIP won't pay for the test. Never mind that I have to have it. Of course, I learn later that there's testing and then there's testing, so if the doctor doesn't know when, where, how to explain the how of it to the patient, and the corollary tests, the test is effing useless. Eighty bucks down the drain. Not the last time a test has been less than useful either.

The real problem? Defunding, incompetence, and slow access.

Chucking more money at OHIP isn't going to solve either the defunding or slow access problems because as long as incompetence is rewarded, the incompetent will continue to vacuum up the money while the good struggle along. Just as the mediocre thrive in business at the expense of the good, so too do they in medicine.

Defunding is solved by the public paying attention to the news and getting off their comfortable fat asses and calling (or these days, tweeting) their MPs when the government announces a new round of defunding and saying don't defund in enough numbers that the government will back off.

Defunding and inadequate funding has done more to decrease the health care services everyone receives, especially the chronically ill and the poor, than private clinics ever will or can.

Slow access can be sped up, but not by the current way of creating wait list time programs. These wait list programs shorten the waiting times of the obvious surgeries, but at the expense of others. There are some hospitals that have so reduced the number of hours some kinds of surgeons operate that they have effectively shut down them down (and may I say with only a few operating hours per month, no surgeon can keep up their skills; thus the publicly run hospitals are also introducing mediocrity at the expense of good skills). Too bad for you if you need your bowel shortened or your shoulder fixed. By the time you get in, you'll be so debilitated that, in the case of shoulder surgery, the operation will no longer heal you fully. If it had been done right away, full recovery. Because you had to wait longer than ever before so the government can trumpet it's shorter knee surgery waiting times, you're fucked for life. And as for living with a severe bowel disease that needs to be operated on immediately and is not, well, I don't want to even think about that kind of special hell.

The only way to increase all access without compromising competence is to increase the number of providers. We cannot fund that with our taxes; we'll bankrupt ourselves. All we have to do is look at hospitals, those behemoth organizations who live off the fat of the taxpayer to the benefit of the admins and at the expense of medical services. They build fortresses in the hubritic names of their donors while cutting back services. Remember when Toronto General Hospital wanted to get rid of all of their hyperbaric chambers? Who cares if police or other kinds of divers needed those services. They had building to do; they had name plaques to erect. There was a hue and cry at the time. But does anyone know if they achieved their goal once the media and public's fickle attention went elsewhere?

Private and non-profit clinics don't usually have such grand dreams for big names and fat admins. Their OHIP dollars go towards providing care and a clean environment for the patient (don't get me started on how a leading publicly-run teaching hospital doesn't understand the concept of hygiene and long ago cut back cleaning services so we patients have to use filthy toilets). And sure some charge extra fees for a nicer environment, but I actually haven't been asked or had to pay that. And, in fact, some doctors in publicly-operated and publicly-funded hospitals will suggest paying annual flat fees to cover the plethora of services OHIP no longer funds (and some they never did). I've always said no and haven't been told go elsewhere as a result either.

So I don't know why it's such a big deal if the operator is private. What do I care if they are -- OHIP pays anyway. You think a private clinic will cost the taxpayer more because of the profit? They couldn't possibly, because right now the publicly operated places aren't exactly models of fiscal prudence. Plus publicly operated get lotsa moolah on top of OHIP.

You think private clinics will turn away the truly sick or put the rich ahead of the line? Well, right now the publicly operated aren't treating the truly sick with complex problems very well, if at all, because OHIP funding discourages that for every provider, public or private. And when OHIP pays, why would the rich get preferential treatment anyway? The perception of preferential isn't because a person can pay; it's because the clinic can provide immediate service to anyone but OHIP won't pay because of ideology.

The problem of access isn't money under the table, it's the OHIP rules as to who can provide and what can be provided, it's incompetence in both the provider and the physician, it's the artificial restriction of services.

One way of containing costs is to restrict access. If providers are only publicly operated, there can never be as many as are needed for economic reasons and thus the government saves on OHIP. Who cares if people suffer or die! And you think the lack of family doctors and specialists is happenstance? It was a deliberate government policy set in play about twenty years ago. We're reaping the rewards today.

As for incompetence, I've ranted about that before and probably will again. But simply put, if me and my GP had access to many providers not just the too-few today -- private or public or non-profit instead of the artificial restriction to just public -- and we could decide whom I saw, we would (hopefully) always pick the competent ones. The mediocre providers would thus die away. Or have to pull up their socks. Maybe then that downtown teaching hospital will have clean bathrooms.



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