Monday, 11 September 2017

Health Care Rationing in Canada.

   "Administrators maintain waiting lists on purpose, the way airlines overbook. As for urgent patients on the list who are in pain, the public system will decide when their pain requires care. These are societal decisions. The individual is not able to decide rationally." — Dr. Charles Wright, previous member of the Health Council of Canada and a former vice-president at Vancouver General Hospital, quoted in a Reader's Digest article.
   It is a sad fact that somehow the government and its administridiots have managed to convince the Canadian public that they have a successful health care system, when in fact it is one of the worst in the developed world.  It was not always thus and in  my early practice years in Canada we actually did have one of the best and most envied services in the world.  Many of the public, particularly those who have had no health care needs continue to think that.  Because the public is notoriously unable to distinguish between good and poor medical care, and because the service is increasingly run by people who's expertise is in  business and finance the ability to  distinguish between good medical care and barely acceptable care has been whittled down  to precariously few.  Thus, the administration is able to place the blame for the inadequacies on others: on a shortage of doctors and surgeons, that they themselves produced in the 90s. ALL the provincial ministers of health, cut medical school positions across the land by ten  percent.  This despite the fact that I and all the other chairs of Family Medicine in Canada and many others warned them that this was a most imprudent move.  Their "money men" had advised them that the  costs of health  care was directly related to the number of doctors and that they could cut the  costs of health by having fewer doctors.  The fact that as medicine was progressing and becoming so much more sophisticated that investigations and procedures that were not available before and that required expensive equipment and  manpower did not seem  to occur to them.  Or perhaps it didn't matter that much once they got  beyond the next election.  By the time they did understand, there was an acute shortage of doctors, so they began scavenging doctors from the poorer countries, instead of training our own.   Mean-spirited and immoral, but they didn't care as long as they thought the folks would be fooled into  thinking this was all someone else's fault.  This is what happens when health care is put into the hands of those who know little about it.  Those responsible, well paid civil servants, with generous defined pension benefits and even more generous sick benefits, paid holidays and other allowances began to feel threatened by  the people who really did know about health care and they recognised they had to do something to protect their jobs.  And that is when the  government and their sycophants realized that they must do everything in their power to diminish the influence and authority  of physicians.  This they attempted to do largely by appointing lackeys subservient to their superiors to 'run' the health care system.  There was only enough room for physicians in this equation to allow the committees to boast of physician involvement in their decision making and conclusions and appear to legitimize them.  Often the physicians were absent because he/she had patients to look after and the administrators liked as far as possible to have their meetings during business hours.  I hardly need to say that most of the physicians in the past did these tasks on a pro-bono basis. 
   Things have changed now, and there are enough physicians and surgeons to go around.  So why have waiting lists grown longer when there are skilled surgeons sitting on their hands?   The politicians would have us believe that there are not enough operating rooms and not enough beds, not enough skilled physicians and nurses.  None of that is true, there are empty operating rooms and empty beds that cannot be used because the administridiots will not provide the staff to support them.  They believe and are largely right that they can shift the blame from themselves to the people who provide heath care and manage to somehow make it work, albeit at a pretty dismal level.  A major part of their plan is to attempt to diminish and vilify physicians and other true health professionals who know so much more than they do and therefore represent a threat to their life style.  If you want to see just how well they do, look up the 'sunshine list'.  The other thing that terrifies administration is that even a small tranche of private health care will so awaken the consciousness of the present care recipients that they will demand something better.  
   That is why the BC government is doing all it can to prevent an Orthopedic surgeon Dr Brian Day and the private Cambie Clinic from continuing to offer outstanding care in a timely fashion and our governments across Canada are doing all they can to prevent people from spending their own money to avoid obscene wait times for alleviation of their suffering.  But at least they will be able to treat themselves with all the pot they want, and perhaps a few opioids.
   More about this next time!

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