Some healthcare rambling.

Consistently in Canada we see opinion polls that indicate that healthcare is at the top of people’s concerns. It is undeniable that the vast majority of Canadians consider the provision of healthcare as one of the most important roles that government has. Despite such concern on the part of Canadians, the closed-minded attitudes and profound ignorance demonstrated by Canadians when it comes to any discussion of healthcare is staggering. One would think that an issue of such apparent importance would compel people to educate themselves on the issue itself. Alas, one would be thinking wrongly in that case.

Canada’s health system has been turned into a sacred cow. The only discussion allowed regarding our system is one of how much extra spending to dedicate to it. Should anybody dare peep about changing the status-quo in any sort of way they will be greeted with shrill hysteria and the discussion will be shouted down.

I frequent quite a few discussion forums on the web. Some I participate in and some I simply lurk on. One site I particularly enjoy is the Calgary Puck Forum.  The puck forum is a Calgary Flames fan site predominantly. Due to the volume of posters (that being due to the vast numbers of Flames fans out there of course) and the seasonal nature of the sport, there is a very busy off topic forum.  Things discussed in that forum range from light distractions to some pretty deep political issues. What I really enjoy at the site is that this is not a political based site of one stripe or another. There is no mandated left or right leaning to the discussions. Reading sites like that gives a person a much better idea of the thinking of the general public than any outright political site would be able to provide. I stick to lurking and not posting there as they have a great site and do not need my opinionated arse messing with it.

 As with any site that has a degree of political discussion, Canadian healthcare pops up now and then. Like any other sites on that issue, the discussion became extended and heated quickly.  The only real sad part was how quickly that conversation degenerated into the usual myopic and unproductive path that dominates Canadian healthcare discussions.

 To begin with, the shrill defenders of the status-quo immediately trot out horror stories within the American health system. This is standard tactic and unfortunately is effective. The debate immediatelybecomes polarized and turned into some sort of all or nothing debate discussing the merits of fully private provision versus fully socialised provision.

 Lets get something straight here:


 Both systems are flawed and unsustainable. Think of it this way, are you more dead when you die on a waiting list or more dead when you die due to lack of coverage? Doesn’t really matter now does it?  

There are dozens and dozens of healthcare systems in the world. Many of those systems rate well above both the American system and our own when outcomes and cost are measured. In the last world ratings Canada had plummeted down below 30th place and was still falling.

 So what are the other 29 (and growing) countries doing that we are not? To hell with the American system. I don’t care what they do. I want to see successful systems. I am saying that again as when discussing this in person I have yet again reached a point where it is realized that I would like to change our system and somebody feels that it is time to try and sidetrack to the USA model again.

 To begin with. we have to look at why Canada’s system has been dropping in the rankings. Sadly, only Cuba and North Korea share Canada’s outlook of actually outlawing private healthcare. Think about that. Our system strangles any chance of innovation and reform and our almost religious-like protection of it assures that discussion of reform is stunted as well. If we can’t even discuss or try minor reforms within the system itself, it is inevitable that the system will stagnate.

 The demographics of Canada are changing. The baby boomers are getting on and thus need more and more treatment. Drug and diagnostic technology has grown by leaps and bounds but it is getting more expensive as well. The bottom line is that we need to spend an ever increasing amount of money simply to maintain our current standard of service. The real tragedy is that we have made massive increases on the amount spent on healthcare and the services have still declined.

 Socialized medicine means rationed medicine. Recent court rulings have literally found the waiting lists in Canada to be unconstitutional and the lists only grow longer. In scanning the newspapers around the country, one can find a person almost daily who has died while waiting for treatement in Canada. The stories of people living in agony while waiting years for knee or hip treatments are endless. Increased spending has done nothing to aid with this.

 In summary, our spending is exploding and our outcomes are deteriorating. While most would agree that such a trend is completely unsustainable, most still see challenging the status-quo as being akin to blasphemy. I wonder and fear how bad things will have to get before Canadians finally begin to treat what they see as one of their most cherished institutions with a little critical thought?

 France has consistently led the world rankings in healthcare systems. While the French have not mastered personal hygiene, they have clearly found something in healthcare that works. The French system offers universal coverage (yes everybody is covered), spends less per-capita on healthcare than Canada and has no waiting lists. How is this possible? Here comes the dirty word. The French have created a system that mixes private and public involvement. Here is where the average Canadian tries to digress into a hysterical comparison with American care again. Well shrill defender of the status-quo, blow it out your ass. I am seeking solutions not religion. Bringing up the American system when discussing Canadian healthcare is essentially an intellectual Godwin award.

 The public/private mixture in France provides many advantages. I am going to commit another form of Canadian blasphemy; I am going to compare healthcare provision with a business. The patient is the consumer. Now, what in every situation on the planet is the worst circumstance possible for a consumer? If you said “a monopoly” you are absolutely correct. The consumer is inevitably shafted when there is only one provider of a service or product. In Canada healthcare is a government monopoly and it shows in the terrible outcomes. Competition in some form or another is essential in the provision of any service. Why and how would any institution innovate if there was no competition? What incentive is there? Competition need not be a wide open free for all, it can be limited and regulated. Currently in Canada there is zero competition. Competition is illegal. In Alberta we are not even allowed to see the ratings of our hospitals for fear that it may shame the management of one or another of them.

 OK lack of a competitive model is stunting the management of our system and the efficiency. Now what else is causing the intolerable waiting lists? LACK OF SPECIALISTS. Unions have framed the debate well in this regard. When it comes to allocation of our increasingly scarce dollars the unions scream and demand that we have more beds. Not more diagnostic equipment, not more surgical theaters they only want to see more beds. Why so you ask? Well that is the normal self-serving nature of unions. You see more beds means more unionized nurses, LPNs, laundry services, dietary services etc. Machines and doctors don’t fill the union coffers even if indeed they do cure people.

 If we had the specialists that we need, we would not need all those beds for Canadians to languish in while waiting for specialized treatment would we? Now why can’t we retain specialists? This gets back to competition again. Set aside your ideals for a moment dear reader and have a look at reality. Specialized medical graduates have put in more than a decade of post-secondary education and are often entering the workforce six-figures in debt. These graduates are people too. They have aspirations for a family, a house, vacations etc. Now, like it or not, there is a competitive world market for these graduates. Canada’s socialized system makes it rather tough to gain or retain specialists as the compensation is capped and the specialists are overworked. While homeland and family ties are strong draws for people, it is hard for a new specialist who is deeply indebted to resist an offer of twice or more the compensation for their services in a foreign jurisdiction (not always those darned Americans by the way). The brain-drain is greatly harming our system.

 Again, a public/private hybrid need not be all or the other. Just for a ballpark example, lets say that we allow a group of specialists to open their own clinic and charge directly for services. We can still regulate this folks. Lets say that these doctors have to do 60% of their procedures within the public system at a set rate per procedure and they may charge whatever they like for the remainder of the 40% assuming they can find folks who want to pay it. This allows innovation and extra compensation to maintain these specialists.

 Now of course the envious will yelp  in indignation: “how dare people pay to get ahead of me in line!”. OK folks, this is one of the hard parts to understand. The “rich” will drive better cars, have larger houses, take nicer vacations, drink better wines, eat better foods and likely will be ****ing better looking women/men than you. Get over it. This is life. Instead of trying to drag these folks down, how about aspiring to get to where they are for a change?

 These mythical and evil rich actually make healthcare provision faster for people in the public system when hybrids are allowed. By paying extra to get faster treatment, that much public money is saved and a facility with specialists is funded. When done correctly, everybody gets faster and better treatment overall and for less public money as with in France.

  That hurdle of learning to get over the envy is tough with some folks however. I have debated many who even when it is absolutely proven that such systems benefit the whole overall, would rather stick to the current system. These people would rather see people die on waiting lists than conceive that somebody bought better or faster treatment. Yes, socialism is the equal distribution of misery indeed. Who are truly the cruel in this healthcare debate?

 A reality to be faced is that many people of means jump the line anyway. These people simply leave Canada in order to do so. If indeed this is going to be done, why the hell can’t we allow them to spend that money here? Lets keep our money and specialists in Canada. If done properly, we could supplement our health system with the revenue generated by foreigners coming here for treatment. Yes, we could actually profit from this (oops, profit is evil isn’t it).

 It is not simply “rich” people who are fleeing Canada for timely treatment. The people doing this are simply the desperate. Imagine this, you are diagnosed with a potentially fatal heart condition. You are scheduled for surgery in 18 months. Chances are however that you may suffer from a fatal heart episode within that period of waiting. You have a choice; roll the dice with your life and wait. or you can remortgage your home, fly overseas and get the procedure done within weeks. The home equity and RRSPs really don’t mean much when your life is on the line. This is happening all the time in Canada people.

 Is every concept that I pointed out in my extended rant completely correct? Perhaps not. Until we have a real discussion of healthcare options we will not be able to find out. Canada’s system is unsustainable and a crash is inevitable. The earlier we can set the sacred-cows aside and begin to look at what really may or may not work, the better we will be when the transition that must come occurs.

 The first step in improving Canada’s healthcare is for people to admit that the system is not perfect. We still are a long way from people generally accepting that unfortunately.

9 thoughts on “Some healthcare rambling.

  1. The Swiss health care system is also very good. It is a mixture of private, public and subsidized private. Everyone has to buy insurance.

  2. Yes, the Swiss is good as well. There are many systems out there that we could study and consider implementing some or all of their methods.

    We have to grow outside of this myopic refusal to think outside of the box and quit comparing any change with the American system first.

    That may take some time yet.

  3. Cory,
    Would our system fall under the Canadian system or is it flawed at a provincial level. The way I understand it the federal gives back a small amount to each province for healthcare as long as we folow their guidelines. I could misunderstand this which is why I ask. Also not all privatization is as flawed as the U.S. so having one province run a different system to see if it is feasible should be tried. Here in Alberta the taxpayer is at the bottom of the list below WCB, RCMP, and criminals for treatment, so I think the changes need to start at the provincial levels to improve the systems in place federally.
    Just my two cents of uneducated rant.

  4. Alberta Altruist,
    You are basically right on the federal funding aspect. An overview of the funding can be found here:
    The block transfer can be spent on whatever a province wants but of course most of it does go to social programs.

    The fed claim to support about 33% of health care spending. See

    The feds are in charge of administering the Canada Health Act. If they see a province in violation and the province won’t make the necessary correction, a fine is levied and deducted from federal transfers. Remember when Alberta was being fined $1 million (or some other amount) per day or week or whatever when the feds didn’t like something Klein was doing.

    Since it is politically impossible to make major changes in Medicare, your suggestion wouldn’t fly, but the provinces should nonetheless be allowed to experiment with modifications to the system. Say a 5 year period is put on an experimental change and then it is evaluated. If it is hurting health outcomes and/or increasing costs, then it has to be dropped. Successful changes would become permanent and no doubt adopted by other provinces. With ten provinces experimenting, the nibbling at the edges over time could lead to major alterations in the system.

  5. Your points are all well taken. I am speaking more of the destination rather than the path at this point.

    As you said, the 33% number is according to the feds. I seem to recall it being much lower by other measures but I can’t remember where right now. The health act says the feds should be funding 50% of our healthcare however so how beholden should we feel to them when they won’t pay their own share?

    The feds are not in charge of administering the act. They are in charge of enforcing it. The feds won’t pay their share yet demand to be able to call the shots.

    Stephen Harper was one of those who penned the “Alberta Agenda” that told Alberta to ignore the health act and make reforms on our own. He would look rather foolish were he to chastise us now for simply doing what he told us to do wouldn’t he? I can think of no better time for a province to try something new.

    Either way, I do understand that we will not see radical change any time soon (despite the need). What we need to begin with though is at least some crititical discussion. We are not seeing that so far from the elected or the electorate.

    Getting back to Altruist, I fully agree that the change must begin with provincial initiatives. Federal governments in Canada will never have the courage to admit that our system is flawed. (admittedly provincial ones have not admitted it either)

  6. You’re right, I should have used the word enforcing as that is what I meant but the feds do administer the Act.

    “In administering the Canada Health Act (CHA), the federal Minister of Health is assisted by Health Canada policy, communications and information officers located in Ottawa and in the six regional offices of the Department, and by lawyers with the Department of Justice.”

    The provinces are in charge of implementing the Act.

  7. The biggest issue really seems to be how to provide to those that can’t provide for themselves, but make those that can endure a reasonable burden of the costs to stop abuse of the health system. It seems to be a common them in every system, that has some kind of bottom run social safety net, no matter how its run on the surface.
    There will always be those that can’t pay for their own care, and there will always be though that take advantage of a charitable system.

  8. I think I have to take exception to a lot of what you have said here. But we must not forget how good we do have it.

    I have experienced both the American system and the Canadian first hand. When I was very young I was very ill. We were living in the USA then. To make the story short the doctors and hospitals ended up with all my parents cash property and houses. My parents would have been at the time what you could call affluent. This was before insurance and HMO’s were running the system. Never the less they ended up having to start completely over again. I do not want a system where Canadians will have to ask permission to be ill, or afraid to go to the doctor because they can’t afford insurance, or worse yet experience what my parents had to endure. As Canadians we must not confuse caring for each other with greed.

  9. Well Gehres I think you missed the entire basis and point of the posting in that you immediately went to comparing our system to the American system.

    Read the posting again and get back to me.

    I really don’t care what happens in the USA.

    You have demonstrated well how so many people seem to think that the Canadian system and the American systems are the only ones on the planet.

    Now if you could provide a heartrending anecdote about the ills of the Swiss system or the French system, you would at least be on the right subject.

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