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:

CANADA AND THE UNITED STATES ARE NOT THE ONLY HEALTH JURISDICTIONS ON THE PLANET!!!!!!!

 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.