Tag Archives: healthcare

Want to conserve a resource? Make it a commodity!

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An unfortunate reality is that the more critical a resource is to the population at large is, the more likely and effective efforts will be to put the management of the resource fully and directly into the hands of governments. I say this is unfortunate as when a resource is collectivized; a sense of consumer entitlement arises leading to even more consumption and more irresponsible management of the resource.

Few resources demonstrate the above principle more clearly than fresh water. Based on the simple reality that fresh water is indeed essential in life, advocates for intrusive government expand from there in demanding that water never be traded or used as a commodity in a private manner. What is overlooked whether purposely or not is that water already is a tradable commodity and it must be in order for modern society to function. Industry and agriculture have been purchasing water since the invention of canals.

Despite the hysterics of groups such as the Council of Canadians, nobody is really coming to steal or buy all of Canada’s fresh water. Our supply of fresh water as a nation is quite safe. Treated water for household use and consumption however is indeed a resource that is expensive to produce and hard to keep up with citizen’s demands for it.

Last Saturday evening was dedicated as the time for people to observe “earth hour” as designated by the international lobby corporation known as the World Wildlife Fund. Despite ads, gimmicks and general lobbying, Calgary happily ignored the hype and I am proud to report that we as a city showed utterly no change in our energy use as during this hour of greenwashing. The usual suspects in the environmentalist world are of course decrying us as rednecks and enemies of the earth for ignoring their foolish little exercise.

Assuming that Calgarians are indeed the heartless, environment-destroying, capitalist bastards that some in other regions like to try and paint us, how on earth did we manage to be the city with the lowest per-capita water consumption numbers in the country?

What inspired so many Calgarians to install low-flow toilets, track down leaking pipes, use rain-barrels and reduce the amount of treated water that we pour on to our lawns? Was it successful lobbying by Greenpeace and the like with their door-to-door work and flyer drops? Was it ads in the paper wagging collective fingers at us for overconsumption? Was it an earth-shattering speech from a civic leader? None of the above apply of course. The key element in the reduction of Calgary’s domestic water use has been household water metering!

I know that we like to envision society as being altruistic to the point that they will embrace every conservation initiative that is fed to them but in reality it is only self-interest that moves people en masse to change anything. Through making water a measurable commodity that people pay for based on individual use Calgary succeeded where decades of socialized water distribution failed. By simply being charged by the liter and being able to see a measure of household use, citizens were suddenly inspired to seek effective ways to reduce their consumption.

Hipsters do love their irony so they should appreciate the figure below from Statistics Canada.

Chart 4 Households in single-detatched dwellings more likely to use water-saving fixtures

wateruse

While the majority of our urban density zealots who preach of the wasteful lifestyles of suburbs live in dense neighborhoods (and their parent’s basements in the suburbs), it appears that they have some issues in practicing what they preach. Why is it that the areas most densely packed with environmental idealists are not embracing water consumption reduction initiatives nearly as much as those evil bourgeoisie devils in single detached homes?

The answer is pretty simple; in apartments and other multi-unit dwellings utilities and resources such as water are much more likely to be collectivized. Renters abound and utilities are often bundled in with their rent. Despite high-idealism, direct incentive to reduce consumption is not seen  so consumption simply isn’t reduced. Like most socialists, it is expected that somebody else has to do it but the demands on everybody else are to be shrill, sanctimonious and as can be seen, often hypocritical.

The principle of making a resource a commodity in order to control consumption works pretty much anywhere. Environmentalists love to screech indignantly at the practices of logging companies. One would assume that crown land under the tight scrutiny and control of government would be where best practices would occur then no?

In reality, private woodlots are far more efficiently managed than crown lands. While only 11% of Canada’s woodlots are privately owned, 19% of our timber products come from them. Private woodlots are carefully managed for erosion control, esthetics and of course productivity. Sustainability and replanting are critical simply due to the element of self-interest in maintaining a healthy, balanced forest. That is not to say that no sustainable practices are done on public lands, this is just pointing out that private practices prove to be superior to public management.

If public ownership of resources were the key to wise environmental practices and sustainable growth, China would be leading the world in clean industry.

If public ownership of critical resources led to more efficient production and a sustainable cost of living, Soviet Russia would have had the most stable food supply on the planet. Google bread-lines or starvation in Ukraine to see what happens when government is given the management of a resource simply on the premise that because it is critical that it should not be left in private hands. Food is a need. Despite that, government management of food has always proven to be a failure with extremely dire consequences.

We need to keep these principles in mind when looking at other resources too. Where are our largest areas of public expenditure? Where are these expenditures growing the fastest?

Healthcare and education prove to be the most important issues to voters and both are proving to be unsustainable to the public purse. Because of massive government subsidization and control, a sense of entitlement has caused an unsustainable trend in demand and direct management of these resources. Nations are going bankrupt around the planet due to entitlements and as we see all levels of government in North America spending far more than they bring in it is clear that we are heading towards a crash as well.

Water and food are needs and we have found that treating them as commodities has been the best way to ensure that these needs are sustainably managed for all. Healthcare and Education are needs as well yet we refuse to recognize them as commodities due to flawed and outdated ideologies.

It should not be an entitlement to go to an emergency room without direct personal cost every time your child has the sniffles nor does every child need post-secondary education. Treating healthcare and education as commodities would mean directing resources towards real need rather than entitled wants. This is not to say that we need to move to a fully private model for either of these areas by any means. What this means is that we have to change how we look at these resources in a new way if we really actually want to conserve them in the most responsible manner.

Whether we like it or not, government resources are finite. We simply can’t fund everything to keep up with every entitled demand by interest groups. We have to look at supply realistically before trying to fill every demand.

I know people fear private provision of services. If we continue to live beyond our collective means as we are now though, the dog-eat-dog system that will come post-crash will make controls that we could make now appear to be a cake-walk. Have a look at Spain, Greece or Russia for examples.

Socialized medicine is rationed medicine.

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With health care consistently polling as the top concern for Canadians it is sad yet unsurprising that so many people see queue jumping by people with connections as being one of the prime problems of the system. In Alberta we are currently holding a nice sidetrack of an inquiry into queue jumping that appears to be heading nowhere. Meanwhile all the real problems with our unsustainable health care system are being overlooked.

People appear to be more concerned that perhaps some professional hockey players managed to get a flu-shot ahead of them in line than they are with the fact that our waiting times for care are simply unreasonable.

Set your sense of envy aside and realize that queue jumping would be a non-issue if our wait times for care were reasonable in the first place!

Wait times for emergency and general primary care in Canada are among the longest in the developed world.

Wait times for specialized treatment are terrible in Canada too.

THE BOY PICTURED ABOVE IS NOW PERMANENTLY PARALYZED AFTER WAITING 27 MONTHS FOR A SPINAL OPERATION! 

People are suffering and dying on waiting lists in Canada as our system fails us despite massive increases in expenditures over decades. The fact that some people managed to jump line now and then is only a symptom of the much larger problem. If you want to get angry, get outraged that the poor child above could have avoided paralyzation had he not been caught in our inflexible system.

People are jumping the line for health care every day in Canada. The majority of these people are leaving the country to do it. These are not rich people, these are desperate people. People are borrowing from friends and family and people are mortgaging their homes to leave Canada for timely medical treatment. If you were told that you needed treatment within months but could not get in for years, what would you do?

Doctors leave Canada to chase those dollars as well. In a gross irony, many people leave Canada and pay for treatment that happens to be carried out by a Canadian trained doctor as our brain drain continues. Among the systemic reforms that we need, cost effective retention of health professionals is a huge one.

We need systemic change in Canada. One commonality in all of the countries that have universal coverage (yes I repeat they still have universal coverage) yet blow us away in medical wait times is that those countries have mixed private/public health systems. Yes, in those countries some people pay cash for faster treatment than others at times. If this leads to shorter times for everybody though, why the hell not? Suck back the envy and enjoy the shortened wait time that the queue jumper just subsidized out of pocket for you.

Getting the best health possible means we have to look at the best systems and emulate them. Currently only Korea and Cuba share Canada’s system of banning private involvement to this degree. Let’s look to the top and see how we can get there. Before we can do so though, we have to accept that our system itself is failing. We also have to get over our envy and use common sense.

I expect the usual commenters beaking about the American system so let me get this out of the way now: I could not care less about the American system. There are hundreds of other systems in the world and dozens and dozens of them have better outcomes for dollars spent than Canada does. Don’t waste the text trying to polarize an issue that has many facets with the shallow black and white Canada/USA system comparisons.

If we want to see an end to these unreasonable waiting times for health care, we need to admit that we need to change our entire system. Every province in Canada has been constantly increasing spending on health care and wait times are increasing despite that.

Queue jumping is not our problem. A broken system sustained by sentiment and stubborn envy is our problem. I hope we realize this and fix things before we see a true health system failure.

Walla walla bing bang.

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Yes folks our Alberta’s provincial government has moved beyond being simply inept and arrogant into the world of the bizzare.

Heathcare consistently ranks as a prime issue with Albertans. With waiting lists hitting critical levels despite massive annual increases in government spending, our brilliant Health Minister Fred Horne has taken it upon himself to give naturopaths full status as “medical professionals”.  

For those wisely not familiar with naturopaths, these cranks tend to practice such brilliant therapies as homeopathy and touch therapy among other forms of quackery. They tend towards conspiracy theories and generally are against medical advancements such as, drugs, vaccines and effective treatment of ailments.

I won’t go into too much detail as to why naturopathy is quackery as it has been so thoroughly covered by many others. I will put a couple links below to save some googling.

A Close Look at Naturopathy Stephen Barrett, M.D.

More naturopathic nonsense in Ontario

Homeopathy: The Ultimate Fake

Below I will add a link to a bit by my my favorite libertarians (Penn and Teller).

Their shows are laden with expletives but they do such an excellent job of debunking the “alternative” medicine movement that they are well worth watching.

People can go waste whatever money, time and health they like with whatever crackpot treatment they like. It is their money and their bodies.

When we are talking about the sanctioning of practices by our government though, we must stick to EVIDENCE BASED MEDICINE. 

Yes, there has been a process set about to determine what falls under evidence based medicine. Double blind studies, peer review and proven results are the sort of hurdles that treatments are expected to pass before being considered evidence based.

Naturopaths of course reject the concept of evidence based medicine. That is not surprising considering pretty much no naturopathic treatments can withstand proper medical scrutiny.

Don’t listen to crap people spit out about how the treatments have been around for hundreds of years. People used to drill holes in the skulls of patients to let the demons out hundreds of years ago, that does not make it a valid treatment. The average life expectancy a couple hundred years ago was 36 years. Is that something to aspire to?

There are claims that now that naturopathy has a college, they will be able to self-govern. Oh good, quacks governing quacks. That should ensure effective treatment.

Don’t let them snow you pointing out how long naturopathic quacks have gone to school. A person could spend decades in school studying astrology, that person still will not be able to predict the future and will be as well trained to treat ailments as your typical naturopath.

Government sanction of naturopathy adds to the facade of legitimacy for these quacks. You can rest assured that naturopaths will soon be demanding public funding for their pap and considering government is sanctioning them, it very well could happen.

Our healthcare system is under pressure and is crit

Outcome or ideology? Which is more important to you?

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There are few sacred-cows that have been more carefully crafted and fiercely protected than that of Canada’s health care system.

Tommy Douglas has been essentially canonized as a founder of our system and it is considered blasphemy to dare even consider questioning the merit of the system. Politicians and journalists alike are pilloried should they ever dare suggest that Canada’s health system may not be the best one on the entire planet. If health system issues should ever arise, the only appropriate response to the zealous is the addition of more funding. Systemic change is simply unacceptable.

Now back to reality. The World Health Organization used to publish comprehensive rankings of health systems based on accessibility, cost and outcomes. Unfortunately they have not done this since 2000. In their last ranking though, Canada was 30th and dropping like a stone when compared to other nations.  Considering we have changed nothing systemically in the last 10 years, it can be safely assumed that the trend has continued.

The most successful systems in the world have involved a mixture of public and private involvement while maintaining universal access. This is not conjecture. This is documented fact. The only other systems that legislate such a degree of government monopoly in them as Canada are North Korea and Cuba. I assure you those countries are not good models to follow.

When the word “private” is used almost immediately people begin chirping about the American system. There should almost be some form of “Godwin’s law” that applies to the insertion of the big bad American boogyman in healthcare discussion. As soon as some fool takes the leap to bring up the American system, they immediately shall have been deemed to have lost the debate.

I am going to expose the big secret here: THERE ARE HUNDREDS OF HEALTH SYSTEMS IN THE WORLD AND DOZENS OF THEM ARE SUPERIOR TO THE CANADIAN AND AMERICAN ONES!!

Protectors of the status-quo (usually unions) constantly try to shut down discussion by trying to polarize debate. It is simply shallow and foolish to assume that Canada and the USA are the only two health-care systems in the world yet if we look at most Canadian discussion it would appear that way.

Another secret is that we have private provision all over the place. There are countless private labs, clinics and yes even hospitals in operation in Canada. Unfortunately, these facilities are still constrained by our inflexible system and often have to be almost snuck into the system by politicians who realize the need for expansion of our provision options but are afraid to dare question the sanctity of the status-quo.

We need to rip down this facade and have a real discussion. Hysterics and demonization of all who dare question the status-quo is harming us all.

We all have to ask ourselves; what is more important; the outcomes or personal ideology?

This is what it comes down to. The outright dismissal of private involvement is an ideology. The polarization of the discussion is an ideology. The self-blinding to all other discussion is an ideology.

We need to open the discussion and look to the best systems if we want to improve our own. I was impressed with Danielle Smith in last night’s debate in her being willing to entertain examining other means of health provision while the other 3 leaders stuck to the cowardly and closed minded defense of the unsustainable and failing status-quo. The whispered and shouted fearmongering continue about the Wildrose Party as ideologues dismiss any notion of real solutions and try to quell all discussion.

We need to stop the politics of envy, fear and division so that we can have a frank examination of our healthcare system based on what can lead to the best outcomes rather than the zealous and closeminded approach that we have had so far. Healthcare consistently ranks at the top of people’s concerns in politics yet it is the issue with which we are the most reticent in discussion.

Take off the ideological blinders and pursue what works best. It really is as simple as that. I am optimistic that a Wildrose government may be willing to be the first in a long time to do so.

 

Do we want the best or not?

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 Year after year, poll after poll we see that health care is considered far and away to be the most important issue to Albertans whether left, right or center. We also see constant stories of shortcomings in our current system. Recently we have literally seen a doughnut shop being used as an ER because a BC hospital was over capacity. People have been literally dying on waiting lists and we are seeing health facilities in dire need of upgrading or repair.

 Two facts are evident here.  One is that health care is paramount in importance to Albertans and that the system is not performing in a satisfactory way. People say that they want the “best”. OK fair enough but how do we determine what is actually the best? Lets look at a few measures.

Spending.

 Almost invariably when shortcomings are pointed out in the system, defenders of the status-quo (unions) suddenly claim that our system is one of perfection and that we simply are underfunding it.

 Alberta has tripled health care spending in the last decade. Despite that massive increase in expenditure, our waiting lists continue to grow and our infrastructure continues to crumble.  if spending alone were the measure of a successful system, the United States are clearly the most successful health care providers on the planet as they spend more by every measure on health care than any developed nation on the planet.

 Many health systems that can brag better results than Canada spend less in measures of per-capita spending and in percentage of gross domestic product. It is pretty safe to say that this means that we can see better results in health care without spending more money if we are willing to change how we do things.

 It must be kept in mind that the most vocal groups for increased spending are unions and their side lobby groups (Friends of Medicare). Despite what they may claim, unions simply do not have the interests of patients in mind (nor should they, the workers are their mandate). Note that the unions constantly call for “more beds”, not more doctors, more procedures, more drug coverage, more preventative medicine or more diagnostic equipment. The reason for this is simply that more beds translates into more union staff whether nurses, janitorial or even in laundry services. If we got all of the other things, we would need less beds as people would not be languishing in hospitals awaiting treatment as they are now. The unions are simply doing their job in that their interest is nothing more than gaining and maintaining more union workers. That always has to be kept in mind when they call for more spending in health however.

World health spending rates can be found here. Canada is near the top in this at least.

Beds per 10,000

 While beds and the need for them can represent a shortcoming in timely treatment, we certainly do need a measure of them. As Canada is among the world leaders in spending, how do we rank among beds? Not too well I fear.

Canada ranks 40th behind such economic powerhouses as Uzbekistan and Palau. 

 Again beds alone are pretty limited in what they indicate and in what they provide in health services. All the same, if we are going to lead in spending, why are we not leading in such measures as this?

Doctors

                   One thing that greatly reduces the need for hospital beds is having an adequate number of doctors and specialists treating patients so that they can be back on their feet again. An increased number of doctors helps reduce the load on the system by diagnosing and treating patients earlier while many conditions still remain more easily treatable.

 Canada ranks 58th in doctors per capita behind such nations as Moldova and Uruguay with 2.1 doctors per 1000 people.

 Gaining and maintaining doctors is not a simple task. Increasing the number of doctors we educate at home is good but it is no assurance that we will keep these recent graduates. Many newly trained Canadian doctors are quickly recruited by foreign countries that have more flexible health systems which are much more attractive to doctors than ours with essentially capped salaries and untenable hours of work. Our system hinders us in trying to draw foreign doctors in to Canada as well.

 It only makes sense that we examine comparable countries to our own and that we emulate what has been working with them.

Life Expectancy

 Many other factors come in when it comes to life expectancy. The local health care system has a huge impact on expectancies though.

In the world rankings, Canada is 11th in life expectancy. Not bad. I still like aspiring to the numbers of the 10 nations ahead of us though (all of whom have mixed health care provision systems).

Infant mortality

Infant mortality is a good measure. Certainly we can’t directly compare with third-world nations that are coping with malnutrition, clean water and getting simple vaccinations. In developed nations though, the infant mortality rate can give a good indication of how the pre-natal and birthing care have been. In Canada we rank 23rd. 

Universality

Universal care is a value that most Canadians share. Ironically, in our stubborn adherence to our flawed system many desperate Canadians are going to European and Asian nations in order to purchase procedures that they simply can no longer wait for in Canada. The irony is that these people are subsidizing the universal coverage of other nations while we languish with untenable waiting lists in Canada due to a twisted sense of “fairness” and an ingrained fear of “two-tier” care. Our socialized and rationed system is self-defeating in that people of means (or desperation) are still jumping the line and are taking their resources out of the country while they are at it. I wonder how many of these people end up getting treated by Canadian trained doctors in foreign nations? Which nations more truly have universal coverage?

 We as Canadians have had it driven into our heads our whole lives that Canada has the best health system on the planet while every measure possible is contrary to that assertion. We have actually built a system of service provision into our national identity which is sort of disturbing when you think of it.

 If we truly want to get the best health care possible for ourselves, we first have to admit that our system is not the best (in fact it isn’t even close to it). We then need to examine the systems that do rate as the best and emulate them.

 In all of the measures I referred to above, some countries consistently ranked near the top. France, Japan, Sweden and Switzerland all surpass us and only Switzerland spends more. One common element of the countries that are surpassing us is that they have set aside the notions of envy and socialism in order to pursue the best outcomes for patients. All of those countries allow a much greater degree of private provision and management than Canada does and that is no small denominator in why those countries enjoy better care than we do at less cost to all. All of those countries have universal coverage as well.

 When we look at the chronic crisis hitting Canada’s health system despite massive increases in expenditures, it becomes clear that change to Canada’s system is inevitable. What we have to ask ourselves is whether we want to proactively pursue that change now or if we will stubbornly hang on to our broken system until it collapses and change comes in a different way.

 I would prefer to pursue the best system myself.

Some healthcare rambling.

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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.