Monday, October 22, 2007

Canadian healthcare's miserable waiting lists

A National Post story, “Surgery waits longest yet” (Oct.16, 2007), reported: “Canadians waited longer than they have in more a decade for non-emergency surgery this year, despite a multi-billion-dollar effort by governments to speed up medical care, according to a controversial think-tank report released yesterday.

The average wait between being referred to a specialist and receiving an elective operation was 18.3 weeks in 2006, up from 17.8 the year previous, concluded the conservative Fraser Institute in its annual look at medical backlogs. That is the longest delay recorded since the institute began studying the issue 17 years ago.”…“Clearly, money is not the solution," said Nadeem Esmail, a Fraser health care analyst and co-author of the report. "We're dumping money into the system; we're piling on cash that the system has available to deliver health care and it is not able to significantly reduce the waiting times. In fact, we're seeing the wait times continue to grow."

As it has in previous years, the institute argued that the way to solve the backlogs is to introduce competition between private and public providers of government-funded health care and allow a parallel private system.”

Nadeem Esmail also wrote in “Imagine: a universal health system without waiting lists”, (National Post, October 17, 2007):

“In 2007, waiting times for access to health care in Canada reached a new historical high: 18.3 weeks averaged across 12 medical specialties. While many politicians will respond to this recently announced news by pointing to costly new government programs, few will ask the important question: Why are Canadians waiting at all?

Wait lists for medically necessary health care are Canada's shame. Canadians are generally proud of their universal access health insurance program. But, as two Supreme Court Justices recently stated, "Access to a waiting list is not access to health care."

Canadians waited some 25 weeks for cataract surgery in 2007, from the time their general practitioner (GP) referred them to a specialist to the time they received treatment. More alarmingly, Canadians waited some 42 weeks from GP referral to treatment for joint replacement.

Consider for a moment the costs a wait of that magnitude entails.

Of course, there are the medical costs: a potentially worse outcome from surgery, or a potentially more difficult surgery/recovery as a result of deterioration over the 42-week period. But there are also significant personal costs. Any wait time, even a short one, entails pain and suffering, mental anguish, lost productivity and strained personal relationships. Wait times can also take a toll on the family and friends of those waiting, and may even have an effect on an individual's ability to earn a living.

According to the Pan-Canadian Benchmark Wait Times announced jointly by the federal, provincial and territorial governments in December, 2005, being treated within 26 weeks from the time a Canadian sees a specialist to the time they receive treatment for hip or knee replacement surgery is considered reasonable. So is being treated within 26 weeks for level 3 cardiac bypass surgery, or 16 weeks for cataract surgery for patients at "high risk," or four weeks for radiation therapy. Yet many of the provincial wait times guarantees announced earlier this year are much longer than even these generous targets.

For those wondering how we can get ourselves out of this mess, the answer is surprisingly simple. Canadians must move beyond the politics and rhetoric that plague the health care debate and let our policy reform be guided by a serious examination of the policies of the nations that deliver universal access health insurance without waiting lists.

Austria, Belgium, France, Germany, Japan, Luxembourg and Switzerland provide what many Canadians might see as the impossible dream. In each of these nations, individuals are guaranteed access to health insurance regardless of their ability to pay. And each of those individuals, regardless of their income, has access to the health care they need without waiting lists. Equally importantly, the cost of these health care systems is, on an age-adjusted basis, similar to or less than Canada's.

In these nations, patients are free to choose for themselves whether their care provider will be a public or private hospital, all under the terms of the public insurance contract. They must, however, share in the cost of the care they consume, which encourages them to make more informed decisions. Patients in these nations are also free to purchase the care they desire privately if they wish to do so. While patients in these seven nations bear more personal financial responsibility, they also enjoy more freedom in determining who will pay for and who will deliver the care they need. The result is that patients enjoy access to care without waiting lists.

Each of these sensible policies has come under fire in Canada as a road to the "Americanization" of health care. But the experiences of those seven nations shows that these polices will do nothing of the sort. Instead, they will provide Canadians with wait list-free access to a world-class health care program regardless of ability to pay, a significant departure from the system we have today.”

Ah, yes, 'Americanization', the left-lib's favourite boogeyman fear-mongering word! Contrast the above story to this, “Keep hospitals public, protesters say at rally,” (Niagara This Week, Aug.22, 2007) : “The Trojan horse is private healthcare,” said Louis Rodrigues of a group calling itself the Niagara Healthcare Coalition. “It’s a false gift to the people of Ontario that will ultimately destroy the public (institution)” . The story wrote: "Rodrigues said that creating a two-tier health-care system would lead to hospitals cutting corners for bigger profits, and higher costs for patients”…“We want to keep everything public,” said Aina Fl;ack, a Niagara Health Coalition volunteer. “We don’t want anything to be how it is in the States. It’s going to cost us more.” Rodrigues said he doesn’t understand why the province ever began considering moving toward privatization."

The “privatization” being referred to was the Liberal-appropriated-from-the-PC’s P-3 public-private-partnerships plan for new hospital construction; and also to John Tory’s election proposal to involve more private delivery into healthcare – paid for by the health card, conveniently not mentioned by this group in the story. This is the level of fear-mongering which has to be addressed. Any concern for patients is overshadowed by a blind faith in the greatness of the current killer status-quo.

Here’s a story from the St.Catharines Standard (Oct.20, 2007), “Union to spend $5M to stop privatization":

"Canada's largest union committed itself Friday to a $5-million national campaign aimed at fighting privatization of services.
Delegates to the convention of the Canadian Union of Public Employees approved the strategic initiative aimed at bolstering public services - or at least stopping their erosion.
The program calls for a combination of strikes, demonstrations, lobbying and political campaigns to achieve the goal of fighting off privatization in sectors where the union is active, such as in health care, municipalities, social services, education and child care."

Note that union millions are to be spent on propaganda to stop privatization, not, of course, to help patients. That’s not on the agenda. Saving cozy, non-competitive monopolies is the goal!

David Maharaj wrote in the Toronto Sun (Oct.19, 2007): “The only way to fix medicare is to unleash the free market into the system. Unfortunately, free-market principles have taken a back seat to ever-growing waiting lists. It seems as though some Canadians, along with the political hacks that keep getting them elected, believe in equality, as in equal access to mediocre health care.”

George Jonas wrote in “Be patient. You're Canadian” (National Post, Oct.20, 2007):

'Doctor, it hurts." "Ah, I see the problem. Not to worry; I know the surgeon to fix it."

"How soon?"

"Well, Christmas is just around the corner, then January, February, March, maybe a bit of April. By Easter you'll be as right as rain."

"Wow! Is it going to take four months to heal?"

"Hell, no; healing takes a few weeks. The four months is to book the procedure."

"Four months! Good Lord ?" "No, the Lord is in charge of healing. Booking comes under universal health care. Be thankful it's not the other way around."

"Thanks, doc. I'm counting my blessings."

"That's the spirit. Remember, you're a Canadian."

The imaginary conversation above illustrates average waiting times, not the longest. An Ontarian only waits from Christmas until the spring equinox. In Tommy Douglas's jolly old Saskatchewan, birthplace of socialized medicine, a patient copes with the pain of being a Canadian from Christmas until the summer solstice.

Like afternoon shadows, Canada's queues have been steadily lengthening since the Fraser Institute began surveying them 17 years ago. This week, the conservative think-tank's annual report confirms what everybody in the country knows -- though some keep denying -- namely that waiting times for many types of surgical procedures in Canada's public health system are uncomfortably and sometimes dangerously long. The 2006 figure, a nationwide average of 18.3 weeks between referral to a specialist and climbing on the operating table, gives new meaning to the word "patient."

Considering that tax dollars aimed at reducing queues have steadily increased during this period, it seems safe to assume that throwing money at the problem isn't making it go away. Usually, people get what they pay for, but taxpayers are an exception. Having paid more for medical care in 2006 than in 2005, Canadians had to wait for non-emergency surgery on average about half a week longer.

Why are people in Saskatchewan content to wait six months for knee surgery that private medicine could offer them in six days south of the border in Montana? It's hard to say. Small farmers may feel reassured knowing that no matter how big a neighbour's spread is, he will not get quicker or better medical care than they do. No one getting better before anyone else is supposed to make us a gentler, kinder society.

How? Why? Don't ask me. Especially don't ask Aristotle, Descartes, Schopenhauer, the Pope or the Dalai Lama. Ask Liberal-appointed socialist health commissioner Roy Romanow.

Health-envy is uniquely Canadian. Most nations are content knowing that money can't buy happiness. Canadians want to make sure that it can't buy health care either.

The curious thing is that in other respects Canadians take it for granted that satisfying wants and needs is a legitimate use of people's resources. In Canada, money buys everything, as it should in a free society, from tastier meals to speedier wheels, from bigger houses to slimmer spouses. A Canadian can buy free-enterprise hamburgers to agitate his gall bladder; he has to stand in line only for a government physician to calm it down.

Come on, someone might say, two-tiered systems aren't allowed in other areas, either. Money can't buy justice.

Well, maybe, but it can buy lawyers, and lawyers do have something to do with outcomes in legal disputes -- at least one hopes so. Money can't buy knowledge, but it can buy training; it can't buy salvation, but it can buy prayers. And while money can't buy love, it can buy a reasonable facsimile, right down to marriage vows.

No one can guarantee health, but people should be able to buy therapy. Making therapy a government monopoly, and then doling it out on whatever basis -- first-come-first-served, lottery, status, connections or some murky bureaucratic set of priorities --combines iniquity with inefficiency.

It's an additional irony that Canadians are deluding themselves. There is two-tiered medicine in this country, or rather three-tiered, only the second tier is called the "inside track" and the third, the United States. Anyone who thinks that wealthy or well-connected Canadians stand meekly in line and wait 18.3 weeks to see a specialist doesn't live on this planet. The well-connected jump the queue, while the rich hop on a plane -- make it a private plane for the really rich -- and get themselves looked after in Cleveland, Austin, Phoenix or Rochester.

Who loses? People with gallstones who could afford private insurance, but aren't sufficiently well-connected for queue-jumping or rich enough for private planes. In short, most Canadians.

"Whatever Lola wants, Lola gets…" Lola, of course, is a Damn Yankee. She'd be singing a different tune if she had a bum knee north of the 49th parallel.”
I’m reminded of a line written by Mark Steyn to the effect that Canadian healthcare has now developed a 10 month waiting list for pregnancies! It just sums up the ludicrousness of it all, doesn’t it?

No comments: