Friday, October 5, 2007

Time to demolish Ontario's broken Liberal healthcare system, or keep on patching it ?

Larissa Hrynczuk says in her letter to the editor (St. Catharines Standard, Oct.5, 2007): “We need our health-care system renovated, not demolished.” If the examples from my essay, (see: Liberal Healthcare Duplicity, An Ontario Overview 2003-2007) are not enough for Hrynczuk to recognize that 40 years of medicare monopoly have demolished our system, here are more stories from people suffering under premier McGuinty’s Liberal 'health-scare' system:

From PC election campaign site Leadership Matters , Oct. 2007:

" Edward A., Brampton
Our old hospital has been shut down and the new one opened without anyone being informed. So instead of us getting an improvement we are in the same situation we have always been in except we now have to travel farther to go to the hospital. We were under the impression we would have two hospitals instead of one.

James G., Toronto
In the last six days available to him, Mr. Tory needs to hammer away at the critical necessity of keeping an appropriate number of young Canadian medical graduates in Ontario in rural family practice and non-urban/academic specialties. If you don't do something about this soon, we will have an enormous health care crisis which will make long wait times look like a Sunday school picnic. I know whereof I speak. I was 40 years a professor of obstetrics and gynaecology in Canada, USA and the Middle East.

Peter V. Peterborough
I was born and raised in Ontario, and consider it one of the best place to live in the world. But I have been disappointed with many things I have experienced recently. A few months ago, I cut my hand at work and had to go to the hospital, I arrived at the hospital around 11 o'clock at night and did not see a nurse or doctor till 6 the next morning. It is easy for the Liberals to say they have put in more money to health care, but I do not see any results.
I am currently attending my final year of high school. My parents have always sent their children to private religious schools. Over the last 14 years they have paid between $150,00-$200,000 dollars on this. I think that it is unfair for people who want their children to be educated from their religious worldview to be gouged financially. I believe that accountability and trust are the two most important things for a government to have. Mr.Tory seems like a straightfoward and accountable man, and I have faith that the he and his party will be able to make Ontario a better place to live. You have my full support.

Robrt H., Tillsonburg
It has been a frustrating four years trying to deal with Mr. McGuinty and his band of village idiots. As a Chiropractor, I know first-hand about Liberal cuts to health care. We have tried to explain how the cuts to services actually are costing the taxpayer more and causing delay in diagnosis and treatment.
Say I have a patient come in my office who has had a fall, and I am concerned there may be a possible fracture. Before McGuinty, I could order an X-ray at the hospital immediately and rule out the fracture so treatment could begin. It would cost the taxpayer about $50 to $70 for the hospital services and, as a Chiropractor, I would not receive anything. Now, I send the patient back to their Medical Doctor which could be days or weeks delay. So now the Medical Doctor gets a billing to send the patient for an X-ray, and then gets a fee to read the report when it is sent back. Often what happens is I send them to the Emerg for quicker service or, which can often be the case, if they don't have a family doctor. This costs an additional $200 to the X-ray and increases emerg delays. When the McGuinty government received thousands of letters trying simply to make them understand it became quite clear this group would not pass the grade 10 comprehension test. The light is on but nobody is home. Thanks for listening!

Samantha K., Brampton
The health care system needs to be addressed in this province. There is a test called a PET scan that will determine whether or not the treatment being received is doing its job or not. The PET scan is used in cancer and alzheimer patients to name just a couple. OHIP does not cover the $2000 fee for this test! There are other provinces that DO cover the cost and will even fly their citizens to Ontario to avoid wait times.
My mother needs to have this test done as she is currently being treated for lung cancer. It would seem that to fund this test would likely save money in the long run since it might eliminate the use of the 'wrong' type of treatment to patients. I'm finding it really hard to swallow that no one is willing to address this situation.

Joe H., London
This letter has been written to all the LIBERAL candidates in London, plus Premier Dalton McGuinty ... I am waiting for an answer!!!!
Ontarians are getting faster access to care: wait times for cancer, cardiac and cataract surgeries,hip and knee replacements and MRI/CT scans are all down. This is a quote directly the Liberal website.
Yet I have been waiting since April to see a surgeon related to doing hip replacement surgery. I had to wait three and a half weeks to get into my General Practitioner to finally get some pain medication. Is this what Dalton McGuinty calls reduced waiting times?
I had a heart to heart discussion with my doctor about how long it would be before I got to see an Orthopedic Surgeon. I was told it would probably be up to 24 months and then my wait time for surgery would likely be about 180 to 240 days ... is this what the Liberals mean by reduced wait times?
I am in pain constantly 24 hours a day 7 days a week. I try to carry on my normal job which entails travel and being on my feet (I am a Realtor) I even continue to give back to my Profession by teaching courses to mentor other Realtors as well as I am an active member of our Real Estate Board of Directors, so I am not just sitting back and whining about the problem. I try to continue a normal life the pain never goes away ... is this what they call an improved Health Care System?
I plan on starting a blog to follow my day to day routine trying to have a life (even though the pain never ends) and how the Ontario Health Care System is failing me, a taxpayer for over 40 years. I will yell loud and long until something changes.

Leor S., Richmond Hill
My story is much like many others who have had to watch their parent wait through agonizing pain for a knee or hip replacement. I should point out that to many this is a very difficult thing to watch happen to a family member, in my case, my father. Not only was I forced to watch my father wait 2 years, watch him strapped to crutches, and in constant pain, but I was forced to put my life, my education on hold while I ran our family business.
I don't think Mr. McGuinty fully understands how much of an impact he has on not one life, but on entire families when he sits on his hands. I would like to see him look my father in the eyes and tell him that wait times are better! Good luck getting my father to believe that, Mr. McGuinty. Thank you.

Terry E., Kawartha Lakes
My husband and I moved to the City of Kawartha Lakes in 2005. To date we are both driving to our family doctors in Toronto & Newmarket. To date there have been 3-4 doctors locate to the Lindsay area. We have applied in all cases to go on their waiting list.
Here is the PROBLEM. These new doctors take applications from prospective patients and the SCREEN who they want to take as a patient. i.e. someone with no health issues. My husband and I both have some health issues - that are under control - but my question is WHY are these doctors allowed to do this? Why are they NOT taking patients on a first come - first serve basis. I stood in line for 4 hours for one, and was amongst the first 100 applicants only to find out we are not eligible - WHY ???
Because we are determined to have a doctor .... regardless of the fact that we have to travel in excess of 100km to get to a doctor. AND, our doctors in the "city" have chosen to keep us as patients rather than abandon us to the system. Out patient clinics are not an option for my husband who needs consistent medical supervision for heart issues for example. We are young, we are in our mid 50's. AND on the Lindsay hospital .... (Ross Memorial), on occasion we have had to utilize their ER .... well let me tell you, on all three visits we observed the waiting room to be a social club...people are not there for valid reasons (ie nothing a walk in clinic couldn't handle), we have also observed this at the Newmarket hospital.
Perhaps wait times may be controlled more by the triage nurses redirecting this users and abusers! I have to say up front though, regardless of WHO or what party brought about the positive changes in our health care system, the current level needs to be continued and expanded.

Shawn R., Brantford
After serving this country for 21 years in the military, I was medically released, and moved back to my home town. After all of these years of service to my country, I could not get a family doctor in my area. There are just no doctors willing to take on even one more patient. My wife has a family doctor, and she has had the same doctor for years. I was fortunate that this doctor was willing to take me on. He is fabulous, and worth the drive. This doctor lives over one hour away from us, but due to my medical condition, I require access to a doctor that can prescribe my medication. Imagine having to go to a walk in clinic everytime I need a refill on my prescriptrion; having to explain the condition and so on. The medication I need to survive could easily be construed as an addictive medication, and having to explain this time and again would be exhausting. I am not saying that I deserve special treatment, but being a modern veteran with no doctors is really unfair!

Lynda W., Toronto
We moved to this riding in 2000, finally finding a new family doctor. But the relationship was not a good one and we switched to someone even worse a few years ago. Part of the problem is the waiting time - the norm is at least one hour before being seen, mainly because he arrives at least an hour late to start his day. In addition, when he booked me for an annual full physical, after waiting for over an hour, he spent 10 minutes - literally - with me, including taking a telephone call and having his nurse come to the door to ask a question. I have been searching for a new GP for about a year and just found one who is taking new patients.

Peter R., Barrie-Orillia
My wife and I moved to this area 9 years ago. We have not been able to find a family doctor in all that time. I have high blood pressure and have been treated by a specialist who treated me in the emergency room at a local hospital. He should have passed me back to my family doctor by now but I can't find one.

Gail P., Bowmanville
We had a family doctor for many years, but this past April when I called to get my ill son in to see him, I found out he retired. I have high cholesterol, so now that I have no doctor I have no medication either. My oldest has been sick for years with one problem or another. My middle son suffers from allergies and asthma. We have to rely on the ER or walk-in clinics which all have very long wait times.

Glenn K., Kitchener
When we married (20 years ago) we were given the name of and signed up with a local family physician who was taking on patients by the emergency ward staff at our local hospital. Over time, we became frustrated and concerned by his incompetence in diagnosing a number of health concerns which were later correctly diagnosed by emergency room doctors and/or specialists treating other conditions. We looked for many years(10+)for any other physician who was taking on patients to no avail.
So we resigned ourselves to going without a GP MD and to going to clinics and/or waiting for up to 12 hours at emergency rooms when we needed medical care. During our search, we registered with our Chamber of Commerce who maintained a waiting list of families looking for a GP MD but no help was forthcoming. The local hospitals and regional health unit were of no help and referred us back to the CoC. We even checked into smaller communities up to 45 minutes from our municipality to see if a family physician there would take us on but unless you lived in their community, they refused (mostly because they already had more patients than they could handle and they had no physician privileges at our local hospitals.
Finally my wife, who works in a hospital heard of a new doctor coming to Kitchener who was taking on patients, last month (August of 2007). If it had not been for her insider information, we would still be on the CoC waiting list with no family physician more than 12 years after starting our search. Many friends and relatives are in the same state as we were, still looking for a family MD.

Shirlie P., Sturgeon Falls
I moved with my family to Sturgeon Falls at the end of 2004. I have been trying to get a doctor ever since.
The closest I could get was a nurse practioner, which I obtained in 2006. I have a lot of medical problems, so each time I get sent to Sudbury or Toronto, depending on which doctor I am being referred to. It is painful for me to sit in a car or a bus/train for 3 or 4 hours just to go to a specialist. Trying to get into see a specialist can take from 8 months to a year or more. There have been people in Sturgeon Falls that go into Emergency Dept. and get sent to Ottawa or Toronto, and have died on the way, because the wait has been so long. The government should make the problem with getting a doctor or a specialist a priority.

Anne W., Belleville
My daughter who is an RN in the operating room does not have a Family doctor, for herself or my two granddaughters. This should not be happening in this great province of Ontario.

Jennifer D., Toronto
I moved from Niagara Region 3 years ago and still have my doctor in Welland ON. I haven't been able to find one here in Toronto.

Robert  L., Grimsby, Ontario, Canada
We moved to Grimsby in 2003. We were unable to get local family doctor. When my wife became pregnant, there was no OB/GYN available. The local hospital said "carry the baby to term, come to Emergency Dept for the delivery." Had we followed this advice, my wife or the baby would be dead, as she was later ultimately diagnosed with serious Gestational Diabetes.
We plan to move to London, ON. (where we found a family doctor and an OB/GYN)

Ed V., Dunnville
I am sharing a few experiences that my family and friends have had in their dealings with the Liberals' idea of a much-improved hospital situation. All of these have been in the last year, so these are not old stories.
I will start with the closest to my home: My youngest daughter is 8 years old, she has been complaining that when she runs around or gets a lot of exercise, she gets chest pain. So being that this is not normal for an 8 year old, we took her to our family doctor located in Grimsby (because you can not get a family doctor in Dunnville as no one will accept you) and they tried to make an appointment for some testing to see what was wrong. This happened in Feb 2007 after months of phoning and complaining; I finally had to get very angry before MacMaster was willing to make a firm appointment. The appointment was finally set for September 20 2007. It took 7 months to test if my daughter has heart problems, being aware that certain things that are left untreated can continue to damage her heart. THIS IS WRONG!
My mother-in-law has had a sciatic nerve problem going on. She has had to wait, while living in SEVERE pain, for just over a year to get an appointment to see a specialist. Once she finally gets to see the specialist, she will need to get in line for surgery. How long with that take? We have been informed it also could be more than 6 months!
My 13 year old nephew broke BOTH his wrists in a fall from a swing. He had to wait at home for 6 days BEFORE the doctors had time to set the broken bone and put a cast on!! Do you think that is even remotely acceptable??
Finally a friend of ours had a shop accident at home in which he seriously injured his hand, almost completely severing 2 fingers. He was taken to a hospital in Hamilton and had to wait 3 days before anything was done to re-attach his fingers.
These are examples of how badly our hospital system has become overburdened and mismanaged. I hope that you can do better for Ontario's hospitals than the Liberals. Lets go back to the common sense approach!

Thomas T., Sarnia
Once again my wife has been turned down by our health system. Due to the shortage of doctors and her developing cancer, we have been forced to visit our local emergency department in Sarnia.
They told my wife they were not able to deal with her problem and she would have to live with the chronic pain. They tried seting up an appointment with a pain clinic in London, and my wife was told that they were not taking new patients. Our local hospital washed their hands of this. I hope that she will be here for the election as I have always voted Tory and we need a change, and a leader who will keep promises.

Sarah B.,  Jasper
At the end of 2005, my 69 year-old diabetic father had to have his big toe amputated. He spent several weeks in the hospital fighting infection and eating the hospital food. Because they don't follow appropriate diets, he was put on insulin when he only used to take pills. After he was released from the hospital, he was given a home nurse who used to come once a day for his antibiotics. It was at this time, he noticed some failing eyesight and hearing.
It took over 3 months for doctors to do something about his eyesight, and almost 6 months for them to realize he had infection in both his ears, creating the hearing loss. Wait times for specialists were horrible, and for a proud man who had hardly been sick a day in his life, he was almost an invalid, depending on my brother and I and various friends to help him do his running around. By the end of the summer of 2006, my father had laser eye surgery on both eyes, but still saw only minor improvements in his sight. He also had his hearing restored in only one ear, and only partially. He was still fighting wait times to see specialists.
In October of 2006, my father passed away from natural causes. My brother found him 3 days later. At that time, his eyesight and hearing had not been completely restored to him in all those months. The most heart-rending thing of all for my father was the Liberal government using the money from the health tax we are now forced to pay after breaking a campaign promise to include in a ban the breed of dog my father had grown up with and loved all his life, the Staffordshire Bull Terrier. That the money which should have been delegated to reform our healthcare system was used by the current government to efectively end my father's 3-generation family tradition is something I will never forget. That my father died a broken-hearted man is something I will never forgive the Provincial Liberals for.

Roger T., Richmond Hill
I took my daughter to the emergency room at York Central last night - she broke her wrist playing soccer.
If I remember correctly, Dalton McGuinty promised improved health care but from what I saw last night, the health care system has deteriorated. When spending on private planes to Hamilton becomes more important than the viability of our health care system, something is dramatically wrong. When schools are underfunded and closed, placing even more stress on the surviving schools, something is wrong. When we were told that education and health care would be a priority and the evidence is only now surfacing due to the upcoming election, something is wrong.
Leadership is putting the welfare of the people of this province before all others. Leadership is about being financially skilled and consistent in delivering on promises made to Ontarians. Leadership is about consistent results that demonstrate progress is ongoing. Saying one thing and doing the opposite does not work in business so why should it be acceptable in politics? If John Tory can bring truth and honesty to the Premier's Office and put health care and education on the road to recovery, I hope that the majority of Ontarians will vote to give him that chance. Leaders are measured by their results and I am disheartened with the record of the last four years.

Robert W., Mississauga
The main problem with Ontario Health system is the time it takes to get help. Last year I was having chest pains. Although I had been having stomach issues this was so intense that I decided I had better go to Credit Valley Hospital. After 2 hours they did a EKG. After 2 more hours asked the nurse if anyone was going to see me. No one had looked at my test . I asked when I would see a doctor and she did not know although waits of 6-10 hours were not uncommon. I decided to check myself out of the hospital as I felt that I could die and no one would notice. This is just not acceptable. I rarely go to the hospital and it is only because my family or I need help. It is clear to me that the health care system in Ontario is far from fixed. Where is the incentive for a hospital to treat me quickly and effectively? Bob

Ann-Marie P., Exeter
We need to invest this money back into the people of Ontario, primarily into health care and education. I am very proud to support a Tory government that would offer to cover the educational costs of religious-based schools for all faiths. As a Catholic school teacher, I can attest to the important of integrating religious education into the classroom within faith-based communities. It strengthens the bond that these faiths have amongst themselves and the wider-community. I am also concerned about the doctor shortage that is seemingly increasing within my riding. It is very difficult to attract doctors to these small rural communities. We need to pump more money into promoting medical doctors to stay within the province to practise, opposed to facing the ever-growing brain drain. Another way to help this problem is to facilitate the transitional requirements that many of Ontario's immigrants must face in order for their forgein medical degree to be considered valid within our province and nation. These are highly capable and initelligent individuals who struggle to gain recognition of their gifts and achievements in this provine and country when we should use their talents to improve our health care system.

William M. Gravenhurst
I live in Muskoka. We were in northern Ontario untill Skinflinty McGuinty decided that his member from Sudbury was right, and that Muskoka belonged in southern Ont. Well, as a person who is disabled but tries to be a productive member of the comunity, I put on 30,000 to 50,000 kms per season. My vehicle is a necessity. The rent in Muskoka is very near the same as the large urban areas, but there is no public transport.
I live 7 miles from town with no public transport . I have 2 vehicles and my wife is even more disabled than I am. We are lucky as we have a doctor, but he is a 30 min drive from my home. I'm currently going around with what boils down to a broken back and can't get a specialist to even book an appointment. This is all a result of guess who. They seem to forget that they are there to help take care of the people of Ontario. They forget that it does no good to save the leg if the patient dies.

Kevin C., Sarnia
A few years ago the Ontario Liberal Government instituted the "NEW" Ontario Health Care Premium. The conveyed purpose of this premium was to attract new doctors improve health care and reduce wait times in emergency rooms in the province.
I had moved to Lambton County in 1999. My experience can easily communicate my own personal frustration with our government and why "TRUE" change is needed. 1) I require constant medical care for a life long illness and require medication to maintain my health. 2) I still have "NO DOCTOR" even though I have been on waiting lists. 3) Every 30 days I have to go to the emergency dept to get a script and only get a maintainance supply. Doctors discretion! 4) My longest wait time was 5 hours and found only 1 doctor in the ER. The reason for this is overcrowding.
Here are my questions and maybe the answers. 1)Why aren't we fast tracking pharmacists on perscription renewal in the province? My perscription is very safe, proven and effective with few side effects. Giving pharmacists this authority will reduce costs and be very effective on personal health care not to mention a positive effect on the stress we face in our lives. 2) Where are the doctors? I paid for services I never received. $1100.00 for services and have yet received nothing for the province. In the private sector, I believe this would be called "FRAUD" and another ministry would investigating. 3) Where is the accountability for the money gathered by the province since this "NEW PREMIUM" was initiated?
What we need is more front line solutions, less tiered structuring and a program of accountability in health care. What we have is "A NEW TAX" but "NO NEW VISION."
End of rant. Kevin, Sarnia
p.s. I have a tee shirt dated with every visit made to emergency in the last 4 years. It is a testimonial of "REAL HEALTH CARE".

Stacey P., Markham
In 2006 I suffered from a pretty severe L5 disc herniation. The sciatic pain was so bad that my husband had to carry me to the ER and to my subsequent doctor appointments because I was unable to walk. My doctor knew I needed an MRI to determine if it was indeed a disc bulge, as well as to determine the area affected. We submitted a request for an MRI immediately-in April. We got confirmation that my appointment was scheduled for November. Not only has this "health premium" not helped wait times, McGuinty also de-listed chiropractics-the one thing that actually helped my condition get better. Where is my health premium going to, because it can't be for health care!

Mary C., Mississauga
I would spend the money to help families with austic children so that these children can get the therapy they need immediately and also other children and adults with special needs. Also the money should be spent on health care and seniors and other families struggling to make ends meet.

Julia B., Oakville
It is time that Ontario restore it's faith in the political process and elect a leader who speaks the truth, a leader who has the ability to set his priorities based on the interests of the electoral, a leader who recognizes the need to improve services with commitment for a brighter tomorrow. Our health care system in this province needs to be improved -- hospitals are run down, patient/nurse ratio is poor and families are expected to step in to help or watch their loved ones abandoned by the ever increasing demands of competing demands on nurses and doctors. The waiting time in emergency rooms are outrageous and the shortages of doctors is unsettling. It took me 3 years to find a family doctor in Oakville. More recently, my mother took ill and was admitted to the Trillium Center Hospital where the care was wonderful but the demands on the staff seemed unrealistic. We need positive, substantial and encouraging change more broken promises and/or bandage solutions.

Taylor E., Orleans
I had an earache in late February. I went to the emergency clinic. I waited 3 hours to see the doctor. When I saw the doctor he checked my ears and gave me my prescription. 5 minutes and I needed to wait 3 HOURS! McGuinty promised to help solve this problem. We need a leader who can eliminate the long wait for surgeries and emergency medical visits. Dalton McGuinty has shown he can't. John Tory is the one to do this and we need to bring him and the PC Party back to power as soon as possible.

Michael O., Cambridge
I have been needing surgery on my shoulder for almost 2 years. The surgeon that I had in Cambridge moved to Montreal before he could operate. The earliest I can see an orthopedic surgeon in the region now is September 2008. I have a friend who requires the same surgery and she also must wait until September of next year. Wait times for surgeries must be improved.

Scott C., London
I recently moved home from Toronto to London, Ontario with my wife and soon to be born first child. We left our fast paced life and stresses behind in Toronto, and are looking forward to starting our family in London. The other thing we left behind in TO was our family doctor; we're currently on a 6,000 person waiting list for a doctor here in London.
I have a chronic health condition that requires close monitoring from a family doctor, so this situation is simply not acceptable. To sustain economic growth in communities outside the GTA we'll need to attract talent and industry. This will require more family doctors in communities like London. "


The above quotes are from the PC Leadership Matters 2007 campaign website.
What Liberals would like us to believe about Ontario healthcare, and what is actually happening now, in 2007, under Liberal rule, are two different things. I'm sure the above kinds of quotes won't be found in Liberal campaign brochures or speeches. Liberals dismiss these patient experiences as cherry-picked anecdotes and anomalies.
Hrynczuk should know better than to misrepresent what John Tory said in his effort to improve healthcare delivery in Ontario - what part of "pay with your health card" does she not get? Her "diminishing and draining" health-care-worker theory was similarly used as a defence by Ted Marmor in Quebec's 2005 Chaoulli decision and was dismissed. It is forty-years-worth of socialized medicare monopoly which has demonstrably been shown to have failed patients today.
And, speaking of our health system being 'renovated, not demolished', as Hrynczuk says, those exact words remind me of Roy Romanow's report, which I suppose is what Hrynczuk is parroting. Here's an another view of the healthcare debate as it stood before Romanow's report (which the left so widely since praised, as if that had been the only 'study' ever done, and even now, in 2007, as if Quebec's Chaoulli never happened...)
Of course, the Romanowites never admit to having an ideological bias, it's always someone else, not them, who is the rigid ideologue. Anyway, the following story is from 2001: Hrynczuk, and others, still invoke the so-called "solutions" of the socialist past, even though its failures are staring them in the face, here, in 2007! And, they're defending what... more of the same failed socialist policies? Are they blaming their socialized, single-payer, healthcare monopoly's failings on 40 years of outlawed, fictious private sector ineptitude?!

Here's what Terence Corcoran wrote in "Inject a little ideology", (National Post, Oct.5, 2001):

"Most Canadians are familiar with the two great taboos of our health care system: extra billing and user charges. Now there's a new taboo: ideology.
The emerging ban on ideology surfaced last weekend at a health care conference sponsored by the Canadian Ditchley Foundation. About 45 people with varying degrees of expertise -- Roy Romanow, Michael Wilson, David Dodge, Michael Walker, along with policy wonks from the United States, Ireland, the United Kingdom, France -- spent two days at a fine country inn outside Toronto flailing away at the nation's biggest policy quagmire.
The proceedings are confidential, but I can report that the prospects for major health care reform are dismal if the best we can do is produce endless managerial jargon and organizational kibitzing. It is doomed because nobody wants to take up the great unspeakable heart of our health care system, which is Ottawa's mandated denial of patient choice that turns patients into cost centres and burdens.
At a summary session, one of the Ditchley workshop rapporteurs hailed the fact that a daylong discussion in his group had been mercifully free of "the pitfalls of ideological warfare." That was followed by comments from another rapporteur who approvingly noted that the participants in his session had also generously "left ideology outside the door."
Purging the health care debate of impure ideological thoughts appears to be the sixth principle of health care in Canada: universal, comprehensive, accessible, portable, publicly administered and non-ideological. The recent report from Senator Michael Kirby's committee on social affairs, in a brief section headed "The Desirability of a Non-Ideological Debate," said "it is absolutely essential that the debate progress beyond political rhetoric."
There's a big difference between political rhetoric and ideology, but the drift of the Senate report seems clear. We will have a national debate over health care, but we will not let the debate be sullied by dredging into the muddy ideas that are its core.
Participants in the Ditchley conference steadfastly refused to be drawn into any serious look at the muddled absurdity of their own underlying assumptions. The tone of neutrality regarding the big issues was set by Mr. Romanow, head of the Chretien government's Commission on the Future of Health Care in Canada. We all know where he stands. As he has said many times, we don't have a crisis, we have a health care system that defines Canada as a country.
The Romanow commission has four themes: Basic democratic values, sustainability, creating a culture of continuous improvement and building constructive and co-operative relationships. As you can see, irritating ideology has been kept out of the debate. His idea of reform is to hold a stethoscope to the inner workings of his own preconceptions and check for structural and managerial problems -- rising "cost drivers," demographic trends, technological trends, drug costs, adversarial relationships, resistance to change, lack of resources and rising spending, public versus private delivery systems. All this, but no ideology. "Any house that is 35 years old, as Canada's Medicare house is this year, requires work, but if the foundations are solid, and I believe they are, we renovate and repair, we do not demolish."
But the ideological foundations are not solid. The Ditchley conference divided health care into a dysfunctional three-player system: patients, providers and purchasers. Patients are the ultimate payers and the focal point of demand; providers such as hospitals and drug companies fulfill the demand; the purchasers are governments that contract the providers to deliver service that fulfills the demand.
What this model needs is a good bout of ideological warfare. The premise that patients can be separated off from purchasers is a loaded ideological starting point that must be debated. In any market sector of the economy, customers drive the demand and have the freedom to make the financial decisions. In health care, the government has essentially nationalized patient demand and taken over patient choice.
Much has been made of the need to empower patients and make patients more a part of the system. But how can patients be empowered when the law takes away patients' power to contract with doctors, pay a private clinic for an MRI, buy private insurance or get their appendix out at a private hospital?
The ethics of denying Canadians the right to buy their own health care services is a profound ideological issue. The Kirby committee, while it generally resisted ideological questions, hit this issue head on. "If access to publicly funded health services is not timely, can governments continue to discourage the provision of private health care through the prohibition of private insurance? To paraphrase Section 1 of the Charter of Rights and Freedoms: Is it just and reasonable in a free and democratic society that government ration the supply of health care services (through budgetary allocations to health care) and, simultaneously, effectively prevent individuals from purchasing the service in Canada?"
But there's a second dark ethical conundrum. What justification can there be for a health care system that turns patients into burdens and cost centres that must be controlled and disciplined? We would not think of applying the same principle to the market economy. In the food and clothing industries, consumers are seen as opportunities.
The food industry does not look at the family walking in the supermarket door as a drain on the supermarket's resources and the food supply network. It seeks out consumers as sources of business and profit, people to be welcomed in the door and provided with the best service possible. In state-run health care, indeed in any mandatory single-payer system, patients are walking liabilities whose access must be limited. Under market pressures, the food industry has undergone structural changes without the benefit of a Romanow commission or a Senate committee.
It may be taboo to get into these subjects, but the alternative is to spend the next decade reforming the system as if the only problem were the non-ideological business of planning and management. The effect of cutting patients off from decision-making is to turn health care into a giant planning exercise that will attempt to determine what patients want and need by some form of managerial alchemy. We don't need more reports filled with consultant jargon about benchmarking, market mechanisms, greater transparency and outcome- setting. We need some good, old-fashioned ideological warfare."

Yes, and we continue, unfortunately, to get most of that from the left. Over six years have gone by since Corcoran's column was written, and the left is still lost in the "muddled absurdity of their underlying assumptions." All talk, no action.

And the crime is that patients are still suffering, and politicians should no longer claim ignorance of medicare's failings.
And finally, here's a National Post (Nov. 17, 2003) editorial "Romanow's lecture":

"Roy Romanow is surprised and angry. He has no reason to be either. It's been almost a year since the former Saskatchewan premier released his $15-million, one-man royal commission report on medicare. In the interim, almost nothing has been done by any government -- federal or provincial -- on any of his four dozen recommendations. On Thursday, in a speech to students at the University of Ottawa, Mr. Romanow chastised governments for their inaction. He charged their failure to do as he demanded was "a democratic affront." Abiding by his recommendations, he said was an "obligation" politicians owed "not only to health, but to democracy."
Excuse us, but we don't remember Canadians electing Mr. Romanow to be medicare czar. Nor do we recall a national referendum on implementing his report's prescriptions. No federal-provincial conference has been held at which Canada's elected leaders voted openly to cede their accountability for the nation's health care system to Mr. Romanow, and him alone. In the 12 months since he brought out his wish list, no fewer than eight of the 13 senior governments in Canada have held general elections. Although many of them have campaigned on fixing medicare, not one of them campaigned overtly on executing his particular advice. In short, Mr. Romanow's report has no more democratic legitimacy than any of the scores of other reports, studies, surveys or reviews governments commission each year. To claim that ignoring it is an affront to democracy is for Mr. Romanow to place himself and his recommendations above Canadians' elected representatives.
Mr. Romanow also complained that no progress could be shown on any of his key recommendations, but particularly on the establishment of a Health Council of Canada -- an independent federal-provincial board charged with overseeing medicare and recommending improvements or even punishments to governments not complying with the Canada Health Act. Well, duh, Mr. Romanow. When you recommend $15-billion in additional public spending as the economy slows, suggest doctors be forced into practice collectives, and that patients' primary contact with the health system be a "case manager" (read bureaucrat) who would choose which doctors or "nurse practitioners" treated the patient -- rather than the patient choosing for himself -- what else do you expect?
He dismissed as "overheated rhetoric" any suggestions that Canada's government-monopoly health system was inadequate already and would worsen as Baby Boomers hit their senior years. He called health care a "moral enterprise," not just another service, and puffed about it being "a right of citizenship ... a public good, a national symbol," one of our "core values," a symbol of Canada's "equity, fairness and solidarity." He even suggested the moral superiority of our medicare would enable Canada to avoid the laws of economics and provide ever-better care without resorting to free market incentives.
In more than 200 years, little progress has been made on implementing the moral recommendations in the Brothers Grimm fairy tales either. Mr. Romanow's fanciful exercise is in good company."

By 2007, Romanow's report indeed is lost in the cobwebs of time. Let's look at Mazankowski's!

1 comment:

Logan said...

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