Tuesday, August 10, 2010

Dictator McGuinty's Liberal health-care diktats

Further to here, is another typical obstructionist head-in-the-single-payer-status-quo-sand (as described by Liberal MP Keith Martin) position, from Len Rose of the B.C. Nurses' Union, "Health care system must not be turned over to profiteers" (Vancouver Sun, Aug. 10, 2010)

"Re: Canada's doctors demand major changes, Aug. 4

The Canadian Medical Association's report summarized in this article calls for a massive transformation of Canada's health care system, which it claims will increase access for everyone.

Nurses agree with the CMA on two counts. First, our health care system needs an overhaul and expanded, efficient services should be part of our universal system. Secondly, the CMA is right to insist that citizens lead the debate on how health care is funded and delivered.

The CMA is wrong, however, to suggest that Canadians shouldn't care whether it is delivered through public institutions or profit-driven organizations. Canadians know that profit-driven health care vacuums up huge sums of money from taxpayers and deposits these in the vaults of corporate executives and shareholders. That money should remain with citizens and supply health care when we need it.

The CMA is correct to call for improved universal health care, but amputating more of our public system and turning it over to profiteers will give Canadians fewer services at a higher cost."


Oooooohhh - scaaaaaareyyyy; better to have health-care turned over to MONOPOLY-PUSHING SOCIALISTS, eh, Lenny??! Chaoulli...? What...? Who...?

As if state-run socialist health-care monopolies DON'T "vacuum huge sums of money from tax-payers", while the same old shortages and rationing continue - to everyone's feigned "surprise", day after day, year after year!! The rhetoric of the anti-patient-payer/provider-choice head-in-the-sand obstructionists is astounding. Let's see Keith Martin follow up his previous observations with comments on the continuing same-old-same-old-leftist-single-payer rhetoric.
Speaking of health-care rhetoric, John Robson had a good column on this topic in "Rx for health care: New rhetoric needed" (Calgary Herald, Aug. 10, 2010):

"With Canada's health-care system in chronic crisis, this is no time for stale cliches. We need fresh ones. Vibrant, patient-centred, 21st-century cliches. We need rhetorical transformation and we need it now.

So I turn to the Canadian Medical Association's new report, Health Care Transformation in Canada. I savour one of those tag lines that hollers vacuity: "Change that works. Care that lasts." And I plunge into a clarion call for transformative inaction.

I am entirely unsurprised, because basically these reports must do two things. First, demand fundamental change because anyone with half a brain can see that Canada's health system is unsustainable, including many CMA members. Second, avoid any genuinely radical ideas for fear of demagogic politicians and CMA members passionately committed to the status quo.

Thus the executive summary sets the boldly equivocal tone: "This document is predicated on the belief of the CMA that new demands for adaptation must be addressed starting now, and in a manner consistent with the spirit and principles that have guided Medicare from the beginning." And as you'd expect from a report written by a committee with all eyes looking nervously over every shoulder real and imagined, it doesn't just endorse the five pillars of the Canada Health Act (all together now: Universality, Accessibility, Comprehensiveness, Portability and Public Administration) but adds two: "Patient-centred" and "Sustainability."

I won't quibble that grammatically it should be "Patient-centredness," lest it spoil the mood of sensitive. But I will say that if wishes were horses beggars would ride and central planning might work.

You can read the entire report at www.cma.ca/cmapaper-hct. But the basic idea is that if only we had better management, better technology and a better attitude, things that don't now work would and we could even expand health care.

In fact what we need is better incentives. And by that I do not mean better targets. The CMA report gives cautious pseudo-endorsement to this notion, in recommendation number 2 in their Framework for Transition. But the fact that incentives matter does not mean any set of incentives will do.

When you get into the details, the report talks about targets for wait times and "activity-based funding" - which is to say, "a reimbursement mechanism that pays hospitals for each patient treated on the basis of the complexity of their case."

Now why, I ask you, should hospitals be rewarded more for treating more complex cases? Surely, some illnesses require intensive but simple treatment.

I'm not just picking nits here. My point is that providing incentives to meet targets will increase the rate of people meeting targets. But no one has ever found a way to match targets to patient satisfaction and if we're not talking about that we're not talking to any purpose.

Consider this trivial example: With Ottawa Hospital emergency waits getting longer, the provincial government just earmarked another $40 million "for an incentive fund to reward those hospitals that see a noticeable drop in how long their patients spend in the ER." Great. Now they'll wait somewhere else. And a much scarier story from Britain, from a recent The Telegraph: "Four babies died at an NHS heart unit where managers were trying to raise the number of patients being treated to avoid closure, according to a damning report."

Targets are not just ineffective. They're unsafe. A genuinely bold report on Canadian health care would start: "There are two kinds of superficially attractive health care targets, those that sacrifice quality to quantity and those that do the reverse."

Later, it would discuss a third kind, which sacrifices both to the needs of the minister of finance. (Another Telegraph story, from two weeks ago: "NHS bosses have drawn up secret plans for sweeping cuts to services ... Some of the most common operations - including hip replacements and cataract surgery - will be rationed as part of attempts to save billions of pounds, despite government promises that front-line services would be protected.")

Thrashing desperately, the new British government just announced new quality standards that will eventually cover 150 clinical areas. Hospitals that don't meet them will lose their right to carry out some procedures and yet, calling them "evidence-based,"

Health Secretary Andrew Lansley denied they were targets: "These are standards, not diktats. It is not politicians establishing these," said the politician establishing them.

These are standards, not diktats. What a vibrant new cliche. Great PR. Utterly useless for health care, mind you."

Robson should look into the other NHS, much closer to home, right here in Niagara, where Ontario's Dictator Dalton McGuinty's diktat was to close the emergency rooms last year in Port Colborne and Fort Erie!

Yet - we're supposed to believe that neither McGuinty, nor Jim Bradley, nor Kim Craitor, nor George Smitherman, nor David Caplan, had anything to do with it - why, the "standard" was set by... who else... the NHS (Niagara Health System), under pressure [diktat] from the LHIN!!!!!!

And the LHIN didn't receive any "diktat" from McGuinty's Liberals - did they?!!!!

Great PR indeed.

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