Single-Payer Healthcare – What Am I Missing? 

We often miss the obvious.

David Foster Wallace described it best in This is Water:

There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning, boys. How’s the water?”

And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, “What the hell is water?

We often cannot see and do things that are obvious and easy for others.

Both the French and English mangle certain words in each other’s language. But neither one finds difficult what the other finds impossible. Steve Martin, as Inspector Clouseau, immortalized the challenge.

Medicare is almost 50 years old. Most of us cannot remember care before Medicare. Many were born after it started. How do we describe something we live with every day?

I am preparing a talk about Canadian single-payer healthcare for an American audience. They want me to describe water. Continue reading “Single-Payer Healthcare – What Am I Missing? “

The Generalist Curse

Questions sting at high school reunions: Are you just a GP? Did you specialize, or are you just a general internist?

It is part of the generalist curse. General surgeons sometimes feel the curse too.

In this case, size matters. Big hospital: generalists grovel. Small hospital: generalists rule.

Generalists grovel out of need, not desire.  They grovel to get the scraps left after hospitals fund, build, and promote fancy programs.

Fancy programs fill hospital flyers and decorate fundraising events. Donors want to donate to shiny machines that whir and beep. Clinical care that only requires a brain and a bed does not raise funds.

Generalist Curse

Generalists exist in a space between ‘the miracle of medicine’ and the yuck of medicine. We do things no one else wants to know about. We disimpact octogenarian bowels and lance hemorrhoids. Specialists reattach limbs and transplant people’s faces.

Banality is bad. The generalist’s sense of impostor syndrome mixed with a fear of incompetence is worse. Generalists know they know less about everything than some other doctor.

We might not know the ‘other doctor’, but we know she exists. Generalists are doomed to offer patients a bit less than the hemorrhoid sub-specialist, assuming hemorrhoids are at hand. Continue reading “The Generalist Curse”

Compassion Not Equality – Canadian Values in Medicare

Obama did it. Trump does it. Trudeau does it too. Politicians talk about values as if they know what voters think.

A politician promotes his values to normalize his vision.

Tricky politicians use familiar words and give them new meaning. They use popular support for one thing to build support for something completely different.

For example, since everyone supports motherhood, it shows we support apple pie too.

On his quest for state medicine, Tommy Douglas told a story. Young Tom needed surgery. His family was poor. A surgeon fixed Tommy for free. It was great for Tommy, but what about all the other sick kids? Is it fair that farmers must choose between losing the farm and losing a daughter’s limb?

Compassion Not Equality

Most Medicare books start the same way. The author tells a story about disease and financial ruin, before Medicare. They appeal to compassion and inflame fear of loss. People should never suffer without care or go broke from medical bills.

Canadians agree. We are moved by suffering and loss. And that is where we get tricked. Douglas and company trades compassion for “equality” and fear for “care regardless of ability to pay.”

But compassion is not the same as equality. They are as different as colour and temperature. No one knows the temperature of purple. They are different categories. Compassion and equality are different categories also. It is a category mistake to conflate the two. Continue reading “Compassion Not Equality – Canadian Values in Medicare”