Shawn Whatley, Author at shawn whatley md

Fear Paralyzes Medicare Change

An orange chopper flashed across the blue ribbon of sky between rows of white pines. I imagined the patient inside, terrified gratitude for the flight paramedics. At the same time, the ORNGE air ambulance fiasco echoed in my mind: millions wasted, allegations of criminal negligence, and high-rolling leadership excess (Toronto Star, Globe and Mail, National Post).

Most of us look at health care as patients, potential patients, or friends and family of patients. Even those of us inside the system, think and speak from a mixture of patient-based anxiety and provider-based self-interest.

One Well to Drink From

Canadians line up for care like drought starved orphans line up for soiled water from a single source, grateful for a drink. Well owners muddy discussions about dirty water. They warn that new wells will bankrupt the current well leaving no water for anyone and certain death for orphans. They march and demonstrate demanding more money for the One Well enlisting orphan survivors in their crusade.

Canadians will not support Medicare change without guarantees that improvement will not compromise the current state. This axiom strengthens as Medicare weakens. As Medicare runs out of money, Canadians grow more militant in their defence of the dying legislation. Like shipwrecked survivors, we place inordinate value on bits of flotsam when no meaningful option exists.

Medicare Change

Essential services upgrades require:

a back-up plan and/or support during upgrade
smallest steps possible
lots of warning for those impacted
a fallback position if things do not work out

Medicare zealots must stop unconscionable fear mongering about change and unbiased devotion to outdated legislation. We should discuss micro-changes to experiment alongside our Medicare mothership. We should partner with everyone – patients, providers, government, and industry – to explore options that might improve things for Canadians.

It should start with re-examining the 5 principles of Medicare: universality, accessibility, portability, comprehensiveness, and public administration. If we still believe in them, why aren’t they upheld? If we do not believe in them, why don’t we change?

We Control Change or Change Controls Us

We can try to orchestrate Medicare change now, or allow stealth privatization and spiralling costs to change things for us. How would you suggest we keep up with necessary change in Medicare? Will we remain paralyzed by fear?

(photo credit: thestar.com)

Compassion Gives You Authority in Healthcare

“You get your authority by how much you care.” I heard professor Aidan Halligan gave a keynote address last week. This video captures much of it. “All of life is a balance between idealism and self-interest.” Leadership is going into the unknown with courage and compassion. Courage and compassion gives you leadership.

This 23 minute speech to British medical students applies to all of us. We all lead. I hope you have time to watch and comment below.

Input Up, Output Down – Gammon’s Law in Medicare

Reading the headlines might remind you of Henny Penny:

Rising costs creating ‘extreme financial constraints’ for funding new drugs in Ontario. (Ottawa Citizen, April 10, 2014)

Luring Medical Tourists for Care is a Trip Down the Slippery Slope. (Globe)

Regardless of Henny Penny’s anxiety, the sky looks awfully close from the tip of the health care spending curve:

Canada spent $211 billion in 2013 on healthcare. Check out the 1975-2013 trend in healthcare spending:

Gammon’s Law

The economist, Milton Friedman, in “Gammon’s Black Holes”, quotes Dr. Gammon saying that in

“a bureaucratic system … increase in expenditure will be matched by fall in production. … Such systems will act rather like ‘black holes,’ in the economic universe, simultaneously sucking in resources, and shrinking in terms of ‘emitted’ production.”

Gammon called it the ‘theory of bureaucratic displacement’ in Health and Security, Report on the Provision for Medical Care in Great Britain (London, St. Michael’s Organization, 1976, out of print).

Later, Friedman mentioned public education in Input and Output in Medical Care:

“I have long been impressed by the operation of Gammon’s law in the U.S. school system: input, however measured, has been going up for decades, and output, whether measured by number of students, number of schools, or even more clearly, quality, has been going down.”

He then turned his attention to healthcare:

“Gammon illustrates his theory from the British National Health Service (NHS). He points out that in the eight years “between 1965 and 1973, the total number of staff employed in NHS hospitals in Great Britain increased” by 28 per cent (and administrative and clerical staff by 51 per cent). On the other hand, “the average number of beds occupied daily” declined by just over 11 per cent. He goes on to note that the long waiting lists for beds throughout the period ensure that the number of beds occupied is a valid measure of output. Input up, output down.”

Input up, output down

Despite this, we still hear experts like professor Stephen Birch blame an over-supply of providers for driving up costs.

Usually, progress and volume decrease cost. Friedman notes elsewhere that only in healthcare do we find improved technology and performance causing an increase in costs.

How do we fix it? For a bureaucratized system:

“The difference is in the bottom line. If a private venture is unsuccessful, its backers must either shut it down or finance its losses out of their own pockets, so it will generally be terminated promptly. If a governmental venture is unsuccessful, its backers have a different bottom line…Little wonder that unsuccessful government ventures are generally expanded rather than terminated.”

Perhaps Friedman was too pessimistic. Maybe Gammon had personal issues with someone in government. Perhaps they were just real life Henny Penny’s. Or, maybe they were right.

(Photocredit: dailymail.co.uk)