A Vision For Healthcare

Health Minister Rona AmbroseHealth minister Rona Ambrose announced a panel to look at improving the quality and efficiency of healthcare.

What would you suggest if you sat on the panel?  What features do you consider essential to a great healthcare system?

If asked, I would offer the following list of concepts, ideas and axioms.  Most apply to all healthcare systems – public, private, hybrid, etc.  Most are funding agnostic and need consideration whether we use taxes, insurance or out-of-pocket dollars.  Many points in the list already feature in Canadian Medicare.

Patient service can suffer in any healthcare system regardless of funding and design. We cannot assume some issues disappear simply by legislating a particular system.

One comment for my libertarian and small-government readers.  Before you spit out your coffee at this list, I think we must acknowledge that no system will ever be 100% market based just like no socialist system can operate without some element of profit (e.g., using medications developed by industry).  We need to make business oriented approaches as compassionate as possible, and statist approaches as customer-focussed and accountable as possible.

Books, lectures and conversations impacted the ideas.  Please add more by sharing your comments!

 

A Vision for Healthcare –

110 Ideas

To incorporate feedback, I put a Vision for Healthcare on its own page.  Please share your thoughts on this post and any other and I’m improve the content as you share.  Thanks so much!

 

Brian Day: 30 years of health-care dysfunction

Healthcare DysfunctionThis fall, five patients will argue that they came to serious, permanent suffering because Canada makes it illegal to purchase healthcare.

Dr. Brian Day, an orthopaedic surgeon and past President of the Canadian Medical Association, wrote an uncommonly direct assessment of healthcare in Canada.  I include the full text below from the Canadian Constitution Foundation website.  Here is the link to the original article: Brian Day: 30 years of health-care dysfunction » theCCF.ca.

All sides will be watching this.  Expect to hear more about it in September.

Dr. Day writes:

Thirty years ago today, on April 1, 1984, the Canada Health Act became law. We can be forgiven for wondering if the date and year were coincidental, or chosen in honour of April Fools’ Day and George Orwell’s novel, respectively. Canada’s Medicare laws have many Orwellian features, including names such as the B.C. “Medicare Protection Act” and the Ontario “Commitment to the Future of Medicare Act.” Citizens face severe punishment for disobedience. Ontario can issue fines of $25,000 on patients suffering on wait lists, or corporations who expedite their care. In Alberta, a clinic which allows access to non-government care can be fined $100,000. The most authoritarian governments on Earth have no such prohibitions.

The Act has been a godsend to bureaucrats, who have led the fight to maintain the resources and power that goes with control of the biggest budgetary item in every provincial government. I admire the skill with which they have manipulated both the public and elected politicians. The fact that Canada has 11 times as many public health bureaucrats per capita as Germany attests to the creative skills of the Canadians.

Dr. Max Gammon once described the British National Health Service as “a huge culture medium for the uncontaminated growth of bureaucracy” that will “grow indefinitely and approach ever more closely to the perfect blackhole state in which its externally supplied resources are entirely consumed by its furious internal activity.” Britain’s NHS is, by comparison with Canadian Medicare, a lean, mean machine.

The North Korean national airline, rated the world’s worst performing carrier, operates on remarkably similar principles to our health system. Air Koryo extracts funds and dictates spending; sets prices while owning and controlling the facilities; decides where services will be located; trains, employs, regulates and funds the workers; governs how, when and where clients are served; determines the level and quality of services; self-regulates, self-evaluates and outlaws competition. Canada’s “Koryocare” health-care model is a remarkable government achievement, but it must be replaced with a patient-focused system that includes competition, excellence and efficiency.

The Canada Health Act requires that care must be comprehensive, universal, portable and accessible, as well as being publicly funded and administered. Governments ignore the first four principles, but ardently enforce the last. “Medically necessary” care must be covered under the Act. It is deliberately not defined. “Reasonable access” translates to care given when government, not the patient or doctor, deems it appropriate. The Act has limited the ability of provinces to adapt to the modern era of medicine.

Governments allow us to spend on gambling, smoking, and drinking, but not on our health

Politicians and trade union leaders often bypass wait lists, turning to the private sector when they or their families need care. They enjoy private insurance for themselves, which covers ambulances, prescription drugs, prosthetic limbs, braces, dentistry and physiotherapy. Thirty percent of Canadians lack this insurance and have inferior coverage. In Canada the lowest socioeconomic groups suffer from the poorest access and have the worst outcomes. An Italian health law expert recently characterized Canada as being hostile to the poor and underprivileged, describing our Medicare as “tailor made for very rich people who can get medical care abroad.”

We do not provide equitable basic health care for all. Our approach of forcing a runner with sore knees or a golfer with a sore shoulder into a queue that includes patients with serious illnesses makes no sense. Equally nonsensical is the fact that governments allow us to spend on gambling (lotteries and casino revenues are a major source of health funding), smoking (cigarettes or marijuana), and drinking (alcohol bought at government facilities), but not on our health.

Sir William Beveridge, founder of the British National Health Service, stated: “The State, in organizing security, should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum for himself and his family.”

We believe that governments act unlawfully when they promise but fail to deliver timely care, and at the same time outlaw other options

Our constitutional challenge includes five plaintiffs (a sixth with brain cancer has sadly died), all of whom have suffered significant harm while waiting for care. One plaintiff, a previously active teenager, languished for 27 months waiting for spine surgery, and is now paralyzed for life. The outcome he suffered would not occur in any other developed country on Earth.

Every other country offers options for non-government care. Our current laws allow injured workers, RCMP officers and members of the armed forces, not to mention foreigners and federal prisoners, such rights. We will plead with our judge that free Canadians should be granted the same rights as those in jail.

We believe that governments act unlawfully when they promise but fail to deliver timely care, and at the same time outlaw other options. In 2014, we hope the Canadian justice system will emancipate patients from their medical enslavement. Laws that force sick or injured Canadians to wait, suffer, and sometimes die must be struck down.

Medicare, Barn-Raising and Collective Effort

medicare socialismMy girls decided to save for a horse.  My wife knew that even a ‘free horse’ costs a fortune to feed and medicate.  There would be no horses.

But the girls persisted. They pooled their money.

“…from each according to what she could give, to each according to her need.”

The communal need demanded 100% sacrifice.  Each girl contributed all her savings to claim a piece of the horse.

Their dedication broke our hearts.  We got 2 rescue horses for ‘free’, and collectivism won a better life for little farmers.

No question, collective effort multiplies effect. Individualism and self-sufficiency did not create the Duomo or Notre Dame.

In the 1950s, Saskatchewan farmers took barn-raising collectivism and applied it to medical care.  Like building a new barn, they knew they had to work together or risk bankruptcy from medical disaster.   So, they pooled their resources to provide for other hard working farmers who would do the same for them.

But instead of applying what they knew from building barns, they listened to bureaucrats and politicians.  Politicians hired ‘experts’ from the British National Health System.

Saskatchewan farmers took a great idea – working together – and gave control to ideological socialists.  Unlike local barn-raising efforts, they created a bloated, state-run system without choice.

British healthcare soon changed.  Britians now have choice.  The NHS has to prove it can provide at least a shadow of the quality and service available to private payers.

It’s like the Saskatchewan farmers built a commune they could not get out of, the only shop in town.  Farmers created one barn-building monopoly and handed over control to city people who never build barns.  The city people now dictate how, when and where barns should be built.

Barn-raising rests on collective effort by like-minded people tackling rare events that individuals cannot manage alone.  Socialized medicine took collective effort and changed it into state-building by bureaucrats.

We need to return Medicare to its roots in collective effort for rare events.  We need to give citizens choice – not for the sake of choice – but to drive Medicare providers to offer the best possible quality and service for patients.  We need to renovate Medicare to remind us that it started out for patients, not itself.  Until we do, politicians will tax and spend, increasing bureaucracy to buy the silence of taxpayers and providers.

The collective effort behind my daughters’ horse fund and farmers’ barn-raising is good and attractive.  Medicare capitalizes on that goodness but hides that it cares more about budgets and policy than patient care.