Category: Vision for Healthcare

Non-Profit Healthcare: Myth or Reality?

GodBlesstheNHSAs one NHS manager put it, without business there would be no buildings, no drugs, no machinery, no beds, no scrubs – just a lot of doctors and nurses in a field in their underwear.

— God Bless the NHS  by Roger Taylor

Healthcare profit is like sex in Victorian times.  We pretend it rarely occurs, and we’d be better without it.

But,

  • Doctors, nurses, techs, clerks, administrators all get paid; they work for profit.
  • Paid bureaucrats profit from running Medicare.
  • Even politicians politicate on healthcare to keep their jobs; they profit.

Furthermore, healthcare cannot run without business providing almost everything needed for care.  All the technology, medical wonders, and super drugs come from businesses driving innovation.  Pharmaceutical company TKM hopes to have an Ebola treatment out soon.  Businesses research and develop new products to help patients and to build profits.  Patients benefit from businesses that profit.

Medicare is not a charity.

Can Medicare Ever Fail?

Business owners expect a return for their investment in business.  Failing companies close.  If they cannot serve customers, they go out of business. Owners hopefully salvage some of their investment.

Public organizations spend all their money.  They never decrease spending voluntarily.  In fact, they put operational savings into more staff or new buildings, even if service doesn’t change.  When publicly run organizations fail to serve customers, they do not close.  Instead, the state spends more to prop them up.

Only Non-profit Healthcare Cares

Fundamentalists insist that only non-profit healthcare values patients more than money.  Only public organizations put patient interests first.  They insist that only state run medicine can truly care, having had its motives purified with other people’s money.  They imply that Dentists, Orthodontists, Pharmacists and everyone else not covered under Medicare cannot genuinely care about patients.

But in publicly run Medicare:

Patients wait for urgent surgery.  The state rations operating room time to save money.

Patients wait for imaging (MRIs etc.).  The state turns machines off at 5 pm to save money.

‘Non-profit’ medicine cares about money just as much as ‘for-profit’ healthcare.  Non-profit care cuts services to save money.  It cannot incentivize productivity or increase budgets by serving more patients.  It can only cut, or raise taxes.

Who Cares Most About Patient Service?

The key difference between non-profit and private healthcare is the value each system places on patient service. Non-profit medicine cares comparatively little about service.  Without incentive to pursue excellence, it aims for average.

Private healthcare must put patients first or risk insolvency.

Profit prudes impugn those who question ‘non-profit’ healthcare.   It’s time to expose the myth.  Non-profit zealots enjoy huge profits as healthcare burns up 50% of provincial budgets.  Non-profit healthcare would have nothing to offer patients without the proceeds of business endeavours.

Non-profit chauvinists denigrate any care other than their own.  It is hypocritical moral supremacy.

 

Patient’s Demands = Doctor’s Duty?

DoctorinhandcuffsShould a patient’s demands always be met?  Are ‘scientific’ reasons the only basis for clinical decisions?  If medical technology can, does that mean we should, every time patients ask? Are doctors automatons of the state?

Patients demand many things:

  • CT head for minor head injury
  • MRI for anterior knee pain
  • Urgent referrals for chronic abdominal complaints
  • Large amounts of narcotics for unspecified pain
  • Repeat referrals for second opinions
  • Tests to determine blood type or Vit D level
  • Referrals for massage ‘because my insurance covers it.”
  • Handicap parking stickers
  • Same day, urgent appointments for chronic issues
  • Notes for work after recovery for an illness that was never assessed
  • Referrals for cosmetic work

A Patient’s Demand Unmet

A 25-year-old woman popped into an Ottawa walk-in clinic recently to refill her birth control.  The physician refused.  She got angry…especially when the doctor told her why.

[Hormone therapy is more than popping a pill to prevent pregnancy.  It includes medical risks (e.g., blood clot and stroke), requires clinical judgment to prescribe safely and should include regular follow-up.  Many make a solid case against walk-in clinics refilling ongoing prescriptions that require monitoring.  Of course walk-in clinics could do it, but discontinuous, episodic care from multiple providers for chronic care is not ideal.]

She got a form letter stating that for “…reasons of my own medical judgment as well as professional ethical concerns and religious values…” the physician would not prescribe her oral contraceptives in the walk-in clinic.  Kate Desjardins shared her suffering at the hands of religious prejudice on social media.

Sermon by the Toronto Star

The Toronto Star flew to the rescue with “Doctors who play God can be pastors, not physicians.”

Martin Regg Cohn, a journalist, launched a jeremiad on doctors who dare to listen to conscience.

His angry harangue drips with clichés like “safeguarding our best interests. Not indulging their own beliefs” [italics original].  He assumes a simplistic understanding of medicine where a particular diagnosis implies a specific treatment, no judgment necessary.  But medicine is rarely specific or particular.  He raises moral alarm with “Instead of carrying out their medical oath to “do no harm,” they opted for “do not help.””

Cohn wags his finger “Remember, too, that our health-care system is publicly funded. While doctors keep insisting on their independence, they must still play by the rules — not impose their own private moral framework.”  States have rules and good citizens must comply.

Cohn counsels physicians that they are “merely a medical practitioner.”  He assumes doctors require merely medical acumen, not clinical judgment or moral reasoning.

“A doctor is neither a judge nor a priest, merely a medical practitioner. If an MD wants to judge people, he should study law, not medicine. If a physician wants to impose religious barriers rather than provide contraceptive barriers, he should study divinity, not doctoring.”

With slightly pompous self-importance Cohn pontificates,

“Doctors who refuse basic family planning shouldn’t sign up for family practice or show up at walk-in clinics. Let them choose pathology — dealing with death, not life.”

Responding to Nonsense

Why bother responding to name-calling and logical fallacies?

We must respond because many unconsciously support anti-freedom, pro-state ideology.  An editor agreed to publish the piece.  Popular journalists promoted his article on social media.  Talk show hosts piled on with the same message.

Cohn’s article assumes public servants, specifically physicians, should not have freedom of conscience.  No doubt, this will emerge as a theme during debate about euthanasia in Ottawa next month at the Canadian Medical Association’s Annual General Meeting.   Do physicians have the right to refuse intervention that society deems appropriate?  If society demands euthanasia (or anything else), do physicians have a duty to provide it?

Freedom Trampled

The Star’s disdain for freedom and individual choice should raise alarm.    History offers many examples of political systems pursuing utopian dreams of social uniformity: states that dictate morality, provide for all citizens’ needs and expect unquestioning obedience from civil servants.  We should be alert to this thinking even when it’s twisted to appear patient focused.  Though my medical practice differs from the physician in this story, I fiercely support his right to follow conscience and explain why.

Medicine, Morality and Freedom

Medicine is a moral enterprise.  It directs courses of action (deontology) and reflects moral values (axiology).  Physicians apply practical reasoning (phronesis) and use current scientific understanding.  Physicians attempt to help, always aware of their own frailty and imperfection, and require freedom to do so.  Medicine cannot be reduced to a technological product dispensed by the state.  Patients’ demands can never define a doctor’s duty; both patients and physicians would suffer for it.

 (photo credit: change.org)

Money Back Medicare

moneybackWe expect to get what we pay for.  Most businesses offer a money back guarantee: it builds trust and save time for staff serving unsatisfied customers.

Should there be a money-back guarantee for Medicare?

Sweden’s publicly funded healthcare system offers a ”money back” guarantee.  In 2005, Sweden offered treatment elsewhere, paid by government, if wait times were exceeded.

Others do the same:

A few dismiss this as pandering to a consumerist society or a violation of historical medical agreements (Money-back IVF: weighing the pros and cons).

Bureaucrats love talking about provider accountability, practice audits and accountability to the public purse. But they seem much less excited to talk about system accountability for patient access to surgery or imaging. Would a money back guarantee promote accountability?

Since Canada outlaws competition to state-funded Medicare, shouldn’t it guarantee healthcare access and service?  On what principle can Medicare offer the only care available and be allowed to provide terrible service?  What Canadian value does this represent?

We tolerate it because those who can, fly south for care.  Those with power to lobby for legislative change see no reason to bother.  They get prompt service south of the border and the public gets ‘free care’.  Pundits preach equality to the rest of us left waiting in Canada.  As long as everyone endures equal waits in Canada, pulpiteers support the status quo.

What do we call wait times guarantees that do not deliver as promised?  When is a guarantee not a guarantee at all? Guaranteeing outcomes might be too hard to tackle, but at least we can start by guaranteeing access and service.

Aside from garage sales and craft fairs, we never willingly accept a no-money-back-guarantee for goods or service.  Why do we accept it for more important things?  Isn’t cancer surgery or antibiotics for your child’s pneumonia important enough to be worthy of a money-back guarantee for access?

The state promised to provide healthcare. If it cannot, government should guarantee service somewhere else, in Canada.