Some think Medicare means utopia; we just need more of it. For them, change is bad. Listed below are 10 tired quips people use to stop change to Medicare (with responses).
1. You exaggerate the problems with Medicare.
Not to people dying on wait lists.
2. Medicare worked so far; why change now?
We need to adapt or go extinct.
3. We just need more money.
Budgets never precede greatness. Steve Jobs started in a garage.
4. You imply we – providers, bureaucrats, etc. – are a failure.
No, you’ve done very well even without the best tools. Imagine what we could accomplish with the right structure, aligned incentives, and patient involvement?
5. You have a hidden agenda.
That’s not fair. Look at the good folks working to improve things.
[BTW, this accusation works to undermine anything you want to oppose; it’s impossible to prove the absence of something!]
6. What about control? What about accountability? What about, what about, what about?
All great ideas raise questions; none can be answered with certainty beforehand.
7. This just sounds like [choose your favourite distasteful concept]. Favourite distasteful concepts include: American Medicine, big business, profiting on suffering, etc.
Actually, it’s not like any of those terrible things at all. It’s about giving patients what they need, when they want it, in a way that makes them feel valued.
8. You’re abandoning our core values.
Change upholds the values that started Medicare. We started with an insurance program for acute needs. We now have a warranty to cover routine maintenance. We need to get back to our original vision and build from there.
9. It won’t work here; we are different.
True. We are different, but people are the same everywhere. Canada ranks next to last on many measures (efficiency, service) against European countries. I’m sure we are smart enough to do better here.
10. This is a slippery slope towards American healthcare [or other scary idea].
Common sense provides a guardrail. We let 10 year olds watch TV, but we do not let them vote or drive a car.
Everyone agrees we need change; just not with Medicare. We need adult conversations that move beyond fear mongering, confusion, and character assassination. Change will be forced on us as the first baby boomers turn 80 in 2027. We’ve outgrown Medicare; we must change now, or watch it fail completely.
Excellent commentary and valued discussion. I asked via a tweet today if Docs run ER departments. Answer was a resounding no……Doctors treat the patients once they’ve broken through the triage. This is troubling to me ..a patient….that the hospital administration coordinates with their direction over riding Docs. Winnipeg death should never have happened….completely preventable. The triage nurse thought he was drunk….that statement alone says volumes. This was HC at its worst. Docs have lots to deal with by being the most knowledgeable and focused at all times BUT they must have the key leadership role from the moment the patient crosses the ER threshold…. not administration. Do no harm is put aside every day with waiting pts. Mothers give birth after many hrs waiting in reception areas, others die in pain, paramedics wait with patients to hand off….this has made them primary medical givers …..in the ER. For Medicare to change for the benefit of patients first and then caregivers will be driven by pissed off patients who can’t find a physician, suffer for hours in waiting rooms, put their lives on hold for 12 months waiting for surgery . I hope physicians like you who ask the tough questions and are willing to participate with solutions are heard and welcomed to drive ……Medicare change.
Wow, fantastic comment, Don. Thank you for writing!
One thing you nailed that most people do not know: physicians do NOT run hospitals…or healthcare. We’d like to be involved, but we’ve been shouldered out mostly. No question, physicians are often their own worst enemies when it comes to gaining influence in the system. They tend to speak after they’ve mounted a head of frustrated steam; never a good thing. With physicians holding leadership roles being a tiny minority, bureaucratic skills have withered amongst MDs making the situation even worse. And even the docs who take on leadership roles still have NO budget to sign off on, and NO hiring/firing jurisdiction. That’s controlled entirely by the admin side who are all nurses, allied health, and bureaucrats. They are good people; they will just never understand healthcare from a medical perspective.
However, we cannot focus on the lack of physician leadership as a problem in itself! Physicians let it happen in the days when money flowed enough for even the most inefficient system to provide good patient access. Now, patients suffer in an inefficient, system- and provider-focussed system. To fix that, we need many more physicians in leadership positions.
Your comments about patient harm remain the key message. We need to improve things for patients, full stop.
Thanks again for responding!
Shawn
Another great post Shawn! We need change and we have to free our innovators to forge ahead. They are trapped in this system with only the courts to turn to for freedom or reprimand.
So true, David. We shouldn’t need court cases to drive change.
Thanks so much for reading and commenting!
S