Money cannot capture the cost of waiting. Single-Payer healthcare separates costs and benefits.
Politicians and bureaucrats draft attractive policies but ignore the costs of their plans.
Waiting for care robs the Canadian economy of almost $15 billion. Patients lose over $2 billion as individuals.
But money misses the most important robbery.
Many patients awaiting hip replacement cannot play with their grandkids and struggle with basic bodily functions.
Self-employed plumbers cannot crawl under cottages to fix plumbing, while they wait for new knees.
Single-Payer Costs
Waiting for care costs. Most of the costs cannot be measured. Every Mom, Dad, and business-owner puts a huge burden on all the people who depend on them, when they are forced to wait for care.
I received this from a physician:
“I went to Belgium in December to have my hip resurfaced. What an experience. The market is fairly transparent in terms of cost (wide range re. Britain, Italy, Belgium, India, US) and surgeon experience. I had a consult here which was laughable – and I’m saying that as someone who is intimately aware of the constraints of our system and resultant effect on practice style.
The wait list here was 14-16 months. Putting myself on the cancellation list would have thrown my colleagues and patients for a loop if I suddenly disappeared for 6 weeks. I needed to plan.
I consider myself fortunate to be able to pay for what I needed, and I developed significant empathy for all those patients who are waitlisted. I think it’s shameful… and a sham.
I talk to people every week who have gone, or are going, out of country for care. I have sent patients to the US myself (check out the Norman Parathyroid Center) when necessary. I just spoke to an acquaintance last week who is going to the Cleveland Clinic (US) for hip resurfacing.
And what are we to make of Medcan and similar corporate boutique pay-to-play medical care in the GTA? Is that not two-tier?
Ugh. Time to face reality.”
“Care regardless of ability to pay” is a wonderful idea but a painful reality.
When we put all the costs for medical care on government, we also give government the final say on how, when, where, and for how long we wait for service.
Activists Get Care
Those who organize and mount the best advocacy campaign get attention. Mothers of autistic children make the news. Grandmothers with bladder cancer do not.
Single-Payer healthcare has run its course. The experiment has more than enough data to prove that we need to do better.
The poor get less care. #CanadaWaits
Central planning fails because no one can collect enough data to plan. And even if they could, no one is smart enough to process all the data to allocate resources efficiently.
We need to ask, “What can we accomplish, and at what cost?” Not “What would be nice to accomplish” or “What should we accomplish”.
We must ask what we CAN do. And then we need to ask what costs we are willing to bear. Until we do, Canadians will continue to live the dream, while their neighbours bear the cost of waiting for care.
Photo credit: Fraser Waiting for Care
PS: One reader noted that they’ve never seen such a fancy, well-lit waiting room full of such well-dressed people. Many (most?) waiting rooms are dingy, smelly, dirty and full of people in varied states of pain and distress.
I try to keep an open mind, but I have to say that I’ve worked with thousands of people through my career who had hip and knee replacements and none of them complained about the wait. Most waited years to make the decision to go ahead with the surgery, so six months or a year was not a big deal. They were grateful the procedure was covered and they did not have to mount “go-fund-me” campaigns like my colleagues in the US.
Also, having lived and worked through the privatization of the long term care system, I would say that the new for-profit system created more problems than it solved. No money was saved. Good jobs were replaced with casual, dead-end, poorly-paying contract jobs. Healthcare workers with tons of experience fled in droves, and multinationals (many from the US) vacuumed up all the contracts.
I am sure that there are many ways that the current system could be improved. I am sure that there are layers of bureaucracy that could be cut. But my vote is for the system that provides the greatest good for the greatest number, and that doesn’t let the wealthy march to the front of the line like they do in every other aspect of life. Yes we can do better. We can increase the emphasis on responsibility, prevention, and self-care. But other values matter too: kindness, generosity, open-mindedness, equality (I know you don’t put much stock in this one…but perhaps you’ve never been poor), and making a decision about how much is enough. Money is a tool, not a measure of your worth. (Unless you’ve let it become your religion). How much money is enough?
Let’s not throw out all the good of our system to satisfy the demands of the entrepreneurs. My parents are fiscally poor (but in many other ways they are rich beyond measure). I want them to have the same care as their wealthy neighbours, and the peace of mind that those working within healthcare will not discriminate based on their resources. I’ve heard the argument that allowing a two-tier system frees up resources for the poor, but I would argue that in countries where that has been done, the actuality has been two distinct systems: one that is high quality and one where you take what little you are offered. The talent follows the money and the poor get the dregs.
Yes, a one-payer system is frustrating…but we could do a lot more to make it more open and accountable.
Thanks so much for reading and sharing a comment, Elaine! I’ll try to respond, but will surely miss some things.
1. I see thousands of patients also. I agree, many do not complain. Many do not know it could be any better. But wait times of over 1 year are unconscionable. I just spoke with a gentleman yesterday: His surgery is booked for next February. He started his journey towards surgery (XR, referral, etc) last summer. The data supports this anecdote. Many wait only months, but far too many wait years. I could also tell you many stories about grandparents unable to kneel down to play with grandkids. Self-employed patients — no disability or pension — who cannot keep up with their business due to pain.
2. “But other values matter too: kindness…” I agree! It is out of kindness that we should be moved to never tolerate an elderly person lying in a urine soaked diaper on a rubber mattress in the hospital hallway for hours. Seniors line our hallways waiting for care. It is intolerable. I care about the person in front of me — only envy would move me to worry about the “rich” person who chooses to pay for care outside the country. What does that matter to me as long as my patient can get care?
As Tom Sowell said, “Envy was once considered to be one of the seven deadly sins until it became one of the most admired virtues under its new name, ‘social justice’.”
3. “…perhaps you have never been poor.” Growing up in a family with 6 children in the 1970s rural, Northern Ontario with one parent working meant I learned to live without. It seemed normal until we went to highschool in the city and got to see how the city kids dressed.
In medical school, we had a lecture on poverty. MANY of us nearly laughed out loud when we learned that we were living FAR below the poverty line. I’m not looking for sympathy; only clearing up misleading implications.
4. Your final comments about countries that have hybrid and blended systems are just false. Even worse, they are fear-mongering. Most developed countries have systems that offer universal care with options to purchase access to faster care if the wait times in the public system are too long. Quality goes down with every monopoly (and monopsony).
5. 80% of Canadians support access to options when the wait for care is too long in the public system.
I think the time has come for people like you, and others who support our rigid ideological approach to care, to take ownership of the physical, emotional, and financial costs of waiting for care in Canada. It is intolerable. Canadians deserve better.
Great response Shawn
Canada neither has the best healthcare system in the world, and neither is it the most socially equitable
http://www.socialwatch.org/node/9364
Old myths being propagated
Thanks Scott!
Really appreciate the link also. Hadn’t seen that one. Excellent.
Cheers
Great line from Tom Sowell…I’m stealing it for my own.
Machiavelli started that there are only two causes for hatred…fear and envy.
Envy is in danger of becoming a virtue in this modern era , guaranteeing a perpetual “ virtuous” political hatred for the foreseeable future….our modern day educational system is churning out a generation of rancorous politically correct “virtuous” snowflakes to fuel the fires …Henry Adams declared that politics is the organization of hatred and the medical profession has certainly been targeted by such organized bigots (those who are obstinately and intolerantly devoted to their own opinions and prejudices)…once rendered professionally impotent …they will then target other envied groups to level them one by one leading to another impoverishing Maoist style cultural revolution dark age…” the un enlightenment”.
Glad you liked it!
I have been toying with “truth bigots” as a way to describe “those who are obstinately and intolerantly devoted to their own opinions and prejudices”. Of course, we need to be vigilant that we do not fall prey to infatuation with our own ideas also.
The frustrating thing about a ‘constrained vision’ (as Sowell calls it) is that those who love rationalism, debate, and tradition do not have a crisp ideology to put into a manual. No doubt, many try to encapsulate it into an ideology to match the ideologies of Marx, Lenin or Mao.
But a love of history defies ideology. There is nothing crisp or manual-esque about saying that we stand on the wisdom of a 3,000 years of human accomplishment. Appealing to tradition means that we must, first, admit that humans know all sorts of ways to fail. Why should we assume that we are the enlightened elites who have finally found the only way to NOT fail?
However, thinking this way often leads to despair. Once we swallow the ‘red pill’ we cannot un-see the real world outside the Matrix. Our job is to find a way to stimulate an appetite in others to take the plunge and swallow the red pill themselves.
Thanks again for posting a comment!
Cheers
I agree with your comments wholeheartedly.
Access to a waiting list is NOT access to health care.
People like Elaine don’t realize that we have had a multi tiered system in Canada since Monique Begin’s Canada Health Act was introduced in 1984 … it’s based on WHO YOU KNOW rather than on how much money you have.People get moved to the front of the line all the time if they know who to call … including hospital administrators and board members,politicians,wealthy business people and yes … health care workers … we look after our own.
It’s time to stop the infatuation with an outdated ,unsustainable system that is ranked 30th in the world,that NOBODY has copied.
Let’s start talking about implementing a blended system that will introduce competition,innovation,improve quality and access.One that will stop the monopoly and stop hospitals from spending 10%of their budget on administration[like a fortune 500 company]when they should spend 5%[like a charity … after all,they receive a ‘donation’from the MOH at the start of each fiscal year].
I could go on ,but I’m tired after an OR day where there weren’t enough nurses,and what I billed for a hip replacement was the same as it was 25 yrs ago !!!
Powerful comments, Ramunas!
Neil Macdonald wrote an article for the CBC called: Free and timely care for all is a fiction. In it, he said, “The system is somewhat corrupt; if you have influence or an elite education or some ‘in’, you’ll get better care than a fellow who doesn’t.”
As always, thanks so much for taking time to comment! Really appreciate it.
Cheers
Thanks Shawn for this blog. As you know, I experienced waits in our health care system first hand when my sister was diagnosed with cancer at UHN, the so called “centre of excellence”. I watched for 2 months as she got sicker and sicker before she got treatment. Since then I have watched two of my patients wait months to get investigations for serious illnesses and get sicker and sicker. One passed away recently because the waits are unconscionable. And that was with me advocating and pushing as hard as I could. Until you experience these examples first hand, I don’t think anybody realizes how bad our system really is. I’m so tired of the fear mongers who fight so hard against blended models. I’m pretty sure that if you put people like you, me, Scotty and others in a room together, we could come up with a system that would be exemplary and improve the public system at the same time. The issue is that I don’t trust any government or bureaucrat to do it correctly.
Well said, Lisa!
Our aim should be to have zero waits in a blended system — at least as a goal. Leaving all the major decisions up to one group of powerful elites puts too much pressure on them. No one has enough facts, and no one is smart enough, to efficiently allocate resources from a central control centre.
I am so glad to see you talking more about your sister now. That was horrendous, but your/her story is so powerful.
Hope you are having a great Passover.