Canadian Health Care Information

Our primary ethical obligation is to relieve and prevent human suffering. What is the solution to this ethical crisis? I believe that it lies in the community of Canadians realizing that we are one. We are the family caregiver who can’t find a doctor. We are the patient who cannot demand faster care for fear of falling further back in the line. We are the physician who feels s/he can’t retire for fear of leaving patients without a family doctor. We are the nurse who can bring pain medication, but not treatment. We are the worried bureaucrat who knows that the numbers spell doom. We are the torn politician who knows privately how bad it is, but cannot have a public conversation. We are one.

Together, we can acknowledge that no amount of money will keep up with the twin forces of technological possibilities and human expectations. And then we can get down to work on the discomforting yet critical job of redesigning a healthcare system that is universal, compassionate and affordable. No politician or healthcare expert can do it for us. Those choices must come from us, the citizens who will use and pay for the service. In our hands lie both the responsibility and the solution.

We have hard work ahead of us. First, we have to sadly, but surely release the myth of Tommy Douglas. It never worked long term anyway. Back then, medical care consisted of a small number of lab tests, diagnostics consisting predominantly of an Xray machine, and a modest selection of drugs. Today we can rescue premature babies weighing less than a pound, analyze your genetics and offer designer drugs. It is time to choose which healthcare services Canadians want their tax dollars to pay for and which services can be secured through different arrangements. Do we want serious illness tax funded and the day to day sniffles paid for with private insurance premiums, subsidized for those below a certain income level? Do we want every person to have a tax paid health care account wherein they continue to accumulate unspent funds?

There are many ways to achieve affordable quality healthcare for all. We are one. We are caring, inventive Canadians. We can do this. Let us not look to our politicians for answers. Let us gather across this great country and talk amongst ourselves and then direct our politicians with the solutions.

In election time, voters look to politicians for promises of more money for healthcare. Money has not fixed our healthcare problems in the past nor will it in the future. For nearly 30 years, since the first waiting lists were documented by the Ontario Medical Association, governments at every level and of every stripe have increased spending. Yet prominent international and national bodies have labeled Canada’s healthcare system financially unsustainable (IMF, December 22, 2010; Dodge & Dion, 2011). The latest 10 billion dollar infusion from the 2004 health accord is rapidly disappearing. Not so our problems. They remain and grow.

The reason that money can’t fix things is that the problem we are facing is not a financial crisis, but an ethical crisis. For example, we do not have a single tier system, but rather one with at least 10 tiers, where the least advantaged suffer the most. They do not have influence like politicians or senior business people. They are not insiders like docs and nurses or that booking clerk for the MRI machine. They are not independently wealthy to fly to healthcare. They are generally not the highly educated who know how to work the system. And they are not typically members of a preferred group like the Workers Compensation or the RCMP. It is morally repugnant to witness this. Further, by not objecting, we bear the guilt of benign complicity, but complicity nonetheless. What are the ethics of being aware that people are waiting one to 3 years for medically necessary care? Canadians suffer significant rates of addiction to pain medication (Paperny, 2009). What are the ethics of addicting people instead of treating them? What are the ethics of being involved in the unspeakable waits for those with cancer? Our healthcare providers also suffer when they must witness and be involved in these situations. As for patients themselves who are waiting, the picture
is one of serious disruption for their life, family and work; profound distress; and for too many, unendurable pain (Walker, 2009).

References
Dodge, David & Dion, Richard (2011). Chronic healthcare spending disease: A macro diagnosis and prognosis. C.D. Howe Institute Commentary.

International Monetary Fund (2010). Canada: 2010 Article IV Consultation-Staff Supplement; Staff Report; and Public information notice on the executive board discussion, December 22. Country Report No. 10/377, p. 16.

Paperny, A.M. Addiction by Prescription. Globe and Mail, Nov 13, 2009. Available at http://www.theglobeandmail.com/life/health/hooked-canadas-painkiller-problem/article1362848/

Walker, Janet (2009). Waiting in Line. Canadian Nurse, 105 (7), 26-30.

A recent story in the Toronto Star asked about the ethics of treating medical tourists after they get home. The focus was on the doctor and the so-called dilemma that they faced in treating or not treating such patients. This story sadly points out yet again that in our healthcare system, there is more concern for the healthcare provider than the healhcare receiver, the patient. And there is more concern about people practising medical tourism than about the reality of Canadians suffering because of lack of access in Canada.

Where are the ethicists? Should they not be speaking for the suffering? Should they not be speaking about the ethical issues in healthcare including the ethics of no care? I hear them speaking against medical tourism or private healthcare, yet I see no one taking on the realities of our current Canadian healthcare.

Ethicists like to talk about fairness. Where is the fairness in our healthcare system that is not one tier but many tiered? Tier one is for those who are simply lucky. They are lucky enough to have a condition for which pain is not a feature and for which there are no waiting lines. Or they are simply lucky because on a particular day, all of the planets align such that they do receive their needed treatment in a reasonable time. Tier two is for those people with enough money such that they can simply bypass the system and find healthcare in private jurisdictions. Tier three is for those folks who have influence in the syustem. Most of these are insiders, for example doctors, nurses and booking clerks. They take care of their own and they have the power to offer queue jumping to others. Tier four is for those folks who "know someone" inside the system - like the mom whose father was the neighbor of the executive assistant to the chief of surgery. Tier five is for everyone else. Under this system, it is the least advantaged who suffer the most.

I see ethicists defending the ideals of Medicare; the advertised version, but they are not speaking about the realities of Medicare. We need our ethicists to speak.

Our primary ethical obligation is to relieve human suffering. We can do this by opening our eyes, hearts and minds to those people and places and practices that provide universal and accessible healthcare for all. Let's make the relief of suffering more important than the preservation of a false ideal.

Everyone is offering ideas on how to fix our healthcare system. Here's my idea. Turn the keys over to the people who have the best qualifications for the job -- ordinary Canadian citizens who are full of common sense and experience. As payers and consumers of the service and as Canadians caring for and about each other, we have the unique right and responsibility to determine the nature and quality of services available. A recent Nanos poll(May, 2010) revealed that healthcare has reclaimed its long standing top spot among issues of concern to Canadians. Yet somehow, in spite of our concern, we continute to leave this vital matter to the so-called pros. No wonder so little changes.

We have known for many years that the current system is not financially sustainable. Every region of Canada has given the numbers showing healthcare to be the Pacman of all tax dollars. Nor is the system ethically sustainable. Waiting lists that began in 1982 continue with little change. The suffering that is present within those waitlines can neither be justified or tolerated. This is Canada. Surely we can do better.

A critical component for doing things better will be the active involvement of all Canadians. I am encouraged by the fairly recent formation of some national patient/consumer groups. If you haven't come across them, here they are. If you know of others, please let us know by leaving a comment.

Canadian Association for People Centered Health. Their tag line is: Giving the People a Voice; Being a Voice for the People. Led by a Canadian dentist, Dr. Vaughan Glover, this organization describes itself as grassroots and encourages the involvement of ordinary Canadians. Website

Patients Association of Canada. Their motto is: Patient Led. Patient Governed. Strengthening the patient voice in health care. Website

Patient Destiny. Started by Dr. Kevin Leonard of the University of Toronto, this group held its first town hall meeting in May, 2010. The focus of the group is patient empowerment through among other things, the electronic health record. Website

Canadian Patient Coalition. Their purpose is to bring the patient voice to health policy decision makers. They recently held a Canadian patient summit in March of 2010 to explore the ways in which the patient voice can be heard. Website

Each of these organizations values consumer voice; consumer choice. This is a good start to Canadians stepping into our rightful place as the decision makers for a healthcare system that is compassionate, effective and sustainable.

In my last blog, I described a personal unintended experience in an American hospital. I committed to post the cost of my visit to Emerg for a broken collar bone and a torn shoulder rotator cuff.
The bills arrived and the total was $2,161. While the cost was not cheap, it was not in the realm of the stories we have all heard. What was mindblowing was the storm of paper and phone calls required to manage the bill(s). This was in spite of my immediately and faithfully sending any bill or piece of paper to my Canadian insurance company for handling and payment. And just when I thought that everything was done and paid for (it took 5 months), today I received a call from a collection agency for the phsician bill of $327. This was the second call from such an agency. The first one was a few months earlier regarding a radiology service for $29. For a country that is known for its "good old American know how", it was shocking to witness ongoing across-the-board confusion coupled with multiple redundant circular phone calls. It seems that the hospital costs are separate from the radiology costs and that physician costs are separate from either of these. But nobody communicates or coordinates these facts or these systems. I am beginning to understand why their paper costs and admin costs are so high.