2005-03-15

Canada's Health Care System: What is Going On?

The following is purely the observation of the health care system from a citizens point of view. As a patient I have seen first hand the good and the bad the system provides. Even as a visitor certain drawbacks of the system become apparent.

To start, Canadians are proud of their universal health care system. In theory, it has all the components of an advanced, compassionate and egalitarian society. Like all social monopolies, in practice it is sometimes a bureaucratic a nightmare. It is neither compassionate in its waiting periods and neither egalitarian as privileged citizens gain quick and easy access. Nor, above all, is it free. It costs a lot. Too much when you measure against what we get in return.

It's to the point I wonder is misplaced pride. Especially when we use it to compare against the U.S. system. Far from being an expert on the American health system, I read and speak enough to Americans (friends and family) to understand its basic function and structure. Besides, one does not need to know the inner workings of either system. What for? The blemishes to the Canadian system is appallingly apparent from the minute you submit your medicare card. It is there for all to see. The plain reality is that, within all the paradoxes of our system (we can pay for a breast implant but are prevented from increasing treatment for breast cancer to cite one), our lives are not being dealt with in any dignified manner.

Canadians spend millions and millions of tax dollars on a system that turns around and throws something like 75% of the funds at payroll and staff. It does not take a genius to figure basic financial math, assuming these figures are correct (and by all accounts it is an average number from various sources from doctors, newspapers and health care officials) that any business that chews up three-quarters of its revenues (or in the case of public institutions tax dollars) to labour costs simply is not going to make it in the long run if those revenues do not expand over time.

It is worse when it comes to public finance as our tax base is not growing enough to offset any shortfalls. Hence, taxes increase. Why? So far, the only answer, after endless summits and conferences about health (where typical power struggles between the federal and provincial governments bicker to the point of paralysis) is to throw money at the system without functional safeguards (those currently in place do not seem to be working) ensuring the funds are properly managed.

At this point, it is only right and fair to point out that the problem does not reside with the doctors and nurses and other care workers of the public health system. Personally, I have come to acknowledge that Canada has a strong health care system when it comes to care....once you get it. If you are an American and find yourself sick in a Canadian hospital I am confident you will be in good hands. The fact remains, however, that Americans have better access to care and technology (the overall quality is higher in the U.S.) than do Canadians but Canada is not third world by any stretch of the imagination.

Please allow me to use simple human logic and experiences during a typical day in the Canadian health care system. This is where the waiting time becomes third world in its length. The system is Byzantium to average users. We must cut through many layers of gunk to get to the core of who we need to speak and see once we are in the vortex. Key public officials, like politicians and their families, do not wait in line. They do not have to sit and stew in anger waiting a whole day for simple procedures. Politicians talk about the fact they understand the need to reduce waiting times but have yet to introduce feasible solutions. The system is overwhelmed, understaffed and mismanaged. It will have to take miraculous enlightened leadership to solve the problem.

In case you have not noticed, the Liberal party of Canada has not been a bastion of quality leadership.

Case 1: A husband takes his wife who is pregnant and considered to be high risk to the emergency ward of a reputable hospital. The hospital itself is old and not well kept. One person, is laying on a bed in the hall way, obviously fighting a bad fever. In fact, a few people are in this state as the emergency ward does not resemble a first-rate medical system in any way. So, she waits there for 3 hours before she passes. The husband and his wife wait 30 minutes to see a nurse. They wait 3 hours to see a doctor and an additional 3 hours for the results of blood tests. One person was on staff to process the blood results. The doctors blame cut backs. They move on utterly exhausted. They get home at 2 am. Unacceptable.

Case 2: It is not uncommon for people to lose a full day of work, hence wages, to prepare for the drudgery of sitting around in the health care lounge. Someone should consider an impact study on wages lost to people wasting precious productivity time needlessly in the stressful realm of the public health system.

Case 3: On a personal level, I once had to wait a whopping 3 hours with my shoulder dislocated before any doctor had the presence of mind to pop it back in. They insisted on taking me, in pain, to the x-ray room. The nurse could not seem to comprehend my range of motion was limited due to the pain. There I was, like a shlepp, forced to take the x-rays. It was not a bone problem. Every minute my shoulder stayed that way meant the more the ligament stretched thus reducing my chances of strengthening it in rehab. Thank you Canadian health system. As a note, I have always had shoulder problems. One time, when I popped it playing a sport. a doctor was on hand to pop it back in. No x-ray was necessary.

Case 4: A father needed an aortic surgery fast according to doctors. They told him he must not go anywhere. They set a date for the surgery. The system, over flowing as it is, rescheduled a life-threatening condition, not once, not twice but three times. Would athletes wait? A politician? Accessibility has become almost impossible in a time friendly manner. Canadians do indeed have access - when they give their card. After that, good luck. The surgeon, for his part, was both brilliant and caring. The nurses did their best to deal with cocky and rude ICU doctors and grieving friends and relatives and were nothing short of remarkable in their professionalism. Still, unacceptable. It was Russian roulette with a man's life. Is this how we define 'compassion' in Canada?

Case 5: Unsuspecting gentleman leaves for his annual check up with a family doctor. During the session, the doctor decides to send him for some x-rays. The wait? 3 hours.

Case 6: Canada, for all the taxes poured into the system, has among the longest waiting lines in the Western world. Many Canadians are finding it more human and practical to head to the U.S. for certain treatments. Canada also lags behind in the number of bed and MRI units available.

The provinces, no doubt, will blame the federal government for such nightmarish waiting periods but that is not the point. The point is that amidst all the political games, the health care system has whithered away to the point that it is no longer viable and acceptable to an advanced society like Canada.

The howls you hear in the background are from the ghost of Tommy Douglas and his supporters. They should be ignored. It is time for a massive and intelligent overhaul of the public health system. If we do not, politicians, every single one of them from every parts of this land, should be made to answer for its failures. They will have to account for blood on their hands for deaths that could have and should have been prevented with some bold changes.

Canadians are losing faith. We should demand for more. Many are willing to pay for peace of mind and I do not blame them. However, such notions are met with horror from health care zealots. At his point, we should explore all options and avenues (including a two-tired private system. Private clinics exist in Canada) to make the system more responsive. Throwing money at it will not solve the system. Nor should we be indifferent to it. We should be forceful in knowing what is going on with the public health system. After all, it is our money; our lives.

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