CKNW Editorial
for April 3, 2000

We’re kidding ourselves in this healthcare crisis folks … all the health economists in the world with Shirley Douglas, her sainted father and All Rock aren't going to make the problems go away.

The problems are both philosophical and practical. First the practical and that one is simple. We simple have not kept up with the demographic changes. We knew 30 years ago that our problems in 2000 and beyond would be in Long Term Care. We knew then that because of an aging population and the baby boomers that we simply would not have enough beds to look after the impact. We did some things. Under Bob McLelland we started the Long Term Care Program and under his successor we moved into home care. But over the years we simply didn’t follow up and now we have a very big problem. It perhaps could be fixed with one big effort but I doubt it – besides, in this province anyway, we have decided on other priorities such as fast cat ferries.

But we have a philosophical problem too. When medicare was brought in – not by Tommy Douglas as myth would have it but by Premier Lloyd, his successor, we did two things. We decided that the model would revolve around a doctor serviced system and that we would, basically, pay for whatever treatment they thought was appropriate. Now that latter statement is not quite true – medicare retained the right to reject procedures but in fact where the crunch came was in expensive new diagnostic tools, first scanners then the more sophisticated MRI and in organ transplants. What the plan utterly lacked was any real preventive component, despite the lip service that every health minister dutifully pays to it. And there is more – we didn’t ever foresee that people would want treatment – a lot of it – outside the medical profession. And it is here that the health economists and number crunchers go wrong for it is here that the true second health care tier is. People pay for much if not the majority of alternative medical care out of their own pockets yet somehow the health experts fail to not that when computing the cost of health care in terms of dollars per person. The arguments against a two tired system under the present Medicare system get quite emotional about the poor getting worse service than the wealthy. Well, under the two tiered system we have the poor get no service at all except on the bounty of the practitioner himself.

We have not yet. Of course, defined in detail the services we will pay for out of the public purse nor come up with a satisfactory system for changing the list.

Back in the early 40s when Aneuran Bevan brought in the National Health Service into Britain he and all the experts were sure that there would be a one time impact while people got their health up to snuff and thereafter people would scarcely ever see a doctor they would be so healthy. That theory was quickly proved to be calamitously wrong. Yet here we are, nearly 60 years later operating essentially the same system Bevan brought in.

The problems won’t go away even if the feds do restore traditional funding. We must understand that. We must do something different and soon.

What to do?

Well, of course, the moment I suggest looking at other systems I’m accused of wanting an American style system with people dying on the streets for want of care. But we must do something – for they may not be dying on the streets but that’s where mental patients under this system spend their nights.

It’s very easy for Shirley Douglas and others to bellow from the pulpit that the system cannot be changed but must be made to work but that is to say we will continue to have a system utterly doctor driven, without adequate care to the mentally ill and using acute care beds to house the elderly and leave those who believe in preventive health practitioners on another tier.