CKNW Editorial
for December 14, 2001

Putting into place machinery through which to deliver health services is a mugs game. The fact is that no matter how you do it, there will be great unhappiness and the usual one-liners. I can’t comment specifically on Health Services Minister Colin Hansen’s new plan except to say that it will probably be three things – more cost effective, more effective at delivering most services and unpopular as hell with many people.

The minister is looking at a balancing act. I lived for some time in Kamloops where you get a different perspective on things than you do in Vancouver or Victoria. The perspective is even more different between, say Fort St John and Victoria. When you live in what we lower corner folks called the boondocks, you know from the outset that it’s an uphill fight to get enough influence in Victoria to get the services you want. You want health delivery as decentralized as possible.

If you’re the government, you see local authorities as parochial and spendthrift. And there is something in both arguments.

Perhaps the biggest headache of a Health Minister is rationing services. It is a three pronged problem – it’s financial, it’s about fairness and it’s about politics. From the financial position, the closer the authority is to Victoria, the better control can be exercised. From the fair play point of view, you must do the best you can to see that all regions have as close to equal service as possible. This is, in fact, impossible. You get into disputes like the one a decade ago between Kelowna and Kamloops as to which city should have the cancer clinic. From the fiscal point of view, both having the clinic was out of the question. From a point of view of fair play, both areas had about the same size catchment areas. It got down to politics.

But politics rears its ugly head another way. Local authorities tend to attract trainees for the bigger arena. Local authorities can easily embarrass the government and if this is to further patient care it may be OK but more often it is or is seen to be part of a much bigger political contest.

Some years ago the British government decentralized the system and gave hospital authorities carte blanche, after allotting them a certain sum of money each year. The result was nothing if not predictable. As had happened at the Municipal Council level, the health authorities were taken over by the loony left which proceeded gleefully to overrun budgets daring London to let the hospitals be put in bankruptcy and be closed. In the end, of course, London paid the extra bills – but altered the system.

Having said that, there are individual characteristics from community to community, There is no one size that fits all. There are dangers in letting too much authority go to local boards but there is perhaps an even greater danger in having "big brother" making all the decisions. I think that on the restructuring of health delivery that we’ve seen, the jury is out.

There are other parts of what Mr Hansen is doing that disturb me. The system has been virtually confirmed as a doctor centered and doctor run system. Here’s the trouble I have with that.

Chiropractors, it has been conclusively demonstrated, do great things with necks and backs. If they didn’t, they would be quacks and punished accordingly. If they do good, why should their bill not be paid every bit as much as a medical doctor’s is? It’s illogical to discriminate against one form of healer in favour of another. Especially when you say to low income people "we will pay because we recognize this as an essential medical service". How can a service be essential enough to be paid for if one group is getting treatment but no longer essential when sought by another?

If costs are the factor, why aren’t the doctors treated the same way? Is it because doctors are more certain to help their patients than chiropractors are? Where is the proof of that? Is it, more likely, because the doctors got there first at a time when chiropractors were indeed thought – by doctors mostly – to be quacks? Is it just that when medicare came in the doctors were at the head of the lineup and remain there for no better reason than that?

There is another point – won’t people who now see chiropractors avoid treatment because it costs them too much? Will not many people now go to their medical doctor, who will charge a fee, and then be referred to a physiotherapist who will also bill the Medical Services Plan?

Let me leave with a note of cautious praise for the minister. Within the next year, I understand, there will be a working definition of what health care qualifies for publicly funded care. This is about 40 years late but better late than never. The need for such a definition increases every day as medical and pharmaceutical research find new cures. The classic Australian case of doctors refusing a scarce heart to an overweight smoker is just a harbinger of things to come. We simply cannot go on paying for everything medical science makes possible.

But how to draw lines? If, as I suggested with chiropractors the test ought to be simply whether or not the procedure helps, we’d better find a forest of money trees.

Of one thing all can be certain. The health care system is a bust in the sense that for all its fine points, the overriding factor is that we can’t afford it as presently constituted. I think this government is entitled to say that they are fixing a mess they inherited. And the minister is right to make changes.

What is also certain is that health care is the #1 political football in the world and whatever this government does, they’ll get few cheers and many jeers for their trouble.

Twas ever thus.