The Written Word
for April 26, 2000

The health care debate is fascinating if only because no one wants to debate the real issue which is whether or not we want more private money in the system now, on our terms, or whether we wait and get it on their terms.

The present system is not sustainable … it goes without saying that it will not be able to handle the advances we make in medicine especially since they come at a time where the baby boomers are reaching the high cost years of their lives. What I have said is true and it’s no less true because those on the left don’t want it to be. This is the trouble with the left ,,, they always say that there is enough money and that is only true if you are prepared to make some very hard decisions about building highways, bridges and schools – and ferries. The current provincial government has, of course, wanted it all ways. They defend the current system as sustainable yet at the same time run up $1 ½ billion deficits each year. If it is the wish that this province that we not only make health care our priority but make it to the exclusion of all other capital expenditures then I suppose the system is sustainable but I would argue that even then, it would be close. The reality is that people want and need new schools, new highways, repairs and replacements for ferries and so on. We want our health care system to be the best possible but we’re not prepared to become a third world country in all other things.

I am not now nor have I ever been a fan of the American system which leaves about 15% of its citizens without health coverage and perhaps an equal number or more without adequate coverage. The US have without question the best health care in the world – for those who can afford it.

There are things we can do without making any changes to the structure to our system. We can, on a one time basis, do a crash building course for long term care and home care. If we did this it would be a huge item but thereafter it would more than pay for itself in the freeing up of acute care beds now being occupied by extended care patients.

We could put doctors on salary – what they call elsewhere a capitation system. I don’t like this idea much because it tends to take the personal doctor/patient relationship to an unsatisfactory level but it would save money. I have no doubt that there are many other economies in the system to be found.

The trouble is we already are cutting back simply because we’ve never undertaken proper responsibility for mental health care nor for appropriate care outside the medical fraternity. We have funded some alternative health care but not all and it’s illogical as hell to admit that, say, chiropractic works and so does standard medicine yet pay one in full and the other only partially.

What, then to do.

Several things starting with an admission that we already have private money in the system and that there is a two tiered system. Much long term care is private and funded in part only by Medicare and many surgeries are private and some diagnosis is private as well.

Second, we should admit to ourselves that we will never have a perfect system.

Third, we could do as the state of Oregon has done and set priorities – in other words we should define for the first time just what care we will and what we won’t fund out of medicare. Like Oregon, that should be done with the public making the decisions.

Fourth, we should look at all other systems and see how they do things and whether we can learn from them.

Lastly, we must at least accept the notion that there may be some places where it is more cost effective and more efficient to use public monies. This, admittedly, takes care. You don’t want a private facility to be the low bidder because it waters the milk or deprives the patient of necessities.

The important thing we must do is get the politics out of all this – the system that Tommy Douglas envisaged and his successor brought in was eons ago when much of what we do now wasn’t even dreamed of. We must set aside all of our prejudices and look not nostalgically at our system but look at it through a new lens then have a debate with nothing being sacred. Then and then only will we be able to have a medical system that both works well and is sustainable.