A Good Healthcare Story

If you have a ear infection due to a bacterium, Nasonex may only help with inflammation as it is a cortico-steroid and not an antibiotic.

This is similar to my most recent trip to the clinic. Their phone lines opened at 11a for appointments starting at 12a. I called at 11:05a, got an appointment for 12:30p, and had a prescription filled by 1:15p. No, it’s not a perfect system, but it’s awfully good.

Last year we drove through a blizzard from Summerside to get to the Friendly Pharmacy when we were all (2 adults and 3 kids) really, really sick. We got there in time to pick up five numbers (not sure if that is still the way it works) and then waited about two hours to get it. At the time I can remember feeling so thankful that they were there…despite the long drive and wait. I don’t think I have ever spent so much at once on medications as we did on that day. So yes, the system does work - kind of - but the lack of family doctors is still a really large issue. If we had had access to one, we would not have needed to become truly so sick so as to take up 5 spots all at once at the walk in clinic.

Hope you’re feeling better soon, Peter: ear infections are no fun.

There are shortages of everything except problems in the health care system, but the-system-is-falling-apart meme is part of the not-so-hidden privatization (sorry, innovation) agenda that’s been around as long as Medicare itself. A related thread — and more popular of late — is the one trotted out with particular enthusiasm every time a province brings down a budget and we are breathlessly informed about “spiraling” health care costs”swallowing” 30% - 40% of projected spending. Intriguingly, this seldom seems to provoke serious discussion about the particular costs that really are increasing sharply, namely those for pharmaceuticals and medical equipment and the fees charged by private contractors (i.e. doctors; proud members all of that historic friend of Medicare, the Canadian Medical Association). Provincial budget season would also seem an opportune occasion to consider that if costs really are spiraling, perhaps blowing holes in the government revenue stream with stupid tax cuts may not be the best move. Instead, we get a lot of talk about how private clinics could relieve wait times, and how greedy health care unions are going to have to be “reasonable”.

People can (and should) complain all they like about struggles to find a family doctor, hours in the waiting room, etc., etc. But let’s never say “the system is broken”, and let’s never, ever shrug about how politics is all boring and icky and that all the parties are the same … Yucky taxes and tedious, unhip politics got us Medicare in the first place, and it will take plenty of both to keep it. Mind you, I’m probably a little biased: in the past dozen years, public health has saved the lives of my Dad, me, and my Mum, without bankrupting us in the process. Our respective illnesses were all very different, but had two things in common: we never saw ‘em coming, and the quality of care we all received was top-notch.

I’ve been pondering this for some time, and it seems that the right approach is one that accepts and corrects for the imbalance of market power inherent in health care delivery (especially urgent care) without insisting that the government administer everything.

Markets work best when there are large numbers of buyers and sellers, enabling either side to walk away from a deal. If I want to buy a new stereo, I can shop around, buy new, buy used locally, try eBay, etc. And in the end, I can simply do without. But if I break my leg, or my wife is hemmorhaging on the delivery table, you can charge me more or less whatever you want, and I’ll pay it.

So despite being a card-carrying member of the vast right-wing conspiracy, I’m solidly in favour of publicly-funded health care. I grew up in relative poverty (I say this acknowledging that anyone born in North America is fabulously rich by world standards) and our system has saved me and my family a great deal of pain and money.

Where I think we go too far is insisting that everything be publicly administered. We don’t do this with doctors; we don’t tell them where to open an office or how many staff to hire or what equipment to purchase. We just say “here’s the list of services and corresponding fees. If you think you can make a buck opening in [location], go nuts!”

We do something similar with haggling over drug prices: we tell the pharma companies “You want access to our markets? Fine. We want your drugs, too — but not at usurious prices.”

Why not do the same with hospitals? You want to open a specialized surgery centre for hip replacements? Fine; knock yourselves out. You want to open a clinic that combines chiropractors, dietitians, nurses and doctors? Terrific; set up any configuration you want. But this is the fee list, and you can’t charge at point of provision.

We want to even out the market power imbalance using the public purse. I think we go too far when we insist that the government be the source of provision, too.