Thursday, September 1, 2011

Can we cure healthcare?

With the possible exception of peace in the middle east, is anything in this world more studied, to less effect, than the Canadian healthcare system.

Dr. Jeff Turnbull, outgoing president of the Canadian Medical Association, led a year-long public consultation with the organization that represents 75,000 physicians. Thousands of citizens shared their concerns.

Now, as he says goodbye, he is frustrated by the absence of [political] leadership for essential changes needed to ensure the healthcare system's survival, and he fears that it may slip away.

Turnbull's study follows the well-trodden footprints of the Health Care in Canada (HCIC) survey (1998-2007), the Romanow Commission on The Future of Health Care in Canada (2001-2002), and the First Ministers' 10 Year Plan to Strengthen Healthcare (2004). Another 38 studies compared patient outcomes for the Canada and American healthcare systems, and there are countless books and articles written on the topic.

Currently, the 5-year McGill University research program, Healthier Societies Initiative, is underway.

Why are we so incapable of addressing the problems of this public healthcare system that, polls repeatedly confirm, is revered by Canadians and viewed as the country's principal defining symbol? It is so central to our self-image as a country that we voted Tommy Douglas, father of medicare, the Greatest Canadian ever!

Remember how defensive we were when our system was criticized by opponents of American president Obama's healthcare initiatives in the U.S?

Well, wake up kids. This system is heading for the intensive care ward if we don't come out of our national coma of denial. If nothing changes, this huge program that instils such pride will be on life support in a very few years.

• The population is aging, as baby boomers enter their patch-it-up years. For folks up to the age of 64, annual healthcare costs per person average about $4,000. By age 80, it's about $17,500. Average life expectancy of Canadians now exceeds that age.

• In Ontario, healthcare is 46% of the provincial budget and, if present trends continue, it will represent 80% of the province's spending by 2030. Other provinces face similar funding crises.

• By many measures, service has fallen to unacceptable levels. The Wait Time Alliance, comprised of 14 national medical specialty societies such as the Canadian Anesthesiologists' Society, the Canadian Association of Emergency Physicians, and Canadian Medical Association, issues an annual "Report Card."

This year's report [PDF] again points to long wait times for a wide range of treatments.

(Among the chief causes, the report cites the "high number of hospital patients waiting for alternative levels of care such as rehabilitative or long-term care." In other words, patients for whom homecare or chronic care facilities would be more appropriate and less expensive than a hospital bed with all its attendant costs.")
In his farewell address to the CMA last week, Dr. Turnbull described, "a startling lack of vision and imagination, widespread apathy and self-interest. He went on to say that he has "been struck by the lack of leadership, coordinated management, accountability and responsibility, and the needless waste."

So, now what?

We have a right to expect that our federal and provincial political leaders will demonstrate the good sense, stewardship, and courage to make changes, unpopular as they may be in some quarters, in order to save this most prized of public programs.

Will we get it?

Or are they deliberately waiting until the costs become so unsupportable that wholesale amputations of fundamental services become the only recourse, with the choicest bits going to the private sector? Too cynical?

We'll see. Stay well.

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