Repair Medicare, don't privatize Legal or not, downgrading health services is un-Canadian
BY DR. MICHAEL RACHLIS, Edmonton Journal OCTOBER 11, 2009
While he was running for president, Barack Obama said that if the U.S. could start all over again, he would implement a Canadian-style single payer public health system. The details remain to be decided, but the eventual U.S. health legislation will include more public finance and a lot tighter regulation of private insurance. The U.S. health-care debate has presented an opportunity to Canadians to reflect on our system. According to opinion surveys, we prefer our health-care system to that in the U.S. and Americans agree with us. They prefer our system too. Canadians also favour fixing Medicare with non-profit solutions.
Single-payer systems have much lower costs than private or mixed systems. For example, Canada spends 10 per cent of its economy on health care; the U.S. spends 16 per cent. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. And providers and suppliers can't charge as much when they have to negotiate with a single payer. That's why keeping spending public is the foundation of a sustainable health system. Then why did Alberta Health Minister Ron Liepert tell a May meeting in Banff, "I believe that down the road the public cannot be the sole payer
of the health-care system"? And why is the Alberta provincial government cutting back on the public system?
The province has drastically reduced the number of auxiliary hospital and nursing home beds available to seniors. In these facilities, the province pays for drugs and medical equipment. Now many seniors find themselves in "assisted living" facilities which are inadequately regulated and do not have on-site nurses. Seniors pay for their own drugs and, as they become more debilitated, they can pay $4000-plus per month for a la carte baths, medication administration, and other services.
The government has eliminated public funding for chiropractic and vision care and off-loaded much spending for drugs to patients themselves. The government denies a hiring freeze, but jobs posted by Alberta Health Services are usually restricted to existing employees. As a result, nurses exiting the system aren't replaced and new nurses are moving to Saskatchewan.
In this tough economic environment, like every other jurisdiction, the Alberta government faces a deficit. But, unlike other jurisdictions, Alberta has no debt and substantial financial reserves. Publicly funded health care at five per cent of the province's economy is the lowest of any jurisdiction in the world, down from a peak of six per cent in 1992.
The U.S. debate has highlighted that waiting for elective care is Canadian Medicare's Achilles heel. Notwithstanding some highly publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures.
However, these problems have little to do with public insurance or even the overall resources in the system. A number of Alberta initiatives demonstrate that most waits can be eliminated through better management. By reorganizing the intake and referral process, the Alberta Bone and Joint Health Institute's pilot project reduced average wait times for hip and knee replacements from 15 months to 8 weeks. The Alberta AIMS (Access Improvement Measures) project has been working with specialists and family doctors to enhance access and patient followup.
Pincher Creek family doctor Dr. Tobias Gelber sees his patients pretty much on the same day they call. Edmonton endocrinologist Dr. Richard Lewanczuk is now seeing most new referrals within one week and his department is dedicated to continuously reducing their waits.
There are lots of other promising Alberta public initiatives. Edmonton's Comprehensive Home Option for Integrated Care of the Elderly (CHOICE) provides intensive community care for people who would otherwise end up in hospitals and nursing homes. Palliative care initiatives in Chinook, Calgary, Edmonton and other parts of the province help patients die comfortably at home or in homelike settings while freeing up dozens of hospital beds. The province's primary care networks started slowly but now show tremendous potential to reform the important front end of the health system.
The government has argued that cuts to long-term care or drugs don't break the law because the Canada Health Act only covers doctors and hospital services. But that is beside the point. Letting long-term care charges force people into bankruptcy is distinctly un-Canadian, even if it isn't strictly contrary to the existing Medicare legislation. And no jurisdiction can hope to have a sustainable hospital system without adequate long-term care, home care and pharmacare. Some powerful people in Alberta have dedicated their lives to destroying our most beloved social program. With the distraction of the economic crisis and the shock to government revenues, they hope to accomplish what
they could not in less-troubled times. But Albertans can fix their system's problems, including waits and delays, with made-in-Alberta public sector solutions. You will never repair Medicare if you privatize it.
Michael Rachlis is a medical doctor and health policy analyst. He is touring the province to participate in discussions on the future of health care in Alberta. He will be speaking in Edmonton at 7 p.m. on Tuesday, Oct. 13, at the Polish Hall, across from the Royal Alexandra Hospital.
Health cuts 'ideological choice,' crowd told More than 500 people attend town hall session organized by Friends of Medicare BY RICHARD WARNICA, EDMONTON JOURNAL OCTOBER 14, 2009 6:28 AM
The Alberta government has made an "ideological choice" to blow a hole in the public health system -- a move that will raise costs and erode care, a medicare advocate warned an audience of hundreds at a town hall meeting Tuesday. "We are trying to stop money from flowing out of the system," said David Eggen, executive director of Friends of Medicare.
"The government is completely swimming against the current." The overflow crowd of more than 500 had organizers scrambling to lay out chairs as Eggen took to the podium.
Lining the walls on either side of the hall, people broke into applause as experts argued that planned health cuts are uninformed, ill-timed and unnecessary. "Alberta has less excuse than anywhere in the country to cut back," said Dr. Micheal Rachlis, a family doctor turned health policy analyst who spoke after Eggen.
Rachlis called plans to delist services and shut beds a breach in the "spirit of the Canada Health Act," one that won't save any money in the long run.
If the government really wanted to reduce costs, he said, it would expand coverage to include more drug coverage and community care and reform the way doctors and other health professionals are paid, not allow more private delivery. "I think the best argument against going private is Tony Soprano's," he said: "Fuggetaboutit--you don't need it."
Diana Gibson, research director at the University of Alberta's Parkland Institute, told the crowd that the government is trying to use public relations to make health-care problems disappear.
"It appears with a couple of press releases, we can magic away nursing shortages," she said.
The crowd appeared to be overwhelmingly supportive of the speakers' messages, with some saying they were alarmed by stories of coming cuts and closures. "I'm concerned by what I'm hearing in the media, but I'm also concerned by what I'm seeing," said Bill Davidson, who runs a boarding house for patients who fly in for treatment from the north. "I'm seeing new places getting built, but not enough staff going into them."
Others were there to protest plans to reduce beds at Alberta Hospital, an acute psychiatric care facility.
"I think it's an outrage that they're closing that mental hospital," said Shirley Lewis. "I just feel like it's going to spiral into an even worse situation," said Agata Nowinka, a fourth-year medical student who worked at Alberta Hospital this fall. The government has said it won't close beds at Alberta Hospital until new spaces for treatment are opened in the community. But that doesn't mollify Nowinka. Acute psychotic patients often need constant intensive care, she said. "That just can't happen in the community. It's like sending your car to be treated by a hairdresser."
Eggen said the government is using the economy as an excuse to do what it wants with the health-care system. "It's a business choice and an ideological choice," he said. "You blow a hole in the middle of your public health system and private health care will enter."
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