​Health Care Reform: so now the elephants are coming out

So, everyone wanted major change in health care, or so we thought!  People express disgust with long waits for finding a family doctor, for long term care, for treatment in emergency and ever so much more.  They say they resonate to the government’s promise for reform and government gets accolades for seemingly moving in that direction.

But not so fast!  In every attempt at even insignificant reforms in the last 20 years, resistance has come from interest groups, politicians of a different hue, advocacy groups, and more.  That’s the problem with health care….it is the third rail of Canadian politics!  Everyone wants to complain, to demand change, to express disgust, chide government for not doing more; and many of them say they are supportive of major reforms.

Even though significant elements in the health care system have been managed by the private sector since its inception, we can never get away from this mindless debate.  In how many elections have candidates been derailed from the real issues with the talking head, microphone in hand, says: “so you support a two-tier system”, as if we have ever had a single tier system, whatever that may mean.

But don’t touch that which is really sacred to me and my group.  Don’t think about engaging the private sector in any way even though we have these issues that the public sector has been powerless to resolve.  Government is great at raising money thru various and interminable ways to tax us.  Their second job is to legislate and regulate.  But actual operation of health and long-term care and many other services, the public sector system has never been sufficiently nimble as to manage effectively.

In these fields, innovation and development have come virtually entirely thru initiatives of the private sector.  Have companies done well in that process?  Of course, they have.  Drug companies, medical equipment companies, diagnostic service manufacturers, software companies, IT equipment companies and more, have all done very well.  Were it not for the inventions and manufacturing and distribution of the all these products and services by the private sector, there would be no health care systems as we know them.  Have profit margins been excessive?  Probably so, in some cases, but that is for someone else to judge.

The fact remains that we would not have ICUs, CCUs, modern emergency transport systems, drugs, MRI scanners, and all the things our physicians and nurses need, not to mention the buildings in which they operate, without a vibrant private sector. 

In 2006 when I was looking for new, fresh ideas for long-term care I had to go to Ontario where I met some of the brightest people who operate superb senior care centers and who plough much of their profits back into university education and research!  The innovation I saw there was not available to be found in New Brunswick at that time.

The Canada Health Act is quite specific as to what services qualify for cost sharing with Ottawa and that legislation contains the 5 pillars on which the systems in each province are to be maintained.  The one pillar important to this issue is public administration of services.  That does not mean that government provides the services but that it administers them.  How they administer is entirely up to the provinces.  Many do, in fact, contract many services at some level to external service providers.  And provinces have gotten very creative as they seek the most cost-effective way in which to administer services.

Since the Canada Health Act is prescriptive in what is acceptable for cost sharing, each province has seen many health services provided by pharmacies, dentists, oral surgeons, plastic surgeons, family doctors, audiologists and hearing aid suppliers and more.  There never has been in Canada a health system in which all that we now loosely call health service has been funded thru the provisions of the Canada Health Act.  We have always had, and will always have, a Two-Tier System.  So, could we please stop using this topic as a distraction from real issues?

The real issues are clear, as the government’s announced plan lays out (although not in much detail), and all political parties and advocacy groups need to focus on ensuring that government concentrates on those pillars (the term used in their announcement).  Fixing the real issues so that the system can be brought back from the brink is tough and there will never be total agreement on what government chooses to do.  But we have all said that we want radical change and change at the depth that is necessary will not be entirely popular.

In this whole debate is the underlying assumption that somehow “profit” is an evil thing.  The basic definition of profit is what is left over when a business collects its revenues and pays its labor and all expenses.  Everyone that I have known in health and long-term care works for profit, except our trusted and valued volunteers.  As employees, with or without a union, we apply for work, get accepted to work and in that acceptance, we agree to hours of work, working conditions, performance standards and compensation.  In generating that income, we may have to invest in transportation to get to work, wearing apparel unless provided by the employer, food for the home and lunch money and accommodation.  After we pay for all that, we have funds left over which is our “excess revenue over expense” or profit.

If we were not working under those arrangements, or something similar, we would not be going to work.  We are offering our services in exchange for compensation and the minute the cost of doing the work is higher than the compensation, we leave for another job that offers higher compensation.

Even my friends who work as union officials all are paid under the same scenario.  So, the panning of the term “profit” is downright disingenuous.

The real serious question to be asked and answered is how well do we regulate the health and long-term care sector?  Current regulatory methods have given us long wait times, acute shortage of health professionals, serious issues of access to services that are supposed to be well regulated by the regulatory authorities.  Regulators, by definition, provide a regulatory framework and standards based on current knowledge, current practice, demographic changes and much more.  Simply turning a service over to a private operator without tight performance goals, clear accountability for performance targets, and regulation of profit margins is irresponsible.

The answer to fixing these dreadful problems of public service is not to distract attention from real issues by revisiting again the debate about private vs. public, but to insist that policy makers keep an open mind, adopt the accountability that Dr. Linda LeBlanc’s commentary called for, and get creative.  I want my friends to have access to great primary health care.  We must get those elders out of hospitals; we must clear out the emergency wait rooms; we must improve access to surgical procedures.  None of that will happen in the absence of minds that are open to some non-traditional thinking.
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Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at [email protected] or www.kenmcgeorge.com