By Dian Cohen
None of us needs to be told that our hospital/healthcare system is in bad shape. It was in bad shape before Covid and the pandemic has only brought home to more of us how fragile and needy it is.
Having just arrived home from getting my booster shot, I marvel at the logistics miracle that has turned a rural shopping centre into an efficient factory for disbursing jabs. And I salute the dozens of people working diligently in both languages, checking credentials, asking the requisite questions, staying calm and focused.
We need to bring this kind of focus to fixing the whole system. I say “fixing” guardedly because a total overhaul is what it really needs.
Let’s start with two glaring mistakes that need to be corrected. First, the Canada Health Act is not about health – it’s about publicly funded insurance that pays for part of the cost of treating illness.
Second, because no invoices change hands between those who demand medical goods and services and those who supply them, we all act as though the goods and services are free. And you know how we all act when stuff is free – take as much as you want, don’t worry about wasting it.
Let me flesh out #1. What we really need is a healthcare system that focuses on keeping us healthy. We are no longer the young nation we were when Medicare was created – a nation that needed care for acute events like accidents and birth. We are now a nation of middle-age and getting older, and we need help in managing “the chronic diseases characteristic of old age, conditions not curable but manageable with long-term support and care, most of it non-medical”, says a recent open letter to Canada’s health ministers from the C.D. Howe Institute’s Don Drummond and Duncan Sinclair. Even more, we need help to keep us out of hospitals. Yet there is nothing preventative about our present system – no prescription drug coverage, no dental care, no eye care, no help to keep us limber, no home care. “Accepting the adage that the role of the physician is to prevent illness when possible and treat it when necessary, the exclusion of preventive services from coverage, whether by physicians or other providers of healthcare services, makes no sense. It’s long past time to discuss and decide how best to remedy these failings and achieve Medicare’s prime purpose: optimizing the health of Canadians,” say Drummond and Sinclair.
As to my #2 complaint, statistics from the Canadian Institute for Health Information (CIHI) indicates that healthcare spending in Canada amounted to $267 billion in 2019, jumping 14% to $301 billion in 2020 because of Covid-19 and estimated to cost $308 billion in 2022. Fully 25% of that amount was paid for directly by Canadians with the balance being paid indirectly, but also by Canadians, through their taxes. This is not chump change, yet there is no incentive anywhere in the system to use these very expensive goods and services sparingly.
Our healthcare system was headed toward the sustainability abyss; Covid-19 has propelled it to a tipping point. More long-lasting than the number of Covid patients is the rising rate of healthcare worker absenteeism due to Covid and/or burnout. People under stress for more than two years become exhausted, bitter, angry, depressed. They are ready for a change in the system and a change in how they approach their normal activities. We can wait until the system collapses entirely, or we can start making the changes that have been documented for the past 20 or more years.
We can do this. But will we?
Dian Cohen, C.M., O.M., (economist) firstname.lastname@example.org