Hallway medicine and back-logged surgeries
April 3, 2022 7:55 AM Subscribe
It the Globe and mail so naturally there fix is giving money to businessmen but it is obvious to me from this statement " "that we should nationalize big chunks of private care. Like why the hell are private long term care facilities so popular. Facilities that for the most part seem to provide poorer care and have the most egregious violations. Letting the stock market profit from these places is immoral and a bad use of collective funds for a public service that so many of the most vulnerable need.posted by Mitheral at 8:15 AM on April 3, 2022 [11 favorites]
It’s a serious issue, but this is not a clearly written examination of it.
posted by ricochet biscuit at 8:18 AM on April 3, 2022 [22 favorites]
In 1991, CIHI data shows that there were 937 registered nurses per capita in Canada. Just before the pandemic, it was 800.Not sure what the writer thinks “per capita” means here.
posted by ricochet biscuit at 8:18 AM on April 3, 2022 [22 favorites]
Confusing per capita and per 100,000?
posted by Mitheral at 8:30 AM on April 3, 2022 [3 favorites]
posted by Mitheral at 8:30 AM on April 3, 2022 [3 favorites]
This is dumb and frustrating in an entirely predictable way, given the outlet. What's the point of discussing it?
We all know our health care system is not in a great shape (hey, I have an appointment tomorrow for which I have waited 2.5 years), but there's nothing constructive in here about how to actually fix it, except the constant right-wing drumbeat of privatization. And the weird angle about how we could have let ourselves all get infected with Covid, if only we had more hospital capacity, is just bizarre.
posted by ssg at 8:44 AM on April 3, 2022 [11 favorites]
We all know our health care system is not in a great shape (hey, I have an appointment tomorrow for which I have waited 2.5 years), but there's nothing constructive in here about how to actually fix it, except the constant right-wing drumbeat of privatization. And the weird angle about how we could have let ourselves all get infected with Covid, if only we had more hospital capacity, is just bizarre.
posted by ssg at 8:44 AM on April 3, 2022 [11 favorites]
Privatization: From a political perspective, my one and only response to the question of "privatization" (which is a weird phrase given that Canadian healthcare does involve a lot of private entities already, more on this in a minute) is "how will increasing profit help our healthcare system?"
With privatization either
1) you outsource things to for-profit companies that are not under the same constraints. Example: laundry, food, orderly, security, etc. services in hospitals. Under a publicly funded hospital these services tend to be provided by unionized employees and have to meet certain standards. There can be inefficiencies that are just plain like "how expensive is it to maintain washing machines everywhere and have hot water in every hospital sufficient to do the laundry" but it can also mean "only minimum wage staff in bad conditions will do this job. This has happened municipally in some areas of Toronto with garbage collection, for example.
or
2) what is privitization is actually two-tier healthcare or "can you pay extra for extra/faster/better services." Because my family doctor is already a private business, I don't get to see into her rent etc., but she operates under a strict set of rules including a schedule of fees. So I don't see where privatization for the same fees is going to change anything.
Really it's about extra billing. My MIL had cataracts and she went the usual Ontario route and was given a surgery date in a hospital that was out about a year. She had some money come in and she went to a clinic where she paid $3k or something and had her cataracts done right away. There's plenty of information about this from other countries, long-term care, etc.
(If it hadn't gone well, she would have ended up back in the hospital which is something to think about as well.)
In my opinion, the general trend of either of these two forms over the long term is not cost-cutting but corner cutting and a race to the bottom. The core problem in Canada really is that capitalist forces have gradually eroded the idea that you pay quality money (taxes) and you receive quality services that also provide good jobs -- leading jobs, even, because you can set a standard that private companies have to race to match, like if a long-term care worker in the public system receives a good wage private companies who don't match that will bear the burden of recruiting costs.
Anyways, whenever someone talks to me about this I try to ask them how they think a company making a profit on health care will help public costs over the long term or whether they think cost-cutting comes with cutting corners in areas like long-term care.
So that's my take down on privatization. In terms of improving the system the first step is political will and money. In recent times I think mostly this has been a really corrupt process in my province (Ontario) thanks partly and sadly to say to the Liberals, and Air Orange and eHealth scandals. Mostly change has come out of scandal. I do know from family that when there was the Alberta Fund and Alberta was flowing money like all get out into Alberta health care, things for the staff were good and there was a lot of innovation. I would be curious to know how that panned out.
In other words I would like to see more about systems that work, both provincially and worldwide.
posted by warriorqueen at 9:44 AM on April 3, 2022 [20 favorites]
With privatization either
1) you outsource things to for-profit companies that are not under the same constraints. Example: laundry, food, orderly, security, etc. services in hospitals. Under a publicly funded hospital these services tend to be provided by unionized employees and have to meet certain standards. There can be inefficiencies that are just plain like "how expensive is it to maintain washing machines everywhere and have hot water in every hospital sufficient to do the laundry" but it can also mean "only minimum wage staff in bad conditions will do this job. This has happened municipally in some areas of Toronto with garbage collection, for example.
or
2) what is privitization is actually two-tier healthcare or "can you pay extra for extra/faster/better services." Because my family doctor is already a private business, I don't get to see into her rent etc., but she operates under a strict set of rules including a schedule of fees. So I don't see where privatization for the same fees is going to change anything.
Really it's about extra billing. My MIL had cataracts and she went the usual Ontario route and was given a surgery date in a hospital that was out about a year. She had some money come in and she went to a clinic where she paid $3k or something and had her cataracts done right away. There's plenty of information about this from other countries, long-term care, etc.
(If it hadn't gone well, she would have ended up back in the hospital which is something to think about as well.)
In my opinion, the general trend of either of these two forms over the long term is not cost-cutting but corner cutting and a race to the bottom. The core problem in Canada really is that capitalist forces have gradually eroded the idea that you pay quality money (taxes) and you receive quality services that also provide good jobs -- leading jobs, even, because you can set a standard that private companies have to race to match, like if a long-term care worker in the public system receives a good wage private companies who don't match that will bear the burden of recruiting costs.
Anyways, whenever someone talks to me about this I try to ask them how they think a company making a profit on health care will help public costs over the long term or whether they think cost-cutting comes with cutting corners in areas like long-term care.
So that's my take down on privatization. In terms of improving the system the first step is political will and money. In recent times I think mostly this has been a really corrupt process in my province (Ontario) thanks partly and sadly to say to the Liberals, and Air Orange and eHealth scandals. Mostly change has come out of scandal. I do know from family that when there was the Alberta Fund and Alberta was flowing money like all get out into Alberta health care, things for the staff were good and there was a lot of innovation. I would be curious to know how that panned out.
In other words I would like to see more about systems that work, both provincially and worldwide.
posted by warriorqueen at 9:44 AM on April 3, 2022 [20 favorites]
+1 Warriorqueen. You can also talk about "economies of scale" and spreading the cost of risk (as in unpredictable things in your lifetime that cause you to need healthcare) across the widest insurance pool, the whole population.
Systematic things like polluters causing a whole town to have treatment add to this risk; also the inequity of better and worse zomes in towns; also driving tall vehicles without due care and attention; and also education for job opportunities and working at sustainable efforts; the manifesto of fully automated luxury gay space communism also needs us to have channels for the creativity left over when your soul isn't exhausted servicing other people's capital.
Back on universal healthcare, you can also see that covering the basics causes better lifetimes, but fixing the low-hanging fruit leaves more-complex syndromes to become acknowledge before they're treated, so expensive sicknesses emerge. Consequently, universal healthcare must go hand-in-hand with progressive treatment practices and aggressive research activities. If rare at first, these will gain from the wide population base providing economy of scale.
posted by k3ninho at 10:10 AM on April 3, 2022 [1 favorite]
Systematic things like polluters causing a whole town to have treatment add to this risk; also the inequity of better and worse zomes in towns; also driving tall vehicles without due care and attention; and also education for job opportunities and working at sustainable efforts; the manifesto of fully automated luxury gay space communism also needs us to have channels for the creativity left over when your soul isn't exhausted servicing other people's capital.
Back on universal healthcare, you can also see that covering the basics causes better lifetimes, but fixing the low-hanging fruit leaves more-complex syndromes to become acknowledge before they're treated, so expensive sicknesses emerge. Consequently, universal healthcare must go hand-in-hand with progressive treatment practices and aggressive research activities. If rare at first, these will gain from the wide population base providing economy of scale.
posted by k3ninho at 10:10 AM on April 3, 2022 [1 favorite]
I work in medical admin in Canada, so I have become fascinated with how the sausage is made. I suspect a lot of this info is for Canadians who were already aware of how the doctor shortage came to be but I didn't know (they don't exactly cover this in your citizenship material) how it got there. I deal every work day with people who move to my area and call my clinic, desperately hoping for a family doctor, and our waiting list has been closed due to COVID, and no one has any idea when it might re-open. Or fielding angry or stressed calls about referrals for specialists and whatnot. The clinic I work for is overrostered and yet we add patients who are pregnant or unattached newborns weekly (this is the new patient exception I experience). Patients rightfully get shirty about not being able to get in to see their GP in a timely fashion. Like, why don't medical grads go into family medicine? How bad does the doctor shortage have to get for anyone in power to care?
While obviously it's loads better than the US system I grew up in, I think Canadians deserve a really good healthcare system than one is "well, at least's not the US." So this article provided a perspective for me in terms of how we got here instead of "go team privatization." I guess I just elided over that because I have no interest in privatization.
posted by Kitteh at 10:32 AM on April 3, 2022 [5 favorites]
While obviously it's loads better than the US system I grew up in, I think Canadians deserve a really good healthcare system than one is "well, at least's not the US." So this article provided a perspective for me in terms of how we got here instead of "go team privatization." I guess I just elided over that because I have no interest in privatization.
posted by Kitteh at 10:32 AM on April 3, 2022 [5 favorites]
but the U.S.'s is clearly the worst.
Joining a cancer support board with patients from all over the world has taught me that this is not true. Even countries we lefty types in the US tend to see as superior to ours (UK, Canada) have problems people with health insurance do not see here. When you have a rare, incurable cancer with some possibility of living for decades if it's managed well, limits on treatment choices matter (people in these countries may still prefer it overall to ours, but I think people in the US tend to idealize socialized medicine and don't realize there are problems). I have heard a US doctor say it's hard to do consults for patients in Canada because they don't have access to the drugs he'd recommend for them. And then there are countries where only the very wealthiest have access to health care at all.
There is much to criticize about the US system without resorting to hyperbole. (And I'll step out now and let the Canadians talk.)
posted by FencingGal at 12:14 PM on April 3, 2022 [2 favorites]
Joining a cancer support board with patients from all over the world has taught me that this is not true. Even countries we lefty types in the US tend to see as superior to ours (UK, Canada) have problems people with health insurance do not see here. When you have a rare, incurable cancer with some possibility of living for decades if it's managed well, limits on treatment choices matter (people in these countries may still prefer it overall to ours, but I think people in the US tend to idealize socialized medicine and don't realize there are problems). I have heard a US doctor say it's hard to do consults for patients in Canada because they don't have access to the drugs he'd recommend for them. And then there are countries where only the very wealthiest have access to health care at all.
There is much to criticize about the US system without resorting to hyperbole. (And I'll step out now and let the Canadians talk.)
posted by FencingGal at 12:14 PM on April 3, 2022 [2 favorites]
It drives me nuts that our governments don't do more to protect and improve the health of Canadians when we have such an obvious economic incentive to do so, because it will save money in the long run. Public health interventions are cheap, treating sick people is expensive!
Why don't we make sure everyone has access to healthy food? Provide free checkups with a nutritionist to everyone who wants one? Make sure everyone has access to free sports and fitness opportunities? Provide safe bike lanes and pedestrian infrastructure (which both saves you money on accidents and on long term health issues)? Fund free bike share programs? Give everyone free N95 masks? Make sure everyone has paid sick days? I know there are some limited programs in these areas and some provinces do some of these things to some degree, but it seems obvious even just from an economic standpoint that we should be doing these things very broadly.
Consequently, universal healthcare must go hand-in-hand with progressive treatment practices and aggressive research activities.
Yes! I have a chronic illness and certainly cost our health system more than the average person, even though there is no real treatment. How much does Canada spend on research? Less than $1 per Canadian with ME/CFS annually. This makes no sense at all.
posted by ssg at 12:44 PM on April 3, 2022 [3 favorites]
Why don't we make sure everyone has access to healthy food? Provide free checkups with a nutritionist to everyone who wants one? Make sure everyone has access to free sports and fitness opportunities? Provide safe bike lanes and pedestrian infrastructure (which both saves you money on accidents and on long term health issues)? Fund free bike share programs? Give everyone free N95 masks? Make sure everyone has paid sick days? I know there are some limited programs in these areas and some provinces do some of these things to some degree, but it seems obvious even just from an economic standpoint that we should be doing these things very broadly.
Consequently, universal healthcare must go hand-in-hand with progressive treatment practices and aggressive research activities.
Yes! I have a chronic illness and certainly cost our health system more than the average person, even though there is no real treatment. How much does Canada spend on research? Less than $1 per Canadian with ME/CFS annually. This makes no sense at all.
posted by ssg at 12:44 PM on April 3, 2022 [3 favorites]
Last year The Local (which writes about health and social issues in Toronto) put out this article about the gigification of health care that had me absolutely FUMING. We refuse to budget to pay for full time nurses at appropriate staffing levels but once shortages become desperate we'll schedule a gig nurse for $100/hour?!? It is a fucking travesty.
posted by emeiji at 1:48 PM on April 3, 2022 [1 favorite]
posted by emeiji at 1:48 PM on April 3, 2022 [1 favorite]
Like, why don't medical grads go into family medicine? How bad does the doctor shortage have to get for anyone in power to care?
It's worse than that. I know an experienced foreign-trained doctor who also just got a PhD - cream of the crop. She passed the boards but there are limited spaces for her to do the residency/practicum. She has a family in Toronto including very small kids (which she had while finishing and defending her PhD!) and she can't find a spot, so. We make it incredibly hard for people to succeed.
posted by warriorqueen at 2:09 PM on April 3, 2022 [2 favorites]
It's worse than that. I know an experienced foreign-trained doctor who also just got a PhD - cream of the crop. She passed the boards but there are limited spaces for her to do the residency/practicum. She has a family in Toronto including very small kids (which she had while finishing and defending her PhD!) and she can't find a spot, so. We make it incredibly hard for people to succeed.
posted by warriorqueen at 2:09 PM on April 3, 2022 [2 favorites]
I'm pig-biting mad about this. This article is more conservative propaganda for the privatization of the Canadian health-care system. Which Canadian citizens love, but now that it's deliberately under-funded, conservative pundits say that it's broken.
One thing this article didn't mention is that Ontario's premier Doug Ford has been throttling funding for our health care (Bill 124) while hoarding federal government funds given to our province for Covid relief. When I was reading it, I was waiting for the author to mention it...
The really depressing part is the bland and uninspiring performances by the left/centre opposition parties in the lead up to the next Ontario election coming soon.
posted by ovvl at 3:59 PM on April 3, 2022 [5 favorites]
One thing this article didn't mention is that Ontario's premier Doug Ford has been throttling funding for our health care (Bill 124) while hoarding federal government funds given to our province for Covid relief. When I was reading it, I was waiting for the author to mention it...
The really depressing part is the bland and uninspiring performances by the left/centre opposition parties in the lead up to the next Ontario election coming soon.
posted by ovvl at 3:59 PM on April 3, 2022 [5 favorites]
I don't have much context outside North American, but the North American model of training doctors and nurses is creating wage pressures that is untenable for the rest of society. Doctors and nurses earn incomes well above median incomes and a free market approach to training them would eventually lead to a supply increase in doctors, like what happens in every other field. We've been facing shortages of both workers for a while and I suspect it's their colleges limiting the number of students enrolled to keep wages high. I've heard that nursing in Nova Scotia and Saskatchewan is becoming hyper competitive for entry, which creates a barrier to entry as the system isn't allowing enough people to work in their desired field. I don't understand why anyone should support a free market health care system, but then tolerate a cartel like situation for the supply of labour in the free market health care system.
posted by DetriusXii at 9:36 PM on April 3, 2022
posted by DetriusXii at 9:36 PM on April 3, 2022
Mod note: Please note: I've removed a couple of comments because the site has a bit of a problem with turning topics about other countries into discussions centered on the US instead. The article does mention US healthcare a couple of times, and if you are speaking primarily about the Canadian system, it's okay to reference the US where pertinent, but please don't redirect to talk about the US instead of Canada. Thank you!
posted by taz (staff) at 12:03 AM on April 4, 2022 [3 favorites]
posted by taz (staff) at 12:03 AM on April 4, 2022 [3 favorites]
Confusing per capita and per 100,000?
Maybe. Frankly, each person having potentially eight hundred nurses available seems to me, a layman, a pretty generous ratio.
posted by ricochet biscuit at 5:18 AM on April 4, 2022 [1 favorite]
Maybe. Frankly, each person having potentially eight hundred nurses available seems to me, a layman, a pretty generous ratio.
posted by ricochet biscuit at 5:18 AM on April 4, 2022 [1 favorite]
I also think an important point to remember in the context of Canadian public health performance is that Canada significantly outperformed its cultural near peers of the US and the UK during this pandemic. The true north had about 1/3 the cases and 1/3 the deaths per 100,000 and a very significantly better vaccination uptake. I believe this was due a mix of the culture and the earned better trust in Canadian health care and that increasing the profit motive in health is probably not conducive to preserving that very valuable resource.
posted by srboisvert at 2:03 PM on April 4, 2022 [2 favorites]
posted by srboisvert at 2:03 PM on April 4, 2022 [2 favorites]
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