And so it begins
August 11, 2022 5:05 AM   Subscribe

After a summer of ER closures across Ontario and the rest of Canada with no end in sight, the Ford government's Health Minister Sylvia Jones has not ruled out the possibility of privatizing some services, saying "all options are on the table." (Except for paying healthcare staff--especially nurses--what they're worth.) posted by Kitteh (49 comments total) 13 users marked this as a favorite
 
It blows my mind that any Canadian could look south to the multi-dimensional dumpster fire that is the American healthcare system and decide they want to move towards that model.
posted by rockindata at 5:31 AM on August 11, 2022 [57 favorites]


It shouldn't. The same forces of racism, Calvinism and greed that are destroying the US are also at work in Canada.

I can't comment further without violating site guidelines.
posted by seanmpuckett at 5:35 AM on August 11, 2022 [51 favorites]




I don't understand what BC is up to. They are trumpeting their success in court, but then they are moving incredibly slowly on "looking into" Telus setting up "preventative health" clinics that are hiring doctors left, right and centre. Surely the NDP knows people who are likely to vote for them are big supporters of public health care, so I don't understand why they are letting Telus establish themselves in a way that is going to be difficult to reverse later.
posted by ssg at 6:37 AM on August 11, 2022 [1 favorite]


This has always been the conservative program, at every level. They generally have move carefully, slowly, because we think we love healthcare and it could blow up in their faces, but Ford has taken advantage of the pandemic to manufacture an opportunity and Ontarians are probably stupid and mean enough to let him fuck us all.
posted by rodlymight at 6:46 AM on August 11, 2022 [12 favorites]


I'm absolutely against privatized healthcare (speaking as a person who had medical debt at 15 back home in the US, which I've mentioned before), but I do push back on the narrative of "well, it's better than nothing." Yes, that's entirely true, but it doesn't mean we can't work towards better than resigned acceptance of the current situation. Canadians shouldn't have to settle for "sometimes good, sometimes adequate, but mostly frustrating."

I learned on Monday that one of the COVID screeners at my clinic was a family doctor in her native Mexico, and she's having to go through very bureaucratic hoops just to meet the criteria to practice. And then I learned her husband is a doctor as well and he's working in a completely unrelated field here. This will likely take years before they are able to help others.
posted by Kitteh at 6:58 AM on August 11, 2022 [11 favorites]


Story time.

So my Mom was solo camping up north near Mattawa. Four and a half, five hours from home. She breaks her ankle. She's stuck.

We get her in touch with the friendly park wardens, and they take her to the hospital in Mattawa. Tiny hospital, brand spanking new. It's on a gentle slope overlooking the river. Lovely place.

She's in and out with her broken ankle in 90 minutes, from entering the emerg door to hobbling out in cast and crutches. Ninety minutes is incredibly fast.

Anyway, I finally get up there to take her home, and I joke that even with the 4.5 hour drive, her service was still faster than if she'd gone to her home hospital in the GTA.

It was funny because it's true.
posted by Capt. Renault at 6:59 AM on August 11, 2022 [19 favorites]


This announcement from the Ford government horrified me. Especially coupled to Ford's opinion that the system isn't in a crisis, and his refusal to lift nurse wage caps.

It's not that I'm terrified of private businesses being service providers in our system. Our Dr runs an efficient clinic with doctors and an an on-site lab. But his clinic has just one payee - the government. And many service providers, like X-ray and other imaging are businesses.

It really seems that these governments are letting the provincial systems buckle under these recent and current stresses, as an excuse to let more privatization in... then they will allow them to direct bill for services, and that's the thin end of the wedge.

Or - another possibility - this threatened privatization is just a gambit to hit up the federal government for more healthcare funds.
posted by Artful Codger at 7:03 AM on August 11, 2022 [5 favorites]


One small thing might be pushing back on the word “private” medicine. It sounds too close to private schools and private country clubs. We need to start calling it “insurance company run” or “commercial”.

Easy to see this coming. The dipshits in this province voted Conservatives in with a majority for the second time. If you drive south of Hamilton, you'll still see lots of pickups with flags on them. There's long been a soft allegiance to US white nationalist culture in rural Ontario and it's getting bolder by the day.
posted by brachiopod at 7:09 AM on August 11, 2022 [25 favorites]


O, Canada... 😢
posted by xedrik at 7:11 AM on August 11, 2022


.
posted by SNACKeR at 7:14 AM on August 11, 2022


It's not that I'm terrified of private businesses being service providers in our system. Our Dr runs an efficient clinic with doctors and an an on-site lab. But his clinic has just one payee - the government. And many service providers, like X-ray and other imaging are businesses.

I think the plan is to continue just having one payer (as required by the Canada Health Act). I was originally ok with expanding private services as long as it's still single payer, but I read an article recently that explained that the problem with doing things like surgery and disease-treatment stuff privately is that the private hospitals will do all the mass and easy surgeries. Figure a private hospital doing 50 knee replacements a day. But then the really complicated surgeries they're not going to do, which is going to leave those for the public hospitals. But those complicated surgeries are the ones that use more resources than the bring in. So it's going to siphon funds from the public system because they won't be making money doing the simple procedures but will still have to do the money-draining procedures.

Note: knee replacement example may or may not be accurate. The point was simple profitable stuff will go to private providers and then the expensive difficult stuff will be left for the public system.
posted by If only I had a penguin... at 7:14 AM on August 11, 2022 [21 favorites]


It really seems that these governments are letting the provincial systems buckle under these recent and current stresses, as an excuse to let more privatization in... then they will allow them to direct bill for services, and that's the thin end of the wedge.

I liken it to vampires: once you invite them in...
posted by Kitteh at 7:14 AM on August 11, 2022 [9 favorites]


MetaFilter: I can't comment further without violating site guidelines.
posted by ricochet biscuit at 7:18 AM on August 11, 2022 [11 favorites]


So it's going to siphon funds from the public system because they won't be making money doing the simple procedures but will still have to do the money-draining procedures.


I am not in favour of privatization, but either way hospitals should not be "making money" on simple procedures.
posted by fimbulvetr at 7:36 AM on August 11, 2022 [5 favorites]


I am not in favour of privatization, but either way hospitals should not be "making money" on simple procedures.

They should be getting money to pay the staff and keep the lights (and ventilators) on.
posted by If only I had a penguin... at 7:44 AM on August 11, 2022 [4 favorites]


Yes, agreed, hospitals should be fully funded to provide whatever procedures are necessary.
posted by fimbulvetr at 7:56 AM on August 11, 2022 [4 favorites]


I’m opposed to private healthcare but I can’t shame patients for wanting to pay considering how bad the public system has gotten since the pandemic. I write this waiting in line outside an urgent care with a line halfway down the block before it opens. It’s impossible to get a family doctor where I live, walk-ins are slashing hours in favour of virtual appointments (which just don’t work for many things) and ER wait times are insane. It’s just really, really bad right now.
posted by vanitas at 8:00 AM on August 11, 2022 [6 favorites]


I suspect that if there is a discrepancy in how much the system will pay for simple procedures (too much) and complex procedures (not enough), it too has deliberately been created precisely in order to create space in the system for the kind of private practice that just churns out knee replacements all day, or whatever. Nothing about our health care system is a coincidence.

I also wonder -- does anyone know the situation with the Saudi doctors right now? I recall that for a long time, we had, at any given moment, about 1000 doctors from the middle east training in Canada -- both medical students and residents. Which perhaps helped to deliver health care in the moment since they were taking shifts in hospitals, etc, and maaaaaaybe helped to subsidize spots for Canadian students, but also used up a lot of supervisory capacity that then could not be used to train Canadian students who would stay in Canada afterward. And then shortly before the pandemic, Saudi Arabia got mad at Chrystia Freeland and called them all home. Did they all go? Is that part of the massive staff shortage in hospitals?
posted by jacquilynne at 8:00 AM on August 11, 2022 [4 favorites]


And apparently Canadian Blood Services is in talks with a private firm to outsource blood collection. Via personal connection I have some reason to believe this article is accurate.
posted by stray at 8:02 AM on August 11, 2022 [2 favorites]


I want a focus to be on family doctors because the majority of folks winding up in the ER and Urgent Care centres are there because they don't have one. Unless it's life and limb (heart attacks, strokes, possible loss of body part), you are going to be sitting in the ER a long ass time. I know it's not as simple as that, but I do feel if you have access to a regular family doctor, it would lessen the burden on hospitals.
posted by Kitteh at 8:14 AM on August 11, 2022 [7 favorites]


I know it's not as simple as that, but I do feel if you have access to a regular family doctor, it would lessen the burden on hospitals.

It is as simple as that, especially with regards to ERs and Urgent Care.

I've had the same Dr/clinic for about 30 years, and when Mrs C's Dr got out of family practice, she was able to get on with them too. It's easy to get an appointment, often within the same week. They have one urgent clinic every week. My elderly mom is also with a practice; in her case she's most often seen by the nurse-practitioner.

This is how the system is supposed to work: the family (aka "primary care") dr is the first contact, and is the conduit to specialists when required, and (in the best arrangement) acts as your advocate. It's faster and more efficient.

The shortage of primary care physicians has been the case for a while in Ontario, with little gov't action to rectify, and the numbers of people without a family dr are overstressing the rest of the system, at a time - post pandemic - when it can least support this growing burden.
posted by Artful Codger at 8:48 AM on August 11, 2022 [4 favorites]


We need to start calling it “insurance company run” or “commercial”.

I prefer PROFIT-DRIVEN because it makes it clear what the difference is.
posted by warriorqueen at 8:53 AM on August 11, 2022 [32 favorites]


Apparently Canadian Blood Services is in talks with a private firm to outsource blood collection.

Good lord, I thought Kitteh's vampire comment was a joke.
posted by Abehammerb Lincoln at 10:00 AM on August 11, 2022 [9 favorites]


I’m opposed to private healthcare but I can’t shame patients for wanting to pay considering how bad the public system has gotten since the pandemic

I can. Paying to skip the line, which is what private healthcare is because it isn't like this increases resources nation wide, is straight up acting like your time/health/well being is somehow more important than someone else just because you have money and it pisses me off. FTS. And that goes double for anyone who wants private healthcare and also complains about taxes.
posted by Mitheral at 10:27 AM on August 11, 2022 [27 favorites]


There are a substantial number of private healthcare organizations that are non-profit (with some fairly significant variation inside of that definition).

Similarly, there are a lot of countries (ie. nearly all of Europe, including many countries way to the Left of Canada) that actually have well-functioning public/private hybrid systems.

Obviously, Canada should not sell its public health assets off to a private equity firm. However, privately-run health facilities are actually pretty common, even in countries that are not capitalist hellscapes.
posted by schmod at 10:36 AM on August 11, 2022 [4 favorites]


Oh no, Canada!
posted by zenzenobia at 10:41 AM on August 11, 2022


I'd normally join this to talk about the craziness happening around health services in Alberta, but it's really hot and there's a leadership race happening for the UCP and I just don't have the energy to try to explain the level of weird, so I'll just drop some links.

At least 30 Alberta Health facilities seeing bed closures, reduced hours

Alberta Health Care workers outraged over HInshaw's bonus amid health cuts

Danielle Smith (current leader in the UCP leadership race) blames stage 4 cancer patients for their condition


Danielle Smith's health care plan would help the rich and hurt everyday Albertans


And on the mental/socio-emotional health front:

Alberta cabinet minister disavows racist, sexist essay that won prize
posted by nubs at 11:48 AM on August 11, 2022 [7 favorites]


There are three basic facts that you can't good-intention your way out of: healthcare is expensive, people will get the best healthcare they can afford, and that government provision of healthcare will always lack the two key motives for investments in healthcare services: profit, and donor vanity.
posted by MattD at 2:01 PM on August 11, 2022 [1 favorite]


There are donor names all over hospitals in downtown Toronto. So, maybe not????
posted by seanmpuckett at 2:06 PM on August 11, 2022 [9 favorites]


Lots of parts of hospitals here on the West coast of Canada are named for donors too.
posted by WaylandSmith at 2:48 PM on August 11, 2022 [2 favorites]


If a politician were thinking, "my constituents will burn down my offices and put my head on a pike if I don't ensure adequate healthcare", would that not constitute a key motive for investment in healthcare services?
posted by Rainbo Vagrant at 4:22 PM on August 11, 2022 [2 favorites]


Lately, politicians seem more worried that mobs will come for them for supporting healthcare, e.g. vaccines and public health measures during a pandemic.
posted by rodlymight at 5:18 PM on August 11, 2022 [10 favorites]


if you have access to a regular family doctor

My family doctor (in Toronto) is basically terrible. The sum of his advice concerning some of my health issues are "just eat less" and "just exercise more". (And yes, he includes the "just" every time.) I've been a large bloke for more than 50 years. If it were "just" that easy, I could have done it by now. Also, he shut his office completely, disconnecting the phone even, during the height of the pandemic. Last time I saw him, I brought that up, and he tried to gaslight me with a broken-record "We never closed. We never closed ..." - even though I have documentary proof that they were. He also refuses to consider changing my swingeingly expensive medication (~ 15% of my income on one med) because it would be too hard for him to contact the one (semi-private) doctor who prescribes in Toronto.

I've tried to get a new doctor. A new practice opened down the road and they advertised for new patients. They took my number and never even called back. So almost everything I've done about my health in the last two years has been avoiding my family doctor. Long ER waits, but at least I get seen.
posted by scruss at 5:46 PM on August 11, 2022 [4 favorites]


It's symptomatic of the breakdown of civilization as we know it when basic health-care is barely available, and a majority of the zombie moron voters that bothered to vote re-elected the asshole government that was taking federal health-care funding and spending it all on shitty driver's license rebates. It's like almost everyone (not everyone) no longer has any concept of what society is and what society requires in order to function properly. They've all turned into fucking zombies. Those zombie movies have now come true.
posted by ovvl at 6:17 PM on August 11, 2022 [13 favorites]


Almost all legacy media in Canada is right wing, except for the CBC (which conservatives want to defund) and (I think it’s) two papers. Social media algorithms are pushing people down wormholes suitable for propping up turbo capitalism. People are broke and resentful (have seen sentiments expressed like “why should nurses get paid more for whining, I work hard, too” and “why should I pay into healthcare, it’s not like I use it. I take care of myself”. Really just need to scroll through comments to any article online to see where they’re at in their race to the bottom). 100% the social contract has broken down. If Poilievre wins, which I fear he will, because the RW media are blaming Trudeau for everything difficult in people’s lives, knowing their consumers don’t know or care about differences in jurisdictions or macroeconomics.

If there are protests we need to attend them in big numbers. We need to do everything we can to prevent the RW from strengthening their foothold in politics. We need to be active wrt regulation of social media. Despair is the alternative, that may be appropriate, but I’m not ready yet.
posted by cotton dress sock at 6:38 PM on August 11, 2022 [6 favorites]


I'm really sorry, Canada, and wishing you the best.

Y'all don't want any of this... gestures at US insurance shitshow

My work-provided health insurance is going up $115 per month. Just because. They had the gall to tell us it was because too many people went to the ER unnecessarily.
posted by Fleebnork at 5:37 AM on August 12, 2022 [2 favorites]



Obviously, Canada should not sell its public health assets off to a private equity firm. However, privately-run health facilities are actually pretty common, even in countries that are not capitalist hellscapes.


This is both true and very non-obvious, even to a lot of people working in healthcare.

The primary socialized component of healthcare in most civilized countries is the payment/reimbursement mechanism. That's what sets the United States apart from virtually everyone else.

Hospitals and doctors in much (most?) of the world still need to turn some kind of positive margin in order to operate. The hospitals are mostly state owned or non-profit (as are most American hospitals), but a non-profit still needs to cover its costs and pay its staff.

In the rest of the world, reimbursement is centrally controlled by a single major payor and so the only way you make margin is by lowering your costs. There's lots of nuance there (capitated vs. fee for service payments, who owns the healthcare delivery system, who pays doctors, etc) but that's the biggest single factor.

In the United States, it's much more complicated. You get paid a LOT by some payors and very little by others. Prices are all set in individual negotiations between providers and insurance companies and then kept top secret. There's no clear incentive structure and you don't really even know who your customers are (is it patients? insurance companies? independent providers?). That's probably the root of all evil here in the USA.
posted by woof at 8:20 AM on August 12, 2022 [2 favorites]


Why financial incentives aren't enough to deal with health-care staffing shortages

Insanity is doing the same thing over and over, expecting a different outcome...

Rather than repeatedly bribing people to remain in a chronically overstressed system, someone needs to notice the systemic problems and address them.

If I were Prime Minister... I think I would try to make Canada a true world leader in medicine, educating medical professionals for the world, hosting the top research schools, and constantly perfecting our delivery systems. Medical expertise would be a better export commodity than tarsand.
posted by Artful Codger at 9:49 AM on August 12, 2022 [3 favorites]


I read that article this morning, too.

It's interesting. What doctors and nurses seem to want most is not for the provinces to pay them personally more salary, but for the provinces to pay more salaries generally. Use the retention bonuses you were going to pay us to actually have enough nurses on the ward so they're not exhausted and broken all the time. But authorizing a one-time payment is so much easier than permanently increasing the line items on the budget to create sustainable, fully funded staffing positions.

Even though nurses other medical professionals are purportedly wildly in demand, everyone I have known who was early-career -- and often even mid-career -- in health care seems to be forced to cobble together part time, casual contracts at multiple facilities to make up one full-time job. And that's a lot of personal management and overhead relative to just having a job and knowing in advance when you were going to get time off, etc.

Which, as an additional note, is also how nearly all of the early COVID outbreaks in Canada were spread from one facility to another. Having your medical professionals traipsing from facility to facility to cobble together a living wage is also just bad medicine.
posted by jacquilynne at 9:58 AM on August 12, 2022 [4 favorites]


[This is not a thread about the USA]
posted by schmod at 10:06 AM on August 12, 2022




Haha, I just came here to post that, oulipian.

Even the bees are opposed to health care privatization.
posted by jacquilynne at 10:47 AM on August 12, 2022


It is very close to impossible to see a doctor here in Victoria BC. And it's not like the States, where you can go to the chain drugstore's clinic and see a nurse or physician's assistant for basic things.
posted by quiet wanderer at 2:29 PM on August 12, 2022


I'm one of the lucky Calgarians who has a family doctor, I called him last week to see if I could book a physical and some tests because I've had some weight loss and I want to get my thyroid checked, and I was informed he's on vacation until october and then won't be taking physical-length appointments until the new year. Also they're now only open from 9-2pm. Their suggestion? "you can go to a walk in clinic!"

I booked at and donated money to the women's clinic instead. At least they could get me in within a couple of months.

I don't think that privatization is the answer but I can see just wanting to be able to see a doctor to find out if you're dying of something without having to wait 7 hours at a walk in (not realistic for me, I have a non negotiable job), or 5 months for a blood test.
posted by euphoria066 at 4:55 PM on August 15, 2022


I live in Toronto and I had a kidney stone a few weeks ago. I get one or two a year, I'm prone to them. Those of you who have had them know they present with excruciating pain.

I am also prone to kidney infections due to stones. Kidney infections are life threatening.

So I realize I have a stone because I go from standing to curled up and vomiting within 20 minutes, and I look at the news, which is all "TORONTO ERs IN CRISIS, MASSIVE WAITS" and I call MG Hospital and talk to a lovely doctor who was very sympathetic and said, in these exact terms:

"If you feel you have to come, come to the ER. But you will be waiting a very long time to be seen. If you can avoid it, then do so."

This is the Toronto Emergency Room Doctor's advice to someone in 8/10 pain who has not been able to keep fluids down for 24h.

And she was right! The difference was between curling up and crying for hours in my bed, or curling up and crying for hours on a filthy ER floor. There is no where else in Toronto to get pain relief, due to the opioid crisis and clinic prescribing restrictions. My GP won't even prescribe 6 percocet for an active kidney stone. The ER is the only place to get effective pain relief for acute, excruciating pain.

And they asked me to please not come.

And, because I was asked to not seek out care for my acute condition, my condition significantly worsened, because that's what happens when you tell people not to get to a doctor:

It did turn into a kidney infection. I was really really really sick for a week, at home, when I probably should have been hooked up to IV antibiotics in a bed. Last time this happened I spent 5 days admitted to Toronto General. It took 3 telemedicine visits, and a nursing friend coming and injecting me with IM Gravol so I could keep the antibiotic pills down, and it was really fucking scary for everyone involved. I've been scared since! What will happen with my next stone?

And they want to take this stuttering system and drain its funds and giving it to the fucking for profit healthcare vultures. Won't even pay nurses half of what they're worth during a fucking pandemic but Ford's friends over there have a nice little kickback, just give them a little slice of a sweet public healthcare pie.

I am livid. I am so scared.
posted by robot-hugs at 12:40 PM on August 17, 2022 [5 favorites]


I think I have mentioned I currently work in healthcare admin. Right now a soul-crushing part of my current role is to tell people who contact us (elderly, parents of newborns without family doctors, pregnant folx who need OB care, folks who require complex medical care, people whose family doctors retired or quit) that we are not accepting any new patients for the foreseeable future. All of our doctors are incredibly over-rostered and have been for a while, but my workplace was for years where at least the newborns and pregnant peeps could get care regardless. We had to stop that because our current roster of patients were being booked anywhere from a month to a month and a half out for any appointment. (Also: please don't yell at the clinic clerks who deliver this news; we have absolutely no control over so so much.) And then we had doctors retire and/or leave due to the stress, which made everything worse.

It really sucks to have to tell people who are stressed/scared/distraught that we can't accept them as patients. And it sucks that their options are ER or Urgent Care (the latter of which has had to reduce hours severely due to understaffing) or a walk-in clinic.
posted by Kitteh at 1:22 PM on August 17, 2022 [1 favorite]


Ouch, robot-hugs.

All I can suggest is to discuss some arrangement with your family doctor or your urologist about where to go when you have an attack, in order to be seen ASAP.
posted by Artful Codger at 1:23 PM on August 17, 2022


Update from Ford Nation!

What an absolute shitty thing to say, though, Sylvia Jones:

Jones said Ontario needs to be "bold, innovative and creative" when looking for ways to improve the health system.

"There are some who will fight for the status quo no matter what," she said at a news conference announcing the plan.

"They're ideologically opposed to change or improvements. We won't accept that. We can't accept that. People want better health care."

posted by Kitteh at 8:53 AM on August 18, 2022


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