Can we not accept that the current, government system no longer works? If you don't like the American system (such as it is) fine. Look to Europe. Many counties have a blend of Public and Private systems. Wait times are shorter than here, treatment appears to be comparable, if not better. It's time for a change, and some fresh thinking. We can't avoid this any longer.
That the Canadian government medical system doesn’t work is pretty much universally accepted. The only thing that keeps it going is the well established fact that no politician or civil servant will ever admit that they made a mistake. So they double and triple down on a system that doesn’t work. As the saying goes, doing the same thing over and over again and expecting different results is the definition of insanity.
The only part of the “medical” system that meets deadlines is euthanasia where government paid functionaries gaslight victims into choosing MAID by pointing out that no timely alternative resources are available. Canada is now a country where you are over 50 times more likely to be killed by one of your own government’s paid medical practitioners than by a firearm. (16499/287-, 2024 data).
"hat the Canadian government medical system doesn’t work is pretty much universally accepted." Except by the proponents of the current system who, at any possible hint of a change, yell, "American style!!"
Well, we know the US system doesn't work for everyone and costs more per patient than ours. So I would agree it is not where we should be looking. Or is losing your house to pay your medical bills an attractive proposition?
Do people regularly lose their houses to pay for medical bills in Australia? France? Germany? Any of the *every single other developed nation* with a hybrid medical system?
I am so tired of the "government mandated single payer only or we will be the US" brain dead boomer Canadian argument.
Wish there were an easy answer. US people are covered by Medicare ( funded through social security taxes) if they’re over 65, if they’re really poor and live in a state that has Medicaid, or work for a - generally large - corporation that pays for your premiums while you’re working. You can get in financial trouble if you work for a small company and make too much to qualify for Medicaid. Yes then you have to choose to be either dead with a house or alive without one. But what percentage of the population falls in that last category? Also Americans are extremely generous when go fund me or similar requests come up.
Actually it’s interesting that some Canadians - again, how many? - are relying on go fund me or taking out mortgages, etc to get care outside of Canada either because the care they need is not available at home, the wait time is unacceptable, the procedure is not covered by their province etc. Kind of ironic - or disappointing - isn’t it?
Not my solution. But pointing out what people do. I’m always impressed with the generosity of Americans. Twice the per capita rate of Canadians. Does the US tradition of not expecting government to do everything for you help explain this?
All 50 states plus DC have Medicaid programs. 41 of them plus DC have been expanding those.
Nothing government does surprises me. But I still believe government wants the boomer population bulge to end through death as quickly as possible. They were probably happy when Covid killed a lot of them off.
No, the US system doesn't work for everyone: remember, price?
By contrast, the Canadian system doesn't work for everyone: waiting, remember?
Some folks just fall aside in the US system and die or suffer terrifically adverse consequences, including death; some folks just fall aside in the Canadian system and suffer terrifically adverse consequences, including death.
My point is that simply saying the US system is awful but not recognizing the faults of the Canadian system is foolish. There is no perfect system; it is simply a matter of choosing which of the three alternatives are most important to you; the Americans chose speed and quality of service whereas the Canadians chose price and quality of service.
Put another way, many Canadians look at the American system and say that in that system you can go broke or die without care; many Americans look at the Canadian system and say that you can die on a waiting list of in an emergency room. Both are right.
David, in any service business - and the medical industry is supposed to be a business, even hospitals - there are three principles that a provider can hope to achieve and a user can hope to receive.
Principle one is cost; principle two is speed; principle three is quality.
Both Canada and the US try their best to meet the objective of high quality of service; Canada somewhat compromises quality for cost.
The US works real hard on giving impressive speed of service; Canada wants to give speed but compromises speed for cost.
Canada absolutely wins on cost as medical care is (for covered services) free but that free stuff causes quality to be affected by the overloading of the system with just everyone. The US absolutely loses on cost at the expense of making medical care costly and therefore available to relatively few.
Until Canadians stop talking about folks in the US being being bankrupted and acknowledge that we have chosen compromises and that there are consequences we will not be able to do better. The same comment apples to Americans who look at Canada and talk about socialized medicine and wait lists. Both Canadians and Americans are correct but until both sides admit that they cannot have all three principles but, at best, they can have two of them, there will be no improvement.
We can't have quality or speed if we don't have enough people in the critical roles. We don't have enough people in the critical roles. That, by itself, will drive up the cost as we ship people out of the country for treatment...or they'll suffer or die for lack of care. You can't run a system at 95% when times are quiet and expect it to cope with a surge. We should have learned that from Covid and every flu season. I don't want a system that is just great for the rich. We need more bodies in doctors' offices, lower patient loads, more nurses. We don't need more managers and consultants. The people providing the service have the expertise to make it work. Give them enough bodies to provide it.
All valid points but I respectfully suggest that when a provincial government tries something new or different that you and yours should make sure that you don't immediately yell, "American style" and ignore that it could be Swedish, French, etc. style.
My point is that the Canada Health Act is a straight jacket that makes bold reform difficult and a population that immediately tries to shut down ANY reform by comparing it to the "American" system is worse than pointless; it is a roadblock to creativity. I can absolutely predict that a whole lot more mistakes will be made in Canadian healthcare but the CHA sure makes life a whole lot worse for provincial governments.
If you want more money in the system to be able to hire more staff you might consider narrowing what medical services are covered so that the public pays only for some services and the "saving" is used to hire those extra staff.
You can argue that no services should be de-insured but you then need to provide details of precisely where the money is to come from. Will we close the prisons and release the inmates? Will we close down highways to save on maintenance? Will we abolish welfare and stop subsidizing low cost housing? Those are all foolish examples but they illustrate that we need to think about where money can be freed up.
I will never understand people's objection to MAID. We treat our pets better than people suffering a debilitating illness. Quality of life matters, and people should have the option to end it with the dignity they desire. That our gun death rate is where it is seems to be a compliment.
I and I believe most Canadians don't have a problem with ending someone’s misery at the end of their lives. But the issue I have is the Canadian medical bureaucracy is using euthanasia as a cop out for not providing more facilities, palliative care, or treatments that work. Their hope I believe is that the strain on the medical system will ease once most of the boomers die off. And promoting MAID from a bureaucratic financial perspective is a great way to speed up the process.
Which goes back to what this article is saying. Who closed chronic care hospitals? Who is responsible for ER's closing? Who cut medical spaces at universities? The healthcare crisis lies almost entirely with provincial governments, which have gutted it, while paying millions to consultants to cut costs while trying to run a system at 95%+ capacity 24/7. The number of bullshit charts these clowns generate about how long hospital stays should be to justify their exorbitant charges....the system needs workers, not managers, who are nothing but a drain on resources.
I know there have been a couple of classic public screw-ups around the suggestion of MAID. I believe that is the exception and not the rule.
I just remembered the early days of MRI introduction when demand was high and delays were long . Some hospitals discovered they could pay for more staff by doing MRI tests on pets at veterinarian’s requests. When the government found out instead of welcoming the extra revenue it banned the practice and cut shifts back.
As a Canadian who received timely care in a mixed system in Germany, I was disappointed by a recent CBC article that seemed to focus on diversion of public resources over market forces increasing supply elsewhere. https://youtu.be/KMu6c9U9vE4?si=Svq849oZMwRRr2sF
Quite simply: Canada has 2.8 physicians per 100,000 people and Germany has 4.5. Supply is constrained. Public/Private doesn’t matter to me. We need to find a way to increase supply and moderate costs. We can learn a lot from Europe.
Thank you, Dr. Wiedrick, for addressing the need for fundamental reforms.
Patrick, it is my recollection that some years ago the governments (very much plural) found, to their immense surprise, that the more docs there were, the more that those docs billed for services. Legitimate billings for legitimate services, but more money paid by the governments. The miracle cure was to limit med school enrollments thereby limiting med school graduation thereby limiting docs billing the system.
How often have you heard of qualified medical school applicants being unable to get accepted and, if they were determined, going to a different country for medical education? I know that I have heard of such cases. And, of course, it is highly unlikely that those folks return to practice here in Canada.
A proper (but long term) approach is to increase medical school enrollments. Short term? That is another issue but one for which I do not have a prescription.
It’s too late. It takes a minimum of 6 years from start of university education to train a family MD and 9-10 to train a specialist, and usually longer for the hyper-specialized ones. The Boomers will be long gone before the numbers issue can be corrected. We needed to start a decade ago.
Like the origin of most bad ideas, limiting the supply of MDs seemed like a good idea at the time.
Nursing is also going to be a huge bottleneck. We are not training nearly enough of them.
The best time to plant a shade tree is forty years ago; the second best time is today.
In other words, actions that are taken today will not bear fruit for many years, as you point out, but no actions today will mean that there will not be fruit to enjoy in the future.
According to my AI conversations the problem is not medical school. Instead it is residency training afterwards that is the biggest constraint. Currently UBC accepts 10% of applicants. I’m assuming you don’t apply to medical school if your GPA is low and your MCAT is dismal. Another CBC link on the topic: https://www.cbc.ca/news/politics/foreign-nationals-medical-residency-canadians-struggle-1.6988983
A CBC report that ignores facts to prop up the dysfunctional status quo which just happens to align with the position of the Liberal Party of Canada? I for one am totally shocked.
Besides, all Canadians know that the only alternative to Our Free Quality Universal Healthcare For All is the US system where you lose your house and all your money if you so much as set foot inside a hospital.
With an elderly parent, who has paid her entire life for her health care, and has never been sick until now, I have sat in ERs (even with a form for immediate triage) for 12 to 15 hours. Having no phone, I was able to watch and listen. Many were there because they had no family doctor (nor google but I digress), some did not speak either official language. Nelson is a wonderful place, with great skiing and great hiking and fishing, but you know what, that comes at a price, and that is timely health care. Living in the City is no fun, with the shopping carts going by pushed by the urban outdoorsmen and women, and the ER with their fair share of such people every night, but there is more than one Doc on call. I feel for people who have worked their whole life and wish to retire to the mountains, but many should be wary of not having a major trauma center around they age. Some doctors are darn good business people, and they have private, efficient and nice private clinics. In Alberta, Alberta Health even pays for people to attend those places. It is time, and Alberta is leading the way, despite the NDP shrills named Friends of Medicare.
Our hospitals are housing folks that no longer require medical care; they simply don’t want to leave.
University Hospital (UH) has something like 200 people taking up beds because they simply refuse to leave. They no longer require hospitalization. They are like squatters.
Extrapolate that across the Province, and the Country to understand the extent of the problem.
One fellow has been in UH for over nine- yes, nine- years.
BOOM! When Don Getty built all those hospitals ok, long term care homes, in every village in Alberta, that started the avalanche of the hospital becoming a care home. We need more long care homes which will certainly reduce capacity. My goodness, The Line its readers, and contributors can drive this change!
We're in this situation not in small part because that generation (nor any before it) did not in fact pay what their care will cost. The great bargain of each generation paying for a small cohort of seniors in exchange for more spending later, paid by an even larger cohort of workers, is over. And current working age people don't even get the care they pay for, given how strained the system is under the ever growing elderly population, who at least got good care earlier in their lives.
Canada has long cried out for a national identity. I think everyone across Canada would agree that universal health care is probably it. Possibly Hockey Night in Canada until CBC lost it.
Two tier health care has existed in Canada all my life and I am 58. Unless you don't consider dentistry, ophthalmology or psychiatric services to be health care. I don't see how they are not. People literally lose their sh#t with the mere whisper of private MRI clinics. There can be no debate. Ever. This is sacred.
There is no one universal health care system in this country. It's in name only.
This is unsolvable. If one believes it is solvable in an unserious country such as ours they need quickly to get their head's examined. Likely by a mental health professional the Canada Health Act does not recognize. I have been hearing the same complaints and horror stories about our health care system for more than thirty years.
Folks that is not the universal health care you have been led to believe. Individual doctors are privately run businesses who bill the government.
If we are to solve the unsolveable, we need to accept that we are batsh#t crazy when health care is the topic du jour.
There are half a dozen private MRI and CT clinics in Calgary with a wait time of a few days. They've been around for decades now and even the union dippers accept them.
Some people in other provinces need to grow up and check their envy mongering.
The good Doctor refers to the 1st principle of the Health Care Act, public administration. We are doomed from the outset because nothing in this country under the perview of public administration works the way it should. Why does AHS, for example, need dozens of VP's? Doctors and nurses are trained front line people. Explain to me how a bureaucrat aids in their performance. We need more Doctors and nurses working in more hospitals. Calgary has 4 hospitals. Phoenix I'm told has 16. As long as the unions, bureaucrats, and politicians dig their heels in against calls for change in the face of rising demand, expect more of the same.
I am amazed that there are no demonstrations in the streets about the state of our medical care. We are living in a crisis. Just another huge problem Canada is unable to face.
Birthdays represent a good time for reflection, and ours is tomorrow. Ideally, we reflect on the positives, but those seem to be in an ever-diminishing supply. The negatives have become worse across the board: costs of housing, food, utilities; all that we lump into the 'cost of living' have increased faster than our ability to pay. Putting taxes aside for the moment, the one cost in dollars that hasn't increased for the individual is health care, and the 'Friends of Medicare' are desperate to maintain this wonderful illusion that separates us from the evil US system. Unfortunately, it also separates us from many models (Western Europe, for example) that provide more doctors per capita and much shorter ER wait times.
Why can we not see that while dollar costs stay low, human health costs are spiralling out of control?
Healthcare is far from my knowledge area, but the very issues Dr. Wiedrick has described I see happening in our ER in Quesnel. This is a powerful piece and I hope the medical community continues to speak up, advocate for specific changes in legislation and collective agreements to put patients first without burning out our physicians, nurses, and administrative staff.
Thank you Dr Wiedrick for the courage to speak out. To all Canadians: The collapse of our healthcare system will one day take your life or the life of a loved one. The people in the system are desperately trying to prevent that but they are burning out under this kind of stress. If we Canadians don't take up the demand for better, this collapse will hit us in the most personal way possible. That is not hypothetical. It is happening. I for one am going to write letters to my Premiere and the Prime Minister. We don't need new money, we need new thinking.
I second this comment - Thank you Dr Wiedrick for having the courage to speak out. I imagine you’re somewhat going against the grain here. But nothing is going to change until those on the front line begin speaking out in detail.
Thank you, Doctor. I'm sorry for your stress. I've been reading articles like yours, each one progessively more depressing, for four decades. I fear nothing will ever change in Canada, despite calls for change and reform dating back to the 1990s, met by cries of ideological purity and just a need to spend more and more and more on the monopolistic public system as results decayed. We are simply too locked into ideological prisons, it would seem.
I'd listen to the suggestions of a doctor a thousand times before I'd take the advice of a consultant.....a huge drain on financial resources in medicine, providing little and costing a lot.
Spending on health care has never been higher than it is right now yet most Canadians still think the solution is even more money. Our single payer universal system is viewed with religious fervour and other approaches which are working better in other countries are simply not open for consideration. Politicians, knowing the whole subject is a toxic third rail, won't go near it leaving rationing of care as the only way to control ballooning costs. Eventually, maybe soon, the situation will reach the point where even Liberals will be forced to consider other options. We can only hope. In the meantime, things will continue to deteriorate as more and more of the healthcare budget is wasted on self-serving bureaucracy and less and less is spent on doctors, nurses and medical equipment.
Bang on. The tried-and-true Canadian Way of tossing more money into a raging bonfire will achieve nothing, apart from worsening the situation. The problem here is not the politicians. They simply pander to a voting public that is, to be frank, so stupid, intellectually inept, and emotionally overwrought as to fall for the "he's for killing medicare!" canard tossed at anyone so unpatriotic as to suggest that our system is a national disgrace perpetuated by the religious delusion that the Canada Health Act is sacrosanct. Frankly, a voting public (and mainstream media) so stupid as to accept a binary choice between the status quo and "US style healthcare", and fall for that canard, simply has way too many people who should not be voting. However, in a democracy, even uninformed idiots can vote, and that has consequences. We are living through those consequences in the here and now.
Years ago I used to laugh at those who, when queried on what defined the Canadian identify, pointed with pride to our healthcare system. I don't laugh anymore. The moribund, rapidly decaying state of that system, and the collective inability to fix it, now perfectly encapsulates the Canadian identify.
I believe that Dr. Wiedrick is correct in saying that the Canada Health Act is a guilty instrument.
In the name of "national standards" the CHA imposes and prescribes and prevents. The CHA doesn't really allow much experimentation in delivery of medical services and that is a severe problem.
In my province (Alberta) the provincial government is starting a new experiment in allowing docs to work both within and without the public system in an attempt to reduce demand within the public health system. The critics are crying that universal doom song of, "American style healthcare" but refuse to think that it may be Swedish style, French style, German style, etc. All they can think of is horror stories out of the US.
None of the critics seem to be aware that many docs in the US are absolutely horrified at our "socialist style" medicine and, particularly, at the wait lists, the time delays in treatment, etc., all of which is true but is just as ignorant as the Canadians who cry "American style."
The simple fact is that virtually none of the various critics of either Canadian style or American style medicine are willing to accept is that there are three basic principles in providing service - any type of service. I am a retired accountant and I long ago learned that the service industry, including medicine, operates on those principles: you can have any two of quality service, cheap service or quick service. You cannot have all three of the attributes; at best you can have two of them simultaneously and sometimes you get one or even (horrors!) none of them.
What Canada has done is to choose cheap service and quality service (kind of). By choosing universality and free (cheap for everyone) it has made demand far larger and made it more difficult (not impossible but more difficult) to provide quality. Put differently, the greater the demand, the greater the pressures on quality. By contrast, America has chosen quick service and quality service but has ignored cheap service; expensive medical service has, of course, reduced demand. None of those choices are bad in and of themselves; they simply are what they are.
Throwing more money at the Canadian system will certainly ameliorate some of the delays but one can ask just how much will improve and whether more money will increase demand. As a further point, the more types of services that Canada covers through medicare, the greater the demands on the system. One way to generate more money for the Canadian system is to de-insure some medical procedures; I don't recommend for or against that but it is a way to generate more money.
Until the proponents of healthcare are all willing to accept that you can only have two of the three principles and make appropriate compromises that result from that, there will be no possibility of systemic improvement.
Can we please stop blaming Boomers and the previous generation for the demands on the healthcare system. Research helped prolong and increase the quality of life. Wasn’t that the goal? Demographers predicted the grey tsunami, successive governments chose to look the other way.
The good news is that we will die off. And the old that will replace us will not be at all as numerous. We are what is called to postwar baby boom. And there were not the contraceptives available then as there are now!
Canada had patient-focused funding until Pierre Trudeau cancelled the 50/50 funding deal with the provinces, I believe in 1976. He introduced annual block grants to the provinces, who then replicated the practice to hospitals & doctors. Hospitals could have so many doctors & nurses, so many operating rooms and so many procedures per year. Our health administration costs (non-medical) grew to consume 30% of our healthcare budgets. Budget management created waiting lists as our fundamental budget control tool.
We've swallowed the politicians' lies about Canada having the best healthcare system in the world. The truth is that such a system will require more taxes from all we taxpayers. There is no silver bullet. Any politician who says they have a solution is lying.
Can we not accept that the current, government system no longer works? If you don't like the American system (such as it is) fine. Look to Europe. Many counties have a blend of Public and Private systems. Wait times are shorter than here, treatment appears to be comparable, if not better. It's time for a change, and some fresh thinking. We can't avoid this any longer.
That the Canadian government medical system doesn’t work is pretty much universally accepted. The only thing that keeps it going is the well established fact that no politician or civil servant will ever admit that they made a mistake. So they double and triple down on a system that doesn’t work. As the saying goes, doing the same thing over and over again and expecting different results is the definition of insanity.
The only part of the “medical” system that meets deadlines is euthanasia where government paid functionaries gaslight victims into choosing MAID by pointing out that no timely alternative resources are available. Canada is now a country where you are over 50 times more likely to be killed by one of your own government’s paid medical practitioners than by a firearm. (16499/287-, 2024 data).
"hat the Canadian government medical system doesn’t work is pretty much universally accepted." Except by the proponents of the current system who, at any possible hint of a change, yell, "American style!!"
Of course they will. But saying it doesn’t make the Canadian system work any better does it? I suppose anything is OK as long as it isn’t American.
I do hope that your last sentence was sarcasm.
Yes. But the message is definitely there. And politicians love it. Like Doug Ford. As do a lot of voters.
Well, we know the US system doesn't work for everyone and costs more per patient than ours. So I would agree it is not where we should be looking. Or is losing your house to pay your medical bills an attractive proposition?
Do people regularly lose their houses to pay for medical bills in Australia? France? Germany? Any of the *every single other developed nation* with a hybrid medical system?
I am so tired of the "government mandated single payer only or we will be the US" brain dead boomer Canadian argument.
Wish there were an easy answer. US people are covered by Medicare ( funded through social security taxes) if they’re over 65, if they’re really poor and live in a state that has Medicaid, or work for a - generally large - corporation that pays for your premiums while you’re working. You can get in financial trouble if you work for a small company and make too much to qualify for Medicaid. Yes then you have to choose to be either dead with a house or alive without one. But what percentage of the population falls in that last category? Also Americans are extremely generous when go fund me or similar requests come up.
Actually it’s interesting that some Canadians - again, how many? - are relying on go fund me or taking out mortgages, etc to get care outside of Canada either because the care they need is not available at home, the wait time is unacceptable, the procedure is not covered by their province etc. Kind of ironic - or disappointing - isn’t it?
And what is the GOP doing to Medicaid and Medicare? GoFundMe is your solution? Wow.
Not my solution. But pointing out what people do. I’m always impressed with the generosity of Americans. Twice the per capita rate of Canadians. Does the US tradition of not expecting government to do everything for you help explain this?
All 50 states plus DC have Medicaid programs. 41 of them plus DC have been expanding those.
Nothing government does surprises me. But I still believe government wants the boomer population bulge to end through death as quickly as possible. They were probably happy when Covid killed a lot of them off.
No, the US system doesn't work for everyone: remember, price?
By contrast, the Canadian system doesn't work for everyone: waiting, remember?
Some folks just fall aside in the US system and die or suffer terrifically adverse consequences, including death; some folks just fall aside in the Canadian system and suffer terrifically adverse consequences, including death.
My point is that simply saying the US system is awful but not recognizing the faults of the Canadian system is foolish. There is no perfect system; it is simply a matter of choosing which of the three alternatives are most important to you; the Americans chose speed and quality of service whereas the Canadians chose price and quality of service.
Put another way, many Canadians look at the American system and say that in that system you can go broke or die without care; many Americans look at the Canadian system and say that you can die on a waiting list of in an emergency room. Both are right.
David, in any service business - and the medical industry is supposed to be a business, even hospitals - there are three principles that a provider can hope to achieve and a user can hope to receive.
Principle one is cost; principle two is speed; principle three is quality.
Both Canada and the US try their best to meet the objective of high quality of service; Canada somewhat compromises quality for cost.
The US works real hard on giving impressive speed of service; Canada wants to give speed but compromises speed for cost.
Canada absolutely wins on cost as medical care is (for covered services) free but that free stuff causes quality to be affected by the overloading of the system with just everyone. The US absolutely loses on cost at the expense of making medical care costly and therefore available to relatively few.
Until Canadians stop talking about folks in the US being being bankrupted and acknowledge that we have chosen compromises and that there are consequences we will not be able to do better. The same comment apples to Americans who look at Canada and talk about socialized medicine and wait lists. Both Canadians and Americans are correct but until both sides admit that they cannot have all three principles but, at best, they can have two of them, there will be no improvement.
We can't have quality or speed if we don't have enough people in the critical roles. We don't have enough people in the critical roles. That, by itself, will drive up the cost as we ship people out of the country for treatment...or they'll suffer or die for lack of care. You can't run a system at 95% when times are quiet and expect it to cope with a surge. We should have learned that from Covid and every flu season. I don't want a system that is just great for the rich. We need more bodies in doctors' offices, lower patient loads, more nurses. We don't need more managers and consultants. The people providing the service have the expertise to make it work. Give them enough bodies to provide it.
All valid points but I respectfully suggest that when a provincial government tries something new or different that you and yours should make sure that you don't immediately yell, "American style" and ignore that it could be Swedish, French, etc. style.
My point is that the Canada Health Act is a straight jacket that makes bold reform difficult and a population that immediately tries to shut down ANY reform by comparing it to the "American" system is worse than pointless; it is a roadblock to creativity. I can absolutely predict that a whole lot more mistakes will be made in Canadian healthcare but the CHA sure makes life a whole lot worse for provincial governments.
If you want more money in the system to be able to hire more staff you might consider narrowing what medical services are covered so that the public pays only for some services and the "saving" is used to hire those extra staff.
You can argue that no services should be de-insured but you then need to provide details of precisely where the money is to come from. Will we close the prisons and release the inmates? Will we close down highways to save on maintenance? Will we abolish welfare and stop subsidizing low cost housing? Those are all foolish examples but they illustrate that we need to think about where money can be freed up.
Nationalize doctors!
I will never understand people's objection to MAID. We treat our pets better than people suffering a debilitating illness. Quality of life matters, and people should have the option to end it with the dignity they desire. That our gun death rate is where it is seems to be a compliment.
I and I believe most Canadians don't have a problem with ending someone’s misery at the end of their lives. But the issue I have is the Canadian medical bureaucracy is using euthanasia as a cop out for not providing more facilities, palliative care, or treatments that work. Their hope I believe is that the strain on the medical system will ease once most of the boomers die off. And promoting MAID from a bureaucratic financial perspective is a great way to speed up the process.
Which goes back to what this article is saying. Who closed chronic care hospitals? Who is responsible for ER's closing? Who cut medical spaces at universities? The healthcare crisis lies almost entirely with provincial governments, which have gutted it, while paying millions to consultants to cut costs while trying to run a system at 95%+ capacity 24/7. The number of bullshit charts these clowns generate about how long hospital stays should be to justify their exorbitant charges....the system needs workers, not managers, who are nothing but a drain on resources.
I know there have been a couple of classic public screw-ups around the suggestion of MAID. I believe that is the exception and not the rule.
I just remembered the early days of MRI introduction when demand was high and delays were long . Some hospitals discovered they could pay for more staff by doing MRI tests on pets at veterinarian’s requests. When the government found out instead of welcoming the extra revenue it banned the practice and cut shifts back.
As a Canadian who received timely care in a mixed system in Germany, I was disappointed by a recent CBC article that seemed to focus on diversion of public resources over market forces increasing supply elsewhere. https://youtu.be/KMu6c9U9vE4?si=Svq849oZMwRRr2sF
Quite simply: Canada has 2.8 physicians per 100,000 people and Germany has 4.5. Supply is constrained. Public/Private doesn’t matter to me. We need to find a way to increase supply and moderate costs. We can learn a lot from Europe.
Thank you, Dr. Wiedrick, for addressing the need for fundamental reforms.
Patrick, it is my recollection that some years ago the governments (very much plural) found, to their immense surprise, that the more docs there were, the more that those docs billed for services. Legitimate billings for legitimate services, but more money paid by the governments. The miracle cure was to limit med school enrollments thereby limiting med school graduation thereby limiting docs billing the system.
How often have you heard of qualified medical school applicants being unable to get accepted and, if they were determined, going to a different country for medical education? I know that I have heard of such cases. And, of course, it is highly unlikely that those folks return to practice here in Canada.
A proper (but long term) approach is to increase medical school enrollments. Short term? That is another issue but one for which I do not have a prescription.
It’s too late. It takes a minimum of 6 years from start of university education to train a family MD and 9-10 to train a specialist, and usually longer for the hyper-specialized ones. The Boomers will be long gone before the numbers issue can be corrected. We needed to start a decade ago.
Like the origin of most bad ideas, limiting the supply of MDs seemed like a good idea at the time.
Nursing is also going to be a huge bottleneck. We are not training nearly enough of them.
All of what you say is entirely correct. But ....
The best time to plant a shade tree is forty years ago; the second best time is today.
In other words, actions that are taken today will not bear fruit for many years, as you point out, but no actions today will mean that there will not be fruit to enjoy in the future.
According to my AI conversations the problem is not medical school. Instead it is residency training afterwards that is the biggest constraint. Currently UBC accepts 10% of applicants. I’m assuming you don’t apply to medical school if your GPA is low and your MCAT is dismal. Another CBC link on the topic: https://www.cbc.ca/news/politics/foreign-nationals-medical-residency-canadians-struggle-1.6988983
Both are a major problem.
That CBC report really is junk.
Most of them are.
A CBC report that ignores facts to prop up the dysfunctional status quo which just happens to align with the position of the Liberal Party of Canada? I for one am totally shocked.
Besides, all Canadians know that the only alternative to Our Free Quality Universal Healthcare For All is the US system where you lose your house and all your money if you so much as set foot inside a hospital.
Or, a Swedish system or a French system or a German system, etc., etc.
Hope I didn't turn up the sarcasm so high that it looped around and mimicked sincerity.
With an elderly parent, who has paid her entire life for her health care, and has never been sick until now, I have sat in ERs (even with a form for immediate triage) for 12 to 15 hours. Having no phone, I was able to watch and listen. Many were there because they had no family doctor (nor google but I digress), some did not speak either official language. Nelson is a wonderful place, with great skiing and great hiking and fishing, but you know what, that comes at a price, and that is timely health care. Living in the City is no fun, with the shopping carts going by pushed by the urban outdoorsmen and women, and the ER with their fair share of such people every night, but there is more than one Doc on call. I feel for people who have worked their whole life and wish to retire to the mountains, but many should be wary of not having a major trauma center around they age. Some doctors are darn good business people, and they have private, efficient and nice private clinics. In Alberta, Alberta Health even pays for people to attend those places. It is time, and Alberta is leading the way, despite the NDP shrills named Friends of Medicare.
You bring up several great points.
Thank you for sharing.
May I add one more?
Our hospitals are housing folks that no longer require medical care; they simply don’t want to leave.
University Hospital (UH) has something like 200 people taking up beds because they simply refuse to leave. They no longer require hospitalization. They are like squatters.
Extrapolate that across the Province, and the Country to understand the extent of the problem.
One fellow has been in UH for over nine- yes, nine- years.
BOOM! When Don Getty built all those hospitals ok, long term care homes, in every village in Alberta, that started the avalanche of the hospital becoming a care home. We need more long care homes which will certainly reduce capacity. My goodness, The Line its readers, and contributors can drive this change!
In Ontario, many of the long term care beds are taken up by folks being treated for mental illness.
They don’t require long term care; they require affordable housing.
For me, mental illness should be treated no different that physical illness.
We're in this situation not in small part because that generation (nor any before it) did not in fact pay what their care will cost. The great bargain of each generation paying for a small cohort of seniors in exchange for more spending later, paid by an even larger cohort of workers, is over. And current working age people don't even get the care they pay for, given how strained the system is under the ever growing elderly population, who at least got good care earlier in their lives.
“Our monolithic, slow-moving, bureaucracy-bound system lacks the nimbleness to meet practical realities.”
This is a critical moment for Canadian healthcare.
Like so many other files, it has been kicked down the road in favour of expediency, and to the point where we now have fewer and fewer choices.
If Pierre Poilievre wants to separate himself from the failed policies of the NDP/Liberal Alliance, here is that opportunity.
Great essay, sir. It was a disheartening pleasure to read.
My best to you.
Canada has long cried out for a national identity. I think everyone across Canada would agree that universal health care is probably it. Possibly Hockey Night in Canada until CBC lost it.
Two tier health care has existed in Canada all my life and I am 58. Unless you don't consider dentistry, ophthalmology or psychiatric services to be health care. I don't see how they are not. People literally lose their sh#t with the mere whisper of private MRI clinics. There can be no debate. Ever. This is sacred.
There is no one universal health care system in this country. It's in name only.
This is unsolvable. If one believes it is solvable in an unserious country such as ours they need quickly to get their head's examined. Likely by a mental health professional the Canada Health Act does not recognize. I have been hearing the same complaints and horror stories about our health care system for more than thirty years.
Folks that is not the universal health care you have been led to believe. Individual doctors are privately run businesses who bill the government.
If we are to solve the unsolveable, we need to accept that we are batsh#t crazy when health care is the topic du jour.
There are half a dozen private MRI and CT clinics in Calgary with a wait time of a few days. They've been around for decades now and even the union dippers accept them.
Some people in other provinces need to grow up and check their envy mongering.
The good Doctor refers to the 1st principle of the Health Care Act, public administration. We are doomed from the outset because nothing in this country under the perview of public administration works the way it should. Why does AHS, for example, need dozens of VP's? Doctors and nurses are trained front line people. Explain to me how a bureaucrat aids in their performance. We need more Doctors and nurses working in more hospitals. Calgary has 4 hospitals. Phoenix I'm told has 16. As long as the unions, bureaucrats, and politicians dig their heels in against calls for change in the face of rising demand, expect more of the same.
I am amazed that there are no demonstrations in the streets about the state of our medical care. We are living in a crisis. Just another huge problem Canada is unable to face.
For many, as long as everyone is in this together, suffering together, that is better than some having better than others.
Birthdays represent a good time for reflection, and ours is tomorrow. Ideally, we reflect on the positives, but those seem to be in an ever-diminishing supply. The negatives have become worse across the board: costs of housing, food, utilities; all that we lump into the 'cost of living' have increased faster than our ability to pay. Putting taxes aside for the moment, the one cost in dollars that hasn't increased for the individual is health care, and the 'Friends of Medicare' are desperate to maintain this wonderful illusion that separates us from the evil US system. Unfortunately, it also separates us from many models (Western Europe, for example) that provide more doctors per capita and much shorter ER wait times.
Why can we not see that while dollar costs stay low, human health costs are spiralling out of control?
"Only in Canada, you say. Such a shame".
Healthcare is far from my knowledge area, but the very issues Dr. Wiedrick has described I see happening in our ER in Quesnel. This is a powerful piece and I hope the medical community continues to speak up, advocate for specific changes in legislation and collective agreements to put patients first without burning out our physicians, nurses, and administrative staff.
More nurse practitioners will help considerably, I should think.
Thank you Dr Wiedrick for the courage to speak out. To all Canadians: The collapse of our healthcare system will one day take your life or the life of a loved one. The people in the system are desperately trying to prevent that but they are burning out under this kind of stress. If we Canadians don't take up the demand for better, this collapse will hit us in the most personal way possible. That is not hypothetical. It is happening. I for one am going to write letters to my Premiere and the Prime Minister. We don't need new money, we need new thinking.
I second this comment - Thank you Dr Wiedrick for having the courage to speak out. I imagine you’re somewhat going against the grain here. But nothing is going to change until those on the front line begin speaking out in detail.
Thank you, Doctor. I'm sorry for your stress. I've been reading articles like yours, each one progessively more depressing, for four decades. I fear nothing will ever change in Canada, despite calls for change and reform dating back to the 1990s, met by cries of ideological purity and just a need to spend more and more and more on the monopolistic public system as results decayed. We are simply too locked into ideological prisons, it would seem.
the phrase “locked in ideological prisons” really resonates with me
I'd listen to the suggestions of a doctor a thousand times before I'd take the advice of a consultant.....a huge drain on financial resources in medicine, providing little and costing a lot.
Spending on health care has never been higher than it is right now yet most Canadians still think the solution is even more money. Our single payer universal system is viewed with religious fervour and other approaches which are working better in other countries are simply not open for consideration. Politicians, knowing the whole subject is a toxic third rail, won't go near it leaving rationing of care as the only way to control ballooning costs. Eventually, maybe soon, the situation will reach the point where even Liberals will be forced to consider other options. We can only hope. In the meantime, things will continue to deteriorate as more and more of the healthcare budget is wasted on self-serving bureaucracy and less and less is spent on doctors, nurses and medical equipment.
🎯
Bang on. The tried-and-true Canadian Way of tossing more money into a raging bonfire will achieve nothing, apart from worsening the situation. The problem here is not the politicians. They simply pander to a voting public that is, to be frank, so stupid, intellectually inept, and emotionally overwrought as to fall for the "he's for killing medicare!" canard tossed at anyone so unpatriotic as to suggest that our system is a national disgrace perpetuated by the religious delusion that the Canada Health Act is sacrosanct. Frankly, a voting public (and mainstream media) so stupid as to accept a binary choice between the status quo and "US style healthcare", and fall for that canard, simply has way too many people who should not be voting. However, in a democracy, even uninformed idiots can vote, and that has consequences. We are living through those consequences in the here and now.
Years ago I used to laugh at those who, when queried on what defined the Canadian identify, pointed with pride to our healthcare system. I don't laugh anymore. The moribund, rapidly decaying state of that system, and the collective inability to fix it, now perfectly encapsulates the Canadian identify.
LOL. Indeed.
I believe that Dr. Wiedrick is correct in saying that the Canada Health Act is a guilty instrument.
In the name of "national standards" the CHA imposes and prescribes and prevents. The CHA doesn't really allow much experimentation in delivery of medical services and that is a severe problem.
In my province (Alberta) the provincial government is starting a new experiment in allowing docs to work both within and without the public system in an attempt to reduce demand within the public health system. The critics are crying that universal doom song of, "American style healthcare" but refuse to think that it may be Swedish style, French style, German style, etc. All they can think of is horror stories out of the US.
None of the critics seem to be aware that many docs in the US are absolutely horrified at our "socialist style" medicine and, particularly, at the wait lists, the time delays in treatment, etc., all of which is true but is just as ignorant as the Canadians who cry "American style."
The simple fact is that virtually none of the various critics of either Canadian style or American style medicine are willing to accept is that there are three basic principles in providing service - any type of service. I am a retired accountant and I long ago learned that the service industry, including medicine, operates on those principles: you can have any two of quality service, cheap service or quick service. You cannot have all three of the attributes; at best you can have two of them simultaneously and sometimes you get one or even (horrors!) none of them.
What Canada has done is to choose cheap service and quality service (kind of). By choosing universality and free (cheap for everyone) it has made demand far larger and made it more difficult (not impossible but more difficult) to provide quality. Put differently, the greater the demand, the greater the pressures on quality. By contrast, America has chosen quick service and quality service but has ignored cheap service; expensive medical service has, of course, reduced demand. None of those choices are bad in and of themselves; they simply are what they are.
Throwing more money at the Canadian system will certainly ameliorate some of the delays but one can ask just how much will improve and whether more money will increase demand. As a further point, the more types of services that Canada covers through medicare, the greater the demands on the system. One way to generate more money for the Canadian system is to de-insure some medical procedures; I don't recommend for or against that but it is a way to generate more money.
Until the proponents of healthcare are all willing to accept that you can only have two of the three principles and make appropriate compromises that result from that, there will be no possibility of systemic improvement.
Can we please stop blaming Boomers and the previous generation for the demands on the healthcare system. Research helped prolong and increase the quality of life. Wasn’t that the goal? Demographers predicted the grey tsunami, successive governments chose to look the other way.
The good news is that we will die off. And the old that will replace us will not be at all as numerous. We are what is called to postwar baby boom. And there were not the contraceptives available then as there are now!
Canada had patient-focused funding until Pierre Trudeau cancelled the 50/50 funding deal with the provinces, I believe in 1976. He introduced annual block grants to the provinces, who then replicated the practice to hospitals & doctors. Hospitals could have so many doctors & nurses, so many operating rooms and so many procedures per year. Our health administration costs (non-medical) grew to consume 30% of our healthcare budgets. Budget management created waiting lists as our fundamental budget control tool.
We've swallowed the politicians' lies about Canada having the best healthcare system in the world. The truth is that such a system will require more taxes from all we taxpayers. There is no silver bullet. Any politician who says they have a solution is lying.