“This usually means having a family doctor, and, specifically, a family doctor who actually has the time and resources to properly assess and treat people before they are critically sick.”
My buddy’s son graduated from medical school last year. When he entered medical school seven years ago, there were 187 students in his class. This year, the intake at Western was 189.
There is no serious effort to increase the number of family physicians in this Province, or in this Country.
Yes, doctor supply is capped by boards across the province who set the admission numbers. It’s the root problem of the doctor shortage. U of A admission stats are 7-12% of applicants get admitted. Not because of lack of qualification, but because of lack of enrollment spots. Some spend years applying to schools before admission. Others give up and never go to med school.
The population of the province is part of the system around ERs. Like so many of our institutions, the modern health care system was built in the 60s for a population with a certain culture. That culture has changed, largely but not exclusively through mass immigration, and so the institution no longer works. All the basic assumptions about how Canadians behave are simply wrong at the population level.
Reform isn't enough. A gut job renovation is the minimum requirement.
This is just straight up outright racism. Cask strength bigotry. Get the hell outta here with that.
Show me one iota of proof that mass immigration from India or anywhere else is driving a difference in people coming into ERs. (Edit: I mean compared to if the same population increase had happened purely with European stock)
It is population aging, overwhelmingly. Old people get injured more, get sicker, recover far more slowly, and cost generally orders of magnitude more than young people in health care. It is the nature of how bodies age.
To the extent that there have been behavioural changes, they’re mostly good ones (reduction in smoking rates above all), and where there are bad ones, like e-scooters with no helmets, or massive drug addiction, it’s an equal problem across all races.
Indian and Chinese immigrants care for their elderly parents at home as much if not more than white Europeans. Actually it’s probably Scandinavian culture that was the first to ship old people into institutions (and then when there aren’t enough eldercare facilities, to be happy to lean on hospital beds).
I will rage against the comment section of The Line turning into a Nazi bar for as long as I am a paying subscriber.
The problem with this little bit of mental gymnastics is that most of the immigration to Canada in recent years has been concentrated in fairly specific regions and large areas of the country are still relatively ethically homogeneous, and guess what? Their emergency rooms are also disasters.
If we could show that performance per dollar spent was no worse in the high immigration provinces than the low immigration ones, adjusted for population density and age structure, this would be a pretty good argument.
And you couldn't be bothered to exert the least bit of effort to check that before making your assertion that it's all about immigrants, apparently.
Per capita health care spending in the high immigration provinces: Ontario is $8400 annually. It's $9673 in BC, $9370 in Alberta, and $8980 in Quebec. In low immigration provinces: Nova Scotia, $10,500. Saskatchewan: $10,000. Newfoundland: $11,000. Let's also note that places like BC and Ontario are also have much more expensive cost of living, which tends to result in higher wages that inflate costs for heavily labor-intensive services like health care.
What's the real effect there? Average age of the population. Immigrants tend to be of working age, lowering the average age of the population and also contributing more in terms of taxes because they're earning income.
Ask ChatGPT, it’ll give you ten more credible sources. Scandinavia is a global outlier in how little elderly parents are cared for by their adult children.
Scandinavians assume a professional eldercare system. If that elder care system breaks or doesn’t have enough capacity, the duties are then borne by the next-best public institution: the hospitals.
I don’t want this to be about Scandinavians. Canada isn’t much Nordic anyway, my point was just that whatever story you’re cooking up about masses of shifty Indian immigrants happy to leave their relatives to burden the health care system is, if anything, the opposite of what real stats show.
You seriously think norms about when and how to seek medical care, or how hospitals, doctors, staff or patients should operate and behave, haven't changed since 1970? Really?
The majority of the population of Ontario is descended from post-1970 immigrants. You don't think those people came with their own norms about these things? Really?
Try some basic reasoning and arithmetic better reaching for ridiculous as hominem attacks.
I get frustrated by your Steve Sailer-esque style of posting where you make vague handwaving toward “changed norms” and make me guess what you actually mean.
What norms changed after 1970 due to the majority of Ontario being descended from post-Pierre-Trudeau-reform immigrants (btw I am not sure that that’s factually true just as a matter of numbers?)
Can you be explicit so I can either agree or try to rebut your points?
It's very clear that health systems are far more bureaucratized and admin heavy than they were in 1970. That docs have more expectation of a personal life. That the population is fatter. And that patients are more demanding about care for chronic and mental illnesses than they were in 1970. Four cultural changes.
And the majority of the population in the biggest province is descended from recent immigrants.
To think that doesn't drive cultural change is silly.
To claim that it does, but only in good ways, and Canadians are responsible for all the bad things, is simply uninformed racism.
I agree that those four cultural changes are a part of what is breaking our public health care system.
I vehemently disagree that any of those four have _anything_ to do with mass non-European immigration. Family docs wanting more time outside work is, if anything, fundamentally driven by changing gender roles. The stereotypical 1950s Canadian family doc that took care of their patients 24/7/365 and kept them out of ERs could only do that because he had a wife that took care of *100% of his children and home*.
This stuff is all being driven primarily by cultural changes among the white majority; I propose that mass non-European immigration has _slowed_ this process as that immigration largely comes from more conservative cultures.
(I could write similar stuff for the other three cultural changes you said too. All of it is driven by the white majority.)
I think you are casting around for blame for cultural changes and landing in the wrong place.
Finally, I think that the impact of all of these cultural changes is absolutely dwarfed by the impact of an aging population and the impact of modern hard drugs. To first order, those two things are what is breaking health care, no other explanation needed.
You are simply engaging in racial stereotyping. I never mentioned country of origin at all, let alone race. Nor did I ascribe particular changes to particular groups. You just say "everything bad is the fault of Canadians, immigrants (and immigration) are blameless" without any real evidence. Why do you think that's acceptable, when saying that our culture has changed partly due to immigration, and a changed culture requires institutional rebuild, not just more money, somehow isn't?
Ah the 60s. Judaeo- Christian morality and values, a society built on the nuclear family and its values, one language everywhere but Quebec, immigrants expected to integrate with one or the other culture, no thoughts of forcing Quebec values on other Canadians, MPs who were actually “honorable” and resigned if someone screwed up under their watch. Being on welfare was a source of shame and something to be avoided, not a source of pride at screwing the system. Gambling was illegal not a major source of revenue to government. Gasoline and diesel was not a huge source of government revenues. Anyone breaking into a farm property could expect at the least a shotgun driven load of rock salt in the buttocks.
Now the government’s only real solution to the medical service excess demand is euthanizing its own citizens. Coupled with abortion on demand it seems that your only way of avoiding death by government is to pay more in taxes than you get in entitlements.
Reading between the lines, my takeaway is to look after my own health as best I can. The 60s of my childhood are long gone, but damn those decades went fast!
To the author's point, I too see the way the ER system is very difficult for people from all walks, and also how stressful it is for the pros who work there. Not to be overly graphic, but it is slow like a partly blocked** drainpipe. The solution is flow baby, flow.
This is an excellent essay, and I am thrilled to read something from The Line that is true to its brand: intelligent, thoughtful, introspective discussions of problems that concern all Canadians.
“Health care is, obviously, a spectacularly complicated system and it has many problems. I don’t pretend to be an expert in most of them.”
We tried it their way, Matt: their way doesn’t work. Their way has failed Canadians for decades.
When you advocate upending the system and starting from scratch, so-to-speak, you are admitting that we have a problem, and that previous solutions have not worked.
At University Hospital in London, Ontario- London’s newest hospital built in 1971- there are 200 people taking beds that do not require medical treatment; they simply refuse to leave.
One guy has been there 9 years.
In the nursing home where my brother-in-law is housed, there is a backlog for folks who require care. They are rationed out by the mentally ill who have no where else to go.
So, my 94-year-old mother and law cannot transition to long term care because access is blocked.
Take these stories- anecdotes, if you will- and extrapolate them over 10 Provinces and Territories. Extrapolate them over all the hospitals and nursing homes in Canada.
Our systems are not broken: broken systems can be fixed. Our system is rotted from the outside in, and is getting worse.
Great essay, Matt; nice to have you guys back in the saddle.
If you ask 100% of the population if they think the CDN healthcare system performs well and is good value for the dollar you get an almost 100% NO. But if you then ask them if we should make changes to the system my guess is 75% plus are saying NO.
How can this be? My best guess is the vested interests in the system ( unions, nurses, DR's,support workers, bloated administrators & a friendly media) have done an incredible job of convincing the ill informed public that they are not the problem it is just underfunding. Just send us more $$$$ and everything will be better. How has that worked out so far? Also the constant cry that any change to the system will create a US style of healthcare hasn't helped. While almost all informed folks know this is 100% false the constant cry it will, has confused the average person.
When the system has been pushed by groups trying to experiment with change governments both federally (withholding of Transfer Funds) & provincially(think BC & Dr Brian Day) they have been shot down.
Until governments begin to allow & encourage innovation (think Alberta's allowing of Doctors dual system approach) and make changes by implementing proven systems with proven effectiveness (think hybrid European systems) we will continue to flush valuable funds down the toilet & continue to get inferior outcomes.
My wife recently needed an MRI for a knee issue (we live in Alberta) and within days we were given a date - AUG 2028.
Wait 23 months or go private - so we picked up the phone and called a local provider and one week later we paid for a private MRI.
As long as the medical system is chasing a chronically ill society, no amount of funding or re-organization will address the issue - as structured, even with considerable extra resources, it is doomed to fail.
Where public healthcare systems succeed is when citizens view them as assets worth protecting, through personal commitment to health. Think Japan, Switzerland and many other Western-style democracies.
As a Canadian, in Ontario, I have a duty of care to my fellow residents to take whatever steps are within my means to ensure my physical and mental health are robust, so that I am the least burden possible on our collective, cherished resource. That is my duty, my role in healthcare.
However, in Canada, the conversation is consistently around being "entitled to free care", not our responsibility, as individuals, to keep it afloat.
The future I see is beds closing, not because of a lack of funding, but because the population has become so healthy, they are not required.
Emergency rooms for dramatic events, rapid onset calamities - life, limb and eyesight.
It is unpopular, but unless we invest in a healthy population, no level of funding will alleviate the systemic problems in the healthcare system. Great health is achievable with little to no personal funding, but does demand personal effort.
And that is far cheaper with substantially better economic outcomes than dumping money into the healthcare system.
Like you (I suspect) I feel a sense of shame at sucking on the government entitlement teat. Far too many Canadians seem to see it as a source of pride at beating the system. Especially people who can get along quite nicely without it.
I don’t see it as a Canadian value. I see it as a universal moral and ethical value. The Americans so many Canadians demonize have this value in spades.
The ones I hang with view taking advantage of entitlements as stealing from the poor.
The problem is the triage system. We need to find ways to move elderly patients from the ER into proper care for minor incidents. Right now the ER is the catch-all for everything and as the population ages that will get worse! I also think can learn from Europe and triage harsher… we don’t need people to go into the hospital for every sniffle or cough.
One more factor that needs to be dealt with are the heavy demands placed on ERs by drug addicts. They represent a lot of the "frequent flyers" tying up ER resources: the medical problems resulting from their drug use are exacerbated by related issues like mental illness and homelessness. They come into the ER, require a lot of resources to treat for whatever they've done to themselves and also because they're very difficult patients to manage. Then they're discharged, return to whatever they were doing and ignore follow-up care instructions (sometimes because they're homeless, always because of the chaos of being drug addicts), then they're back to the ER again with new problems and complications related to the previous ones. My wife has recently stepped away from bedside nursing, but during her years in the ER she estimated that something like 3/4 of the beds were likely to be tied up treating drug addicts.
Want to unclog the system? It's time to consider options like confining addicts to residential care facilities where they at least will be properly housed, fed, and cared for in ways that they can't manage themselves. The libertarian approach that's been followed in North America simply facilitates their self-destruction using the most expensive resources available like ERs.
And yet if you talk to a "normal" person about health care, ie: someone who doesn't read The Line or stay particularly well informed on politics, most will still just default to "well I don't want American health care" when the reality is that our two systems are at either end of a wide spectrum and there's plenty of room between them for a reformed system to land. So long as our populace remains largely ignorant of how badly structured our system is, the politicians will have little incentive to do the hard work of reforming it.
But don't worry, Danielle's got plenty of time to shove her nose into Edmonton's zoning bylaw. And many of the wealthy lefties in Edmonton are now singing her praises for it. How fucking dumb and easily manipulated can we be?
It's weirder even than that. The Canadian single-payer universal system is limited to primary care. A huge constellation of supportive health care services operate entirely or nearly entirely on a private-sector, for-profit model. And, surprise surprise, those are generally the services that are rapidly available. I'm pretty lucky in that I've got a good doctor (shoutout Dr. J!) at a good, modern clinic that's an easy walk (and easier drive) from my house. I can usually get in for a minor ailment in a few days. But if I want to see an eye doctor, chiropractor or dentist, and give them money for the access, same-day access usually possible and if not, certainly the next day. My basset hound can access his doctor, plus scans and diagnostic tests, vastly faster than I can. Again, for pay. The parts of the system where I'm kept waiting the longest are the ones I'm generally prevented from paying for directly.
Vets are an interesting comparison. There's similar issues there in terms of their colleges and associations limiting supply and driving up salaries. But also the giant sucking sound of the lucrative American market next door. I have a couple friends who are only vets/docs because their families could afford to send them to the UK/Ireland to get their degrees before coming back.
The healthcare system is indeed in a state of near collapse under the weight of a horrible design, and an even worse execution.
The system needs to start from scratch.
How’s this for an idea.
Make it illegal for anyone who isn’t a Canadian to work in the system.
Now don’t jump up and down and call me one of “those” people, cause I’m not. I think we need increased immigration, just not in healthcare. Why, because allowing imported people to keep the system afloat lets government off the hook that would force them to ensure there are adequately trained professionals coming out of our own population.
How about this idea. All healthcare training is provided by the government. All people who graduate go to work for the same government for a set period of time, let’s say a goal of five years, but during the transition, that might need to be ten.
After the term of required service is complete, said professional has the option of working in the new private system that will be developed, but for every hour they bill in the private system, they are required to work in the public system a set ratio of time at the prevailing rate.
The result is a strong public system and a responsive private system that can grow to meet demand, and an insurance business that people can choose to spend their after tax dollars on, along with those who wish to direct pay.
Think it can’t work?
Panama.
Done it for years.
It works.
We have built a system that is imploding on itself because bureaucrats have been sustaining the bureaucracy, which was designed by politicians, whose sole goal is to take down a third of a mil every year as a “Minister” and make sure they get invited back to the shindig next shuffle.
I actually don’t think it’s that complicated. In the US doctors have the choice of private practice or accepting insurance. Many choose to accept insurance because they want to help those who are disadvantaged and it’s easier to fill a patient panel while taking insurance. Taking insurance is less pay for US doctors compared to private practice. So I think that values decision of who a physician chooses to treat would occur similarly in Canada without any government push being needed. (Filling a private panel is time consuming and harder than you might think - and it can actually drive the cost of care down if others are in the same space charging less.
That side of American healthcare isn’t seen much from Canada or other countries because the focus is always on cost to consumer. But insurers are the ones making big bucks from those who are insured. Physicians still choose to take insurance despite lower income potential.
“Did you pay them anything? It was free then?” That’s what I said to someone complaining about the Health Care system. Matt,I’ve been in and out too many times. The system is really showing its age. And for those who can pay,build baby build! I’m 67,and I’m slowing things down. One ER doctor told me he’s noticed more seniors. It takes longer,little slower… after I asked him about the wait and crowd. And I’m lucky to have a family doctor.
“This usually means having a family doctor, and, specifically, a family doctor who actually has the time and resources to properly assess and treat people before they are critically sick.”
My buddy’s son graduated from medical school last year. When he entered medical school seven years ago, there were 187 students in his class. This year, the intake at Western was 189.
There is no serious effort to increase the number of family physicians in this Province, or in this Country.
Yes, doctor supply is capped by boards across the province who set the admission numbers. It’s the root problem of the doctor shortage. U of A admission stats are 7-12% of applicants get admitted. Not because of lack of qualification, but because of lack of enrollment spots. Some spend years applying to schools before admission. Others give up and never go to med school.
Too much administration
https://x.com/KirkLubimov/status/2108256692286930982
The population of the province is part of the system around ERs. Like so many of our institutions, the modern health care system was built in the 60s for a population with a certain culture. That culture has changed, largely but not exclusively through mass immigration, and so the institution no longer works. All the basic assumptions about how Canadians behave are simply wrong at the population level.
Reform isn't enough. A gut job renovation is the minimum requirement.
This is just straight up outright racism. Cask strength bigotry. Get the hell outta here with that.
Show me one iota of proof that mass immigration from India or anywhere else is driving a difference in people coming into ERs. (Edit: I mean compared to if the same population increase had happened purely with European stock)
It is population aging, overwhelmingly. Old people get injured more, get sicker, recover far more slowly, and cost generally orders of magnitude more than young people in health care. It is the nature of how bodies age.
To the extent that there have been behavioural changes, they’re mostly good ones (reduction in smoking rates above all), and where there are bad ones, like e-scooters with no helmets, or massive drug addiction, it’s an equal problem across all races.
Indian and Chinese immigrants care for their elderly parents at home as much if not more than white Europeans. Actually it’s probably Scandinavian culture that was the first to ship old people into institutions (and then when there aren’t enough eldercare facilities, to be happy to lean on hospital beds).
I will rage against the comment section of The Line turning into a Nazi bar for as long as I am a paying subscriber.
The problem with this little bit of mental gymnastics is that most of the immigration to Canada in recent years has been concentrated in fairly specific regions and large areas of the country are still relatively ethically homogeneous, and guess what? Their emergency rooms are also disasters.
If we could show that performance per dollar spent was no worse in the high immigration provinces than the low immigration ones, adjusted for population density and age structure, this would be a pretty good argument.
And you couldn't be bothered to exert the least bit of effort to check that before making your assertion that it's all about immigrants, apparently.
Per capita health care spending in the high immigration provinces: Ontario is $8400 annually. It's $9673 in BC, $9370 in Alberta, and $8980 in Quebec. In low immigration provinces: Nova Scotia, $10,500. Saskatchewan: $10,000. Newfoundland: $11,000. Let's also note that places like BC and Ontario are also have much more expensive cost of living, which tends to result in higher wages that inflate costs for heavily labor-intensive services like health care.
What's the real effect there? Average age of the population. Immigrants tend to be of working age, lowering the average age of the population and also contributing more in terms of taxes because they're earning income.
I'm feeling that those numbers are adjusted neither for population density nor age structure.
And show me one iota of proof for any of the racial stereotypes you are promoting.
https://www.tandfonline.com/doi/full/10.1080/17445647.2012.752334
Ask ChatGPT, it’ll give you ten more credible sources. Scandinavia is a global outlier in how little elderly parents are cared for by their adult children.
Scandinavians assume a professional eldercare system. If that elder care system breaks or doesn’t have enough capacity, the duties are then borne by the next-best public institution: the hospitals.
I don’t want this to be about Scandinavians. Canada isn’t much Nordic anyway, my point was just that whatever story you’re cooking up about masses of shifty Indian immigrants happy to leave their relatives to burden the health care system is, if anything, the opposite of what real stats show.
You seriously think norms about when and how to seek medical care, or how hospitals, doctors, staff or patients should operate and behave, haven't changed since 1970? Really?
The majority of the population of Ontario is descended from post-1970 immigrants. You don't think those people came with their own norms about these things? Really?
Try some basic reasoning and arithmetic better reaching for ridiculous as hominem attacks.
I get frustrated by your Steve Sailer-esque style of posting where you make vague handwaving toward “changed norms” and make me guess what you actually mean.
What norms changed after 1970 due to the majority of Ontario being descended from post-Pierre-Trudeau-reform immigrants (btw I am not sure that that’s factually true just as a matter of numbers?)
Can you be explicit so I can either agree or try to rebut your points?
It's very clear that health systems are far more bureaucratized and admin heavy than they were in 1970. That docs have more expectation of a personal life. That the population is fatter. And that patients are more demanding about care for chronic and mental illnesses than they were in 1970. Four cultural changes.
And the majority of the population in the biggest province is descended from recent immigrants.
To think that doesn't drive cultural change is silly.
To claim that it does, but only in good ways, and Canadians are responsible for all the bad things, is simply uninformed racism.
I agree that those four cultural changes are a part of what is breaking our public health care system.
I vehemently disagree that any of those four have _anything_ to do with mass non-European immigration. Family docs wanting more time outside work is, if anything, fundamentally driven by changing gender roles. The stereotypical 1950s Canadian family doc that took care of their patients 24/7/365 and kept them out of ERs could only do that because he had a wife that took care of *100% of his children and home*.
This stuff is all being driven primarily by cultural changes among the white majority; I propose that mass non-European immigration has _slowed_ this process as that immigration largely comes from more conservative cultures.
(I could write similar stuff for the other three cultural changes you said too. All of it is driven by the white majority.)
I think you are casting around for blame for cultural changes and landing in the wrong place.
Finally, I think that the impact of all of these cultural changes is absolutely dwarfed by the impact of an aging population and the impact of modern hard drugs. To first order, those two things are what is breaking health care, no other explanation needed.
You are simply engaging in racial stereotyping. I never mentioned country of origin at all, let alone race. Nor did I ascribe particular changes to particular groups. You just say "everything bad is the fault of Canadians, immigrants (and immigration) are blameless" without any real evidence. Why do you think that's acceptable, when saying that our culture has changed partly due to immigration, and a changed culture requires institutional rebuild, not just more money, somehow isn't?
Ah the 60s. Judaeo- Christian morality and values, a society built on the nuclear family and its values, one language everywhere but Quebec, immigrants expected to integrate with one or the other culture, no thoughts of forcing Quebec values on other Canadians, MPs who were actually “honorable” and resigned if someone screwed up under their watch. Being on welfare was a source of shame and something to be avoided, not a source of pride at screwing the system. Gambling was illegal not a major source of revenue to government. Gasoline and diesel was not a huge source of government revenues. Anyone breaking into a farm property could expect at the least a shotgun driven load of rock salt in the buttocks.
Now the government’s only real solution to the medical service excess demand is euthanizing its own citizens. Coupled with abortion on demand it seems that your only way of avoiding death by government is to pay more in taxes than you get in entitlements.
Reading between the lines, my takeaway is to look after my own health as best I can. The 60s of my childhood are long gone, but damn those decades went fast!
To the author's point, I too see the way the ER system is very difficult for people from all walks, and also how stressful it is for the pros who work there. Not to be overly graphic, but it is slow like a partly blocked** drainpipe. The solution is flow baby, flow.
This is an excellent essay, and I am thrilled to read something from The Line that is true to its brand: intelligent, thoughtful, introspective discussions of problems that concern all Canadians.
“Health care is, obviously, a spectacularly complicated system and it has many problems. I don’t pretend to be an expert in most of them.”
We tried it their way, Matt: their way doesn’t work. Their way has failed Canadians for decades.
When you advocate upending the system and starting from scratch, so-to-speak, you are admitting that we have a problem, and that previous solutions have not worked.
At University Hospital in London, Ontario- London’s newest hospital built in 1971- there are 200 people taking beds that do not require medical treatment; they simply refuse to leave.
One guy has been there 9 years.
In the nursing home where my brother-in-law is housed, there is a backlog for folks who require care. They are rationed out by the mentally ill who have no where else to go.
So, my 94-year-old mother and law cannot transition to long term care because access is blocked.
Take these stories- anecdotes, if you will- and extrapolate them over 10 Provinces and Territories. Extrapolate them over all the hospitals and nursing homes in Canada.
Our systems are not broken: broken systems can be fixed. Our system is rotted from the outside in, and is getting worse.
Great essay, Matt; nice to have you guys back in the saddle.
If you ask 100% of the population if they think the CDN healthcare system performs well and is good value for the dollar you get an almost 100% NO. But if you then ask them if we should make changes to the system my guess is 75% plus are saying NO.
How can this be? My best guess is the vested interests in the system ( unions, nurses, DR's,support workers, bloated administrators & a friendly media) have done an incredible job of convincing the ill informed public that they are not the problem it is just underfunding. Just send us more $$$$ and everything will be better. How has that worked out so far? Also the constant cry that any change to the system will create a US style of healthcare hasn't helped. While almost all informed folks know this is 100% false the constant cry it will, has confused the average person.
When the system has been pushed by groups trying to experiment with change governments both federally (withholding of Transfer Funds) & provincially(think BC & Dr Brian Day) they have been shot down.
Until governments begin to allow & encourage innovation (think Alberta's allowing of Doctors dual system approach) and make changes by implementing proven systems with proven effectiveness (think hybrid European systems) we will continue to flush valuable funds down the toilet & continue to get inferior outcomes.
My wife recently needed an MRI for a knee issue (we live in Alberta) and within days we were given a date - AUG 2028.
Wait 23 months or go private - so we picked up the phone and called a local provider and one week later we paid for a private MRI.
As long as the medical system is chasing a chronically ill society, no amount of funding or re-organization will address the issue - as structured, even with considerable extra resources, it is doomed to fail.
Where public healthcare systems succeed is when citizens view them as assets worth protecting, through personal commitment to health. Think Japan, Switzerland and many other Western-style democracies.
As a Canadian, in Ontario, I have a duty of care to my fellow residents to take whatever steps are within my means to ensure my physical and mental health are robust, so that I am the least burden possible on our collective, cherished resource. That is my duty, my role in healthcare.
However, in Canada, the conversation is consistently around being "entitled to free care", not our responsibility, as individuals, to keep it afloat.
The future I see is beds closing, not because of a lack of funding, but because the population has become so healthy, they are not required.
Emergency rooms for dramatic events, rapid onset calamities - life, limb and eyesight.
It is unpopular, but unless we invest in a healthy population, no level of funding will alleviate the systemic problems in the healthcare system. Great health is achievable with little to no personal funding, but does demand personal effort.
And that is far cheaper with substantially better economic outcomes than dumping money into the healthcare system.
Like you (I suspect) I feel a sense of shame at sucking on the government entitlement teat. Far too many Canadians seem to see it as a source of pride at beating the system. Especially people who can get along quite nicely without it.
I don’t see it as a Canadian value. I see it as a universal moral and ethical value. The Americans so many Canadians demonize have this value in spades.
The ones I hang with view taking advantage of entitlements as stealing from the poor.
The problem is the triage system. We need to find ways to move elderly patients from the ER into proper care for minor incidents. Right now the ER is the catch-all for everything and as the population ages that will get worse! I also think can learn from Europe and triage harsher… we don’t need people to go into the hospital for every sniffle or cough.
Yes, a UTI can be dealt with by a licensed pharmacist. No need to go into ER for it. Or a sore throat etc etc.
One more factor that needs to be dealt with are the heavy demands placed on ERs by drug addicts. They represent a lot of the "frequent flyers" tying up ER resources: the medical problems resulting from their drug use are exacerbated by related issues like mental illness and homelessness. They come into the ER, require a lot of resources to treat for whatever they've done to themselves and also because they're very difficult patients to manage. Then they're discharged, return to whatever they were doing and ignore follow-up care instructions (sometimes because they're homeless, always because of the chaos of being drug addicts), then they're back to the ER again with new problems and complications related to the previous ones. My wife has recently stepped away from bedside nursing, but during her years in the ER she estimated that something like 3/4 of the beds were likely to be tied up treating drug addicts.
Want to unclog the system? It's time to consider options like confining addicts to residential care facilities where they at least will be properly housed, fed, and cared for in ways that they can't manage themselves. The libertarian approach that's been followed in North America simply facilitates their self-destruction using the most expensive resources available like ERs.
And yet if you talk to a "normal" person about health care, ie: someone who doesn't read The Line or stay particularly well informed on politics, most will still just default to "well I don't want American health care" when the reality is that our two systems are at either end of a wide spectrum and there's plenty of room between them for a reformed system to land. So long as our populace remains largely ignorant of how badly structured our system is, the politicians will have little incentive to do the hard work of reforming it.
For fuck's sake in Alberta multiple people have died after waiting 12+ hours in the ER and it's close to a year since the government announced a triage program that is STILL not implemented: https://edmontonjournal.com/news/politics/alberta-ucp-edmonton-grey-nuns-hospital-health
But don't worry, Danielle's got plenty of time to shove her nose into Edmonton's zoning bylaw. And many of the wealthy lefties in Edmonton are now singing her praises for it. How fucking dumb and easily manipulated can we be?
It's weirder even than that. The Canadian single-payer universal system is limited to primary care. A huge constellation of supportive health care services operate entirely or nearly entirely on a private-sector, for-profit model. And, surprise surprise, those are generally the services that are rapidly available. I'm pretty lucky in that I've got a good doctor (shoutout Dr. J!) at a good, modern clinic that's an easy walk (and easier drive) from my house. I can usually get in for a minor ailment in a few days. But if I want to see an eye doctor, chiropractor or dentist, and give them money for the access, same-day access usually possible and if not, certainly the next day. My basset hound can access his doctor, plus scans and diagnostic tests, vastly faster than I can. Again, for pay. The parts of the system where I'm kept waiting the longest are the ones I'm generally prevented from paying for directly.
Probably just a coincidence.
Vets are an interesting comparison. There's similar issues there in terms of their colleges and associations limiting supply and driving up salaries. But also the giant sucking sound of the lucrative American market next door. I have a couple friends who are only vets/docs because their families could afford to send them to the UK/Ireland to get their degrees before coming back.
Hey Matt,
Interesting article.
The healthcare system is indeed in a state of near collapse under the weight of a horrible design, and an even worse execution.
The system needs to start from scratch.
How’s this for an idea.
Make it illegal for anyone who isn’t a Canadian to work in the system.
Now don’t jump up and down and call me one of “those” people, cause I’m not. I think we need increased immigration, just not in healthcare. Why, because allowing imported people to keep the system afloat lets government off the hook that would force them to ensure there are adequately trained professionals coming out of our own population.
How about this idea. All healthcare training is provided by the government. All people who graduate go to work for the same government for a set period of time, let’s say a goal of five years, but during the transition, that might need to be ten.
After the term of required service is complete, said professional has the option of working in the new private system that will be developed, but for every hour they bill in the private system, they are required to work in the public system a set ratio of time at the prevailing rate.
The result is a strong public system and a responsive private system that can grow to meet demand, and an insurance business that people can choose to spend their after tax dollars on, along with those who wish to direct pay.
Think it can’t work?
Panama.
Done it for years.
It works.
We have built a system that is imploding on itself because bureaucrats have been sustaining the bureaucracy, which was designed by politicians, whose sole goal is to take down a third of a mil every year as a “Minister” and make sure they get invited back to the shindig next shuffle.
I actually don’t think it’s that complicated. In the US doctors have the choice of private practice or accepting insurance. Many choose to accept insurance because they want to help those who are disadvantaged and it’s easier to fill a patient panel while taking insurance. Taking insurance is less pay for US doctors compared to private practice. So I think that values decision of who a physician chooses to treat would occur similarly in Canada without any government push being needed. (Filling a private panel is time consuming and harder than you might think - and it can actually drive the cost of care down if others are in the same space charging less.
That side of American healthcare isn’t seen much from Canada or other countries because the focus is always on cost to consumer. But insurers are the ones making big bucks from those who are insured. Physicians still choose to take insurance despite lower income potential.
“Did you pay them anything? It was free then?” That’s what I said to someone complaining about the Health Care system. Matt,I’ve been in and out too many times. The system is really showing its age. And for those who can pay,build baby build! I’m 67,and I’m slowing things down. One ER doctor told me he’s noticed more seniors. It takes longer,little slower… after I asked him about the wait and crowd. And I’m lucky to have a family doctor.