Be Careful What You Wish For!

A couple of weeks back, I was crossing the street at a corner where I duly noted the flashing red stop lights. As I reached the other side of the street, a woman confronted me, her arms folded belligerently across her chest. "The light is RED", she stated, condescension dripping from every word.

"The lights are broken," I replied without obvious rancor, "You can tell by the way they're flashing." I made a hand gesture that mimicked the flashing, for good measure.

The woman finally looked at traffic lights, and realized that, yes, they were broken. Did she apologize? No. Did she thank me for pointing it out? No. But, dear reader, please note that with her attitude, she could very well have spent quite some time standing there, on that corner, waiting for traffic lights to turn green that were never going to turn green. Or at least, not until a repair crew came along and fixed them... .

The woman saw only what she expected to see, and what she wanted to see: red lights and a jay-walker. In the end, it took the supposed jay-walker to open her eyes to the fact that she was stupidly waiting for something to happen that never would. But, of course, she wasn't the least bit grateful; they never are when they've just made an ass of themselves.

Moving on to China... .

Quite a few years ago, I went on trip to that ancient land. It was an interesting tour, one that offered a rare opportunity to actually experience much of the good, some of the bad, and a very little bit of the ugly. Because we traveled Beijing to Shanghai overland, we were able to experience actual overnight train travel on the Chinese rail system, days of intense smog as we passed through the countryside in buses, and a very limited view of actual Chinese towns, villages and other sites that you don't see when flying city-to-city. We even crashed a couple of weddings!

All in all, it was a pleasant tour with just enough of a glimpse into real Chinese life to provide us with the illusion that we had seen the real, modern day China. I suppose many of the people on that tour came away believing that. I, on the other hand, was well aware of the fact that there were things we were not seeing. Even if this was a more earthy tour, a tour that was designed for people who were interested in the actual culture and traditions, it was still a carefully chaperoned tour. The sights were specifically selected to highlight what was best in Chinese culture. The hotels that we stayed at were hotels specifically designated as hotels for foreigners. Yes, in China there are/were hotels that are designated for foreign travelers and hotels that are designate for regional and/or Chinese travelers. The one we stayed in in Shanghai was split into two sides; one side for foreigners, the other for regional travelers.

Anyone with open eyes could easily have seen that, as foreigners, we were receiving special treatment. Yes, we were allowed to go out an wander around when time permitted, but really, only a fool would expect the locals to start spilling dirt about how they really live with complete outsiders. Most of the locals couldn't even speak enough English to know the difference between 'hello' and 'goodbye' (as I discovered when a happy local tried to extend her greetings to me outside of a McDonald's).

How much truth about the Chinese system do you think I came away with from that visit? If I asked people about the prison system, and the stories of organ-harvesting, do you think they would have told me that it is all true? If it is true, how would this trip have proven, or disproven it? The point of these types of tours is to present the best side of a country, and to make certain that the foreign visitors only come into contact with a carefully selected set of experiences. The idea is to make them come away from the trip with a positive notion of the country and the system that the country operates under.

So, if you go to Scandinavia, do you expect your hosts to show you the down and out people in their cities? You'll be carefully steered away from anyone with a gripe against the system. To see that side of things, well, you have to have a guide who will introduce you to it. The same goes for other countries and their systems.

Okay, so after that long introduction, let's get to the point of this post. I live in Quebec. We have a universal health care system. We have government issued medicare cards that we present at the doctor's office, or hospital reception desk, and our trip is paid for by our government insurance.

Sounds good, doesn't it? Free health care for all. No going broke if the unthinkable happens and we get hit by a major accident or illness! Well, yes and no. It's not that simple, and I'll tell you why.

First of all, our health care system is strapped for cash. The provincial government allots a budget, and it just isn't enough to cover everything. Prior to the 1976 provincial election, an election that brought a nationalist government with socialist leanings into power, the province was a booming economic center. Montreal was the premier city in eastern Canada. In those days, Toronto was a drab backwater that people dreaded being transferred to by their companies. It was dead, it was boring, and it was insignificant. The threat of nationalization, however, sent companies running for the protection of their assets by transferring their head-offices to drab, boring, back-water Toronto. The rest, as they say, is history.

The fact that our cash-cow fled the pasture long ago is obvious to any visitor; our streets and highways are in bad shape, pot holes are everywhere, and pieces of overpasses and bridges sometimes fall on vehicles passing underneath. Sinkholes large enough to swallow construction equipment have opened up in the heart of the downtown core often enough in the last years to cause considerable consternation. With the cash-cow long gone, even with one of the highest income tax rates in the country, and with a VAT of around 14%, our finances just can't stretch far enough to pay for everything. Things need to be tweaked, here and there.

When it comes to health care, basic services need to be provided and paid for. I agree wholeheartedly on that point. People should not be turned away from the doctor's office, or the hospital, because they can't afford to pay for treatment - at least not when they are sincerely ill. That would be counter-productive, and detrimental to our economy. Sick people can't work, and can't pay taxes. However, providing free health-care for everyone is a challenge when the budget is limited. The end result is something of a disaster:

• Wait times at the doctor's office are very long. At a walk-in clinic (one where you don't need an appointment) a three-hour wait is considered wonderfully short. Even with an appointment the wait is often long and tedious.
• If you don't have a family doctor, or yours retires, it is extremely difficult to find a new one. You can put your name on a waiting list, but the wait time is calculated in years, not weeks, or months. When one comes up, he/she may be a specialist in infant circumcision, while you are a senior, or a heart patient.
• Your family doctor decides on whether or not you get to see a specialist, and then the specialist decides on whether or not to send you for specific tests. Your family doctor can order basic blood tests, x-rays and the like, but once again, it is up to him/her to make that decision. You can't just walk into a hospital and ask for tests.
• Getting appointment with a specialist can take months, and even years. I once waited more than two years to see a specialist in sports medicine/rheumatology. Once the specialist decides on tests, there is another long wait. Audiology tests are currently at a wait time of over two years, as are colonoscopies, certain ultrasounds, and a whole host of other high-in-demand tests.
• Possible cancer patients are given a high priority for certain tests, however, once the diagnosis is confirmed, getting the actual treatment can be agonizingly slow.
• Here is a disturbing fact: elderly patients often die needlessly because they are considered a low priority for treatment when they land in hospitals.
• Many tests and treatments that are available elsewhere are not available here. If you want them, you have to travel abroad.
• Not every test or medical procedure is covered under our medicare program.
• Emergency rooms at hospitals are often so backlogged that people end up waiting literally for days on stretchers in aisles and waiting rooms before being seen by a doctor and being admitted to the hospital for treatment. Still, in some cases, it is easier and faster to go via the emergency room route if you need specific tests done.
• Most hospitals no longer offer certain tests, and other services such as physiotherapy, to out-patients. Since physiotherapy is only paid for by medicare when done at a hospital, you're shit out of luck if you are not a hospital patient and have no insurance, or are too broke to pay for it at a private clinic.
• In addition to paying for health insurance through our taxes, if the company we work for has more than ten employees, we are obliged by law enroll in a private health insurance plan. The cost of this additional insurance is split between the employer and employee.
• We have a provincial prescription drug plan that we also have to pay into at tax time. If we are not covered by a private insurance through our employer, we are obliged to enroll in the government plan. Please note, however, that not all drugs are covered under it, and that we still have to pay a certain amount of deductibles on each and every prescription. If the drug prescribe isn't on the official list of drugs that the government covers, you've gotta pay. Brand name drugs are only accepted under the plan if there is no generic alternative. In addition, if two drugs are combined in one pill, it ain't covered.
• Dental care is not covered under medicare.

I have heard the argument put forth that free health care doesn't lead to people running to the doctor needlessly every time they have a case of the sniffles. Unfortunately, that is completely wrong. One of the main reasons our emergency wards are so badly overcrowded, and wait times at our doctors' offices are so long, is precisely because people treat every sniffle as a life-threatening occurrence. During flu season the situation can become so bad that the government and hospitals beg people not to flood emergency rooms without real reason. People literally drag their children to emergency wards because of a case of the sniffles instead of waiting until morning and going to see their regular doctor.

So, what happens when such an overload of demand hits a system where the resources are limited? The doctors can't cope, but can't escape either. They have to get the patients in and out as quickly as possible, in order to accommodate the next batch. The end result is that doctors either don't take the time to properly investigate the patient's illness, or they simply usher them out of the door with whatever prescription seems appropriate or that the patient asks for. It isn't unusual for a doctor to ask what meds the person needs, and then write the prescription without even a physical exam, or to do a cursory exam and and say there's no problem before quickly ushering the patient out.

All of this, of course, makes getting proper treatment impossible at times. Good doctors quickly burn out and become automatons.

The solution? Despite cries of 'we can't have a two-tiered health system!', most provinces in Canada began allowing private healthcare, paid for by private insurance. This took some of the pressure off the overloaded public healthcare system, and allowed those people who could pay, or were covered by insurance, to get medical tests faster than they would through the public system. It was, in many ways, a win-win situation. Those people who couldn't pay still had access to healthcare, and, in theory at least, wait times would be reduced. Sadly, though, it still isn't enough.

All of this nattering about a public healthcare system is, in reality, only a smokescreen that masks a much bigger problem. We don't have enough doctors! Worse yet, many doctors choose to run away and work in other countries where they can charge a small fortune for their services. So long as doctors are at a premium, this will continue.

My opinion is that the root of the problem lies in the fact that medical schools are elitist institutions, not because they only want the best, but because they want to keep the demand for doctors high. If they churned out as many doctors as law schools churn out lawyers, the market value that doctors command would drop significantly. Instead of charging 500$ per visit, competition would force them to drop their rates to 5$ per visit. This, they do not want. Yet, this is what we really need.

So, once again, instead of chasing the red herring, look more closely at the picture to find the real problem. Open up admission to medical schools. There are plenty of quality candidates, even better candidates than the ones currently being let in, trying desperately to get in. Unlike those successful candidates, these people are not in it only for status and wealth that becoming a doctor bestows upon them. At the moment, as things stand, these people are being forced to study abroad (in the Caribbean quite often), or choose a different career path! Furthermore, there are plenty of immigrants who were practicing doctors in their own countries, people whom we lured here with express promises of a brilliant career in Canadian medicine, whom we now refuse to re-certify. WTF??!! I've met a couple these individuals, and they are probably more intelligent and quicker off the ball than many practicing Canadian doctors.

The cost of medical school also has to go down. That, however, is the easiest part of it! The more students enrolled in a medical school, the more money coming in to the school. The more money coming in, the greater profit vis-a-vis overhead. Thus, costs go down, and that can be passed on to the students in the form of lower tuition fees.

Don't start griping about classes being bigger and the quality going down. More classes equal more students, equals more income, equals the possibility of adding more classes, and so on. In fact, more medical schools are really what's needed. And, once we have more doctors, patients will have more choice. Bad doctors will not be able to benefit from a bottle-necked system that demands high payments, but offers no choice.

That is how people should look at the crisis in health care. Stop standing on the street corner, sneering at the person who actually noticed that the traffic lights were broken! And, stop being wowed by the tour guide who shows you only the pretty tourist attractions. Look at the real problem, instead.

Image: Pixabay