If the definition of good governance includes the sound management of public monies and resources, then Canada has very bad governance.
The manufactured health care crisis is a case in point. Solutions to challenges of cost, quality, and access are fairly straightforward but wilfully ignored, and current trajectories towards corporatization are leading us in the wrong direction.
If the challenges are responsibly addressed, every Canadian will have access to exemplary health care, based on need rather than ability to pay. Additionally, Canadians will save money, and the economy will be positively impacted.
3 big ideas
Dr. Danielle Martin – family physician, V.P of Medical Affairs and Health Systems Solutions at Women’s College Hospital, and Assistant Professor in Medicine and Health Policy at the University of Toronto – is eminently qualified to offer solutions.
She argues that we could immediately implement “Three Big Ideas” within an expanded medicare system. Martin describes these ideas as follows:
- “20 Drugs to Save a Nation”
- “Less is More”
- “Sick with Poverty”
The first idea, “20 drugs to save a nation” would save lives while improving the economy.
Currently, one in ten Canadians can not afford their prescription medications.
Consequently, their medical conditions often worsen, which invariably leads to more expensive care, including hospital admissions. A study by the New England Journal Of Medicine, appropriately titled “Dead Man Walking” , shows that when heart attack patients fail to adhere to their prescriptions, they are more likely to be readmitted to hospital.
National public drug coverage also saves lives. As Alan Cassels explains in “Opinion: A prescription for cutting costs” , public drug plans screen drugs for value and safety better than their private drug plan counterparts. He explains:
[quote]… out of the top 50 most costly drugs covered by private drug plans, several of them wouldn’t merit coverage by public drug plans because of their poor value: they were branded drugs which had cheaper equivalent generics.[/quote]
The Vioxx tragedy
The tragedy of Vioxx resonates with this opinion: premature release of the brand drug Vioxx caused between 4,000 – 7,000 deaths in Canada.
Bulk buying through a public drug plan also means that one purchaser (versus many) can secure lower prices for medications. New Zealand, for example, pays 2.4 cents for one Lipitor pill, while Canada pays 32 cents for the same pill.
A national pharmacare program with first dollar coverage (a best case scenario) would save Canada as much as $10.7 billion per year.
Dr. Martin’s “Drugs to Save a Nation” plan would be a first step towards national pharmacare. She argues convincingly that we could start bulk-buying 20 generic drugs, and that such a step would not only improve patient-adherence rates to medications – and their health – but it would save a substantial amount of money.
Less is More
The next idea, “Less Is More”, would also save money, and lives. According to Martin, numerous medical tests, treatments, and procedures are administered more often than necessary. Consequently, health outcomes can be negatively impacted, and additional costs accrued. A sobering study by Dr. Ray Sahelian reinforces the message. He notes that “Radiation from CT scans done in 2007 will cause 29,000 cancers and kill nearly 15,000 Americans.”
The top five tests, treatments, and procedures that are done more often than necessary are:
- Electrocardiograms (ECG’s)
- Imaging tests for lower back pain
- CT scans and MRI’s for headaches
- Bone density tests (DEXA scans)
- Antibiotics for sinusitis
The excellent internet site www.choosingwiselycanada.org not only identifies the numerous problems, and dangers, associated with unnecessary testing, but it also explains “When you need them – and when you don’t” .
Poverty as disease
The final big idea, “Sick with Poverty” explains that poverty is basically a disease. The corollary of this is that if poverty can be eliminated – and 1 in 7 Canadian children live in poverty – then we will be a much healthier (and productive) society.
A 2013 study by the Canadian Medical Association, “Health care in Canada: What makes us sick?” identifies four social determinants of health:
- income
- housing
- nutrition and food security
- early childhood development
Canada’s failure to understand this aggravates and perpetuates an unnecessary situation – poverty. If all Canadians had adequate income, housing, nutrition/food security, as well as early childhood education, our population would be healthier, while societal costs for health care, policing, and other social services would be reduced, and we would collectively be more productive.
Evidence shows that Canada would save $7.6 billion per year on reduced health care costs alone if the lowest group of earners moved up by one “quintile” (to two) on a scale of earnings with the top quintile being five.
This could be financed by discarding Canada’s current welfare system
And replacing it with a Guaranteed Annual Income system which would redistribute monies through taxes.
Clearly, we have the tools and the funds to make Canada a better and stronger nation, but it won’t happen until the current theology of predatory economics that is poisoning the economy, and our collective mindset, is rejected.
Instituting Dr. Martin’s “Three Big Ideas” would be a huge step in the right direction.
Good article. It sure brought out the Cconservative trolls. The fact that a compassionate society is a cost effective society seems to be lost on some people. I guess some folks get an adrenaline buzz out of blaming poverty on the poor.
Sorry, but none of these ideas are “new”.
Affordable drugs are within our grasp as soon as political lobbyists for Drug companies are banned from influencing federal politicians votes. ( or all lobbyists for that matter) The Canadian govt can vote this into law tomorrow if they wish. But they wont, due to favours “owed” for campaign funding. Our political system has become a sad perversion of its former ‘democracy”.
Fewer unecessary tests are also easily within our grasp if lawyers and their financially ruinous awards are limited to “lost of wage” rather than “punitive”.
That being said, I recall hearing a 20 year old girl speaking of visiting 3 seperate doctors before one of them correctly identified her malignant skin cancer. Therefore how many tests are “unecessary” if you’re a doctor and have a potential lawsuit with every patient that walks through your door? Good luck with a solution for that conundrum.
The final “idea” had me almost rolling on the floor with gut splitting laughter.
And I quote:
“If all Canadians had adequate income, housing, nutrition/food security, as well as early childhood education, our population would be healthier, while societal costs for health care, policing, and other social services would be reduced, and we would collectively be more productive”
Define “adequate income” ….. $30,000 per person annually? Who pays for it? Taxpayers?
My taxes are exorbitant thank you very much.
“adequate housing”…. What’s adequate? A room for each person?
“Nutrition”…….. Ok, Im with ya there…..just ban all fast food outlets, processed foods, etc.
Food Security……last time I checked. It was pretty easy to buy food in Canada.
Early Childhood education…….you want to enroll kids earlier than Kindegarten or daycare?
And last but not least, banish Welfare and replace it with Gauranteed Annual Income.
How is renamimg welfare going to enrich people’s lives.
As much as you detest “predator economics” .
The taxes the “evil” business’s and their millions of employees pay every day go towards funding all this socialist drivel.
Communism tried and failed to garantee everyone a job ( aka income).
Time to come up with some fresh ideas. This subject has been beaten more than a rented mule.
Right… You do realize our entire system in the west is predicated upon the over-abundance of everything required for a comfortable life, right?
Have you worked for more than one company? Every single company will, at some point, be holding on to excess inventory or purposely disposing of it in order to reap higher profits. This is an inescapable fact, until we decide that this status quo of allowing others to go with less because a few of us want to lord over them, nothing will change.
Your comment,
“until we decide that this status quo of allowing others to go with less because a few of us want to lord over them, nothing will change.”
Is ridiculous in so many ways.
I highly doubt that people who consider themselves to be “middle class” consciously ( How did you put it?) “Lord Over” someone who has less than them.
They worked hard so they splurge and pamper themselves with a new car or a trip or whatever.
Your idea of a socialist utopia where no matter how hard you work everyone gets the same lifestyle has been tried in Russia, China and every other failed state. Thats why they have opened their systems to small “c” capitalism.
Why?
Because if I work hard and my neighbor is a lazy slob and we both get a Lada and a job at a steel factory earning the exact same amount. Why bother to work?
Do I really have to explain how real life works? Are you THAT naive?
I suppose you are since your comment …” Every single company will, at some point, be holding on to excess inventory or purposely disposing of it in order to reap higher profits….” essentially describes how capitalism works.
Communism is a failed pathetic attempt at “equality” which never worked.
Sorry John,
Until someone comes up with another way to reward hard workers for their extra effort.
I’ll stick with capitalism.
P.S. I’ve had numerous different careers in my 40 years of paying taxes, some union(ugh) most not. Some exciting, some not.
As for me being responsible for “societies unfortunates”
nah, sorry , aint buyin’ it.
John, if you can get all the people who “lord it over those poorer than them” ) in the world to hold hands with each other and sing
http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=2&cad=rja&uact=8&sqi=2&ved=0CC0QtwIwAQ&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3Dvo9AH4vG2wA&ei=YgeNU8fAG8LuoATH5oKIBw&usg=AFQjCNGEnscRpNqzTHXvC8_TBXGPNaPC6A
just before they give all their money to “people poorer than them”.
You might make a believer out of me.
I’m not holding my breath.
Or was that a “Belieber” out of me?
Cant remember.
Doesnt matter.
Good luck.
😉
I suppose we have to feed the trolls now and then.
Seriously? I don’t think I espoused socialism anywhere…
We do need controls on greed and avarice, things that were once considered bad.
You can go on living in a deluded and hate-filled world where you are only responsible to yourself and your dog, but that world is going to fizzle out if we don’t make a greater effort to care for one another.
Caring about the child next door going hungry or the elderly person who can’t afford their prescription pain medication is not socialism. It’s called empathy. It’s actually a good thing. I know we are all bombarded with this individualist nonsense, but at no point in the entire history of man, has there been a person who could survive alone. Or else, you know, their history ended.
So instead of slandering other nations and denigrating folks you don’t know, perhaps we could have a constructive conversation about what to do to make this a better place.
Well you may not have mentioned Socialism but everything you have espoused certainly sounds like socialism………
I think you should look in the mirror for a deluded view of the world.
Helping people? Sure I donate blood, I hold the door for elderly, I donate to charities I believe in.
But helping people who are healthy, educated and completely capable of helping themselves……..and they are on welfare. Forget it.
As far as “slandering ” and “denigrating” “nations I dont know”.
Please google “Tiananmen” for a view of the “friendly side ” of socialism……..
I think I’ll troll here for a while.
Feed me.
I know a physician here in Ottawa who spent years promoting the idea of a significant increase in the number of nurse practitioners who can, as you know, do many of the duties now done by doctors. After years of effort she gave up,not because the province was resisting the idea but because other doctors were. I suggest that in many cases it is physicians that are the biggest hurdle to better health care.