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UNDERSTANDING HEALTHCARE

by Maura Hanrahan

Michael Moore's lively new film Sicko comes when we desperately need it. Nationalized healthcare is under attack. This summer, CBC Radio's physician-in-residence asked people to call his dedicated line with their Emergency Room experiences. The over-excited message on his answer phone implied that he couldn't wait to hear a tsunami of horror stories. The media is full of such tales now, and you even hear commentators refer to the system as "ailing" or even "broken." The extreme right-wing Fraser Institute is quoted as a serious source, reporters failing to ask who funds its research. The Canadian Medical Association issues releases that urge moves towards privatization. And perhaps most worryingly, "Canada's new government," filled with old Mike Harris hacks, turns a blind eye as private clinics pop up in Alberta, Quebec, and elsewhere.

     There is an appeal to altruism, not uncommon in propaganda. The use of private clinics by those who can afford to pay will alleviate intolerable line-ups in state hospitals, we're told. Your great-aunt will get her hip replacement sooner rather than later. More private clinics would be good for the country and its ill citizens. A network of private healthcare running alongside state care would be run for profit, of course, but this is not talked about too much.

     We really have to stop and think about all this.

     First of all, Canada's healthcare system is not broken. I know this from experience, having had half a dozen operations in the past 15 years, most of them major. If you need urgent care, you will get it. And you don't have to add to your stress level by dealing with hospital billing. Unlike our American cousins, losing our houses because of sky-high hospital bills doesn't factor into getting sick in this country.

     Keep in mind that a private healthcare system is really an insurance system, not a pay-as-you-go process, as most Canadians seem to think. In such a system, the power accrues to insurance companies, to whom physicians and hospital administrators are answerable. This is abundantly clear in Sicko, but I've been to two medical conferences in the United States myself and these have convinced me that Moore is not exaggerating.

     Insurance would be expensive and insurance companies are generally not fun to deal with; after all, they don't want to pay out, because they have to make money for their shareholders. And how many of us would qualify for it? Certainly not those who need it. We see this now with health insurance for prescription drugs. I can certainly afford drug insurance, but five insurance companies refused to take me on because of the "pre-existing condition" alluded to above. Without Medicare, there would be one system for the rich and another for the poor, yes, but there would also be one system for the healthy and another for the sick. Keep in mind that "pre-existing conditions" is a huge category, as Sicko shows, including diabetes, thyroid conditions, allergies, asthma, cancer, high blood pressure, and the list goes on.

     If you want to see a broken healthcare system, go to Africa where nurses and doctors lack the basic drugs and other tools to treat HIV-AIDS. In many African countries, people die needlessly because the rudimentary healthcare available cannot meet their needs. It insults these people to repeat, as lobbyists and many Canadian citizens do, that our healthcare system is broken.

     As for physician shortages, they exist almost everywhere. In fact, everywhere I've lived --three countries and four Canadian provinces-- there were always loud choruses of people claiming that healthcare was broken or in crisis. In Britain, this led to the proliferation of private healthcare and an invasion of insurance companies, who were, I suspect, behind all the hoo and cry to begin with.

     Things aren't perfect in the current system, I agree. Human errors do occur and always will, as they will in any system. I concede that there are other problems of a more structural nature too. In some regions, there are shortages of some specialized personnel, including general practitioners. But these shortages are not general, and there are many ways to make things work better. In fact, there are few healthcare problems we can't fix --if we had the will to do so.

     None of these solutions involve privatization. A simple step forward is to educate people about the proper use of Emergency, the focus of so many complaints about wait times. So few of us seem to understand the triage system, whereby those most needing care are prioritized. Recently a woman called a radio phone-in show to complain that she had to wait nine hours in Emergency, watching other people come in and go ahead of her. The show's host reinforced her dismay and wound her up further. But she had pneumonia; she should not have been in Emergency. Both the caller and the host were unaware that there was a walk-in clinic for cases like hers a mile from the hospital.

     We also need to take better care of ourselves. Some self-care is in order for colds and the flu, for example, but sniffling Canadians troop off to doctor's offices and Emergency every winter. And by now, there is no excuse not to be aware of the value of regular exercise, healthy diets, and living smoke and scent-free.

     Granting more diagnostic and decision-making power to pharmacists would also be useful. Nurse practitioners are also part of the answer. Since turf wars are an ongoing feature of health care, politicians need to play leadership roles here, taking the kinds of actions that benefit the population, not certain professions.

     Queuing theory ought to be applied more. It has cleared up wait lists in parts of Manitoba and other jurisdictions. All it means is that a clinic with a six-week wait time hires an extra locum for six weeks, thus eliminating the queue. If good management practices are put in place, the problem should not recur. I'd prefer that the physician shortages that occur in some regions were alleviated through a more even distribution of duties among healthcare personnel, as I've said. It's not right to poach doctors from other (usually Third World) countries. But those doctors who are already in Canada should be able to qualify to practice with greater ease than they do now.

     Finally, physicians should realign their values and realize that salaries of $250,000 and up really are enough to take care of basic needs --and then some. Some specialists in my home province make $600,000 annually. Yet the physicians' association (read: union) continues to cry for more money, saying the doctors elsewhere make more money. In this, they demonstrate little regard for taxpayers, who are their fellow citizens and patients. Hasn't the wisdom of the ages and much psychology literature taught us that once you can take care of your needs with ease and treat yourself, further increased income will not increase your happiness?

     The rest of us, meanwhile, ought to realize that an hour or so in a GP's waiting room is not much of a hardship. We need perspective as much as physicians. But we don't need to privatize healthcare. The best way to take care of our people is to retain and invest in our current system.

Maura Hanrahan's (www.maurahanrahan.com) new book is The Alphabet Fleet: the Pride of the Newfoundland Coastal Service (www.flankerpress.com). She is an independent consultant and an adjunct professor of anthropology with Memorial University's Faculty of Medicine.