Costa Rica is one of the most amazing places you'll ever visit, with the happiest people I've ever met. How it's so close to a utopia I'm not entirely sure. It's not Marxist - sorry, revivalists. It's not from any sense of wealth - most of the people are working class or poor, and unemployment, taxes, and sovereign debt are high. It can't be from any sense of safety, either - the country has no standing army by law, over 100 active volcanoes, regular earthquakes, and poisonous frogs are everywhere. And the national drink - a chili guaro - is like a preposterously spicy Bloody Mary that's too weak to affect anything other than your sinuses (and God knows I tested this assertion to the fullest).
I've come to the conclusion that the source of Costa Rica's happiness must be its national animal. I don't mean one of the gazillion species of toxic frog, but rather my recently anointed spirit animal, the minimally mobile sloth.
Yes, the sloth. Talk about a creature that just gets it...live in a tropical paradise, eat, sleep, chill, sleep some more, and never sweat the small stuff.
Of course, we live in Canada, not Costa Rica. Our weather is atrocious, so much so that we rationalize life in this tundra by inventing ice sports best played while drunk (and get up in arms when we discover people might want to cheat at it when something other than the next round is on the line). And our Prime Minister continues to find ways to rub our noses in the misery of Canadian winter, embarking on a vainglorious Bollywood-cosplay misadventure that would make Peter Sellers blush. But this is a health care blog, and I digress.
Canada was in a less embarrassing but no less interesting set of headlines this month, as its prized (sanctified?) Medicare system was the subject of a feature in the pages of The Lancet, one of medicine's most storied and prestigious journals. But like most items in the medical literature, the Lancet profile didn't translate well in the popular press, exemplified by this piece in the Washington Post:
Long-term care is the obvious case of inadequate investment, but much the same could be said of mental health and addiction treatment.
In contrast, the second "government run" component is a set of highly contentious bureaucracies. They're created with important-sounding descriptions - regional health authorities, care access centres, arms-length agencies - that belie the haplessness under which these organizations run. They're (supposedly) designed to correct some real or perceived deficiency, like lack of communication, poor distribution of services, or not enough "integration". Rarely will these bureaucracies have both the right people and sufficient power to achieve their goals, however. They are fated to fail, infuriating both providers and patients.
Wait times are neither caused nor affected by the design of Medicare. Every test, consultation, or procedure you hear people waiting a long time for is insured under Medicare. The long wait is either a function of lack of support capacity (like operating room times), the insatiability of demand (more MRI machines means doctors now order them when they didn't bother a decade earlier), or the legal constraints of the Canada Health Act. Without getting overly wonky, the federal government legally mandates that all these medically necessary services be covered under Medicare, but no longer pays its half of the costs the way it used to. Without adequate money to meet demand, the provinces charged with administering Medicare have to control costs by rationing, hence the ballooning wait times. In Canada, he who shortchanges the piper is apparently also free to call the tune.
Aboriginal health status cannot and will not improve through Medicare. Health insurance does not provide clean water, secure housing, a decent job, or education. It's a means to medical care and related services, nothing more. The "government-run health system" can improve Aboriginals' health status, but only to the extent of providing services and access to health care...for which, incidentally, the government doesn't spend anywhere near what it needs to. But any notion that reforms to Medicare will be a panacea to the plight of Aboriginal Canadians is wrong. That's a different policy discussion altogether, even setting aside the less concrete questions around reconciliation.
And that's health care in Canada in a nutshell. If you can understand this, you're not only a damn intelligent sloth, you're probably more informed that most politicians and pundits. And if that doesn't tickle your excitement, well, it's time to wake yourself up with the help of some Costa Rica scenery and shots of chili guaro.
I've come to the conclusion that the source of Costa Rica's happiness must be its national animal. I don't mean one of the gazillion species of toxic frog, but rather my recently anointed spirit animal, the minimally mobile sloth.
Yes, the sloth. Talk about a creature that just gets it...live in a tropical paradise, eat, sleep, chill, sleep some more, and never sweat the small stuff.
Of course, we live in Canada, not Costa Rica. Our weather is atrocious, so much so that we rationalize life in this tundra by inventing ice sports best played while drunk (and get up in arms when we discover people might want to cheat at it when something other than the next round is on the line). And our Prime Minister continues to find ways to rub our noses in the misery of Canadian winter, embarking on a vainglorious Bollywood-cosplay misadventure that would make Peter Sellers blush. But this is a health care blog, and I digress.
Canada was in a less embarrassing but no less interesting set of headlines this month, as its prized (sanctified?) Medicare system was the subject of a feature in the pages of The Lancet, one of medicine's most storied and prestigious journals. But like most items in the medical literature, the Lancet profile didn't translate well in the popular press, exemplified by this piece in the Washington Post:
Long-term care is the obvious case of inadequate investment, but much the same could be said of mental health and addiction treatment.
In contrast, the second "government run" component is a set of highly contentious bureaucracies. They're created with important-sounding descriptions - regional health authorities, care access centres, arms-length agencies - that belie the haplessness under which these organizations run. They're (supposedly) designed to correct some real or perceived deficiency, like lack of communication, poor distribution of services, or not enough "integration". Rarely will these bureaucracies have both the right people and sufficient power to achieve their goals, however. They are fated to fail, infuriating both providers and patients.
Wait times are neither caused nor affected by the design of Medicare. Every test, consultation, or procedure you hear people waiting a long time for is insured under Medicare. The long wait is either a function of lack of support capacity (like operating room times), the insatiability of demand (more MRI machines means doctors now order them when they didn't bother a decade earlier), or the legal constraints of the Canada Health Act. Without getting overly wonky, the federal government legally mandates that all these medically necessary services be covered under Medicare, but no longer pays its half of the costs the way it used to. Without adequate money to meet demand, the provinces charged with administering Medicare have to control costs by rationing, hence the ballooning wait times. In Canada, he who shortchanges the piper is apparently also free to call the tune.
Aboriginal health status cannot and will not improve through Medicare. Health insurance does not provide clean water, secure housing, a decent job, or education. It's a means to medical care and related services, nothing more. The "government-run health system" can improve Aboriginals' health status, but only to the extent of providing services and access to health care...for which, incidentally, the government doesn't spend anywhere near what it needs to. But any notion that reforms to Medicare will be a panacea to the plight of Aboriginal Canadians is wrong. That's a different policy discussion altogether, even setting aside the less concrete questions around reconciliation.
And that's health care in Canada in a nutshell. If you can understand this, you're not only a damn intelligent sloth, you're probably more informed that most politicians and pundits. And if that doesn't tickle your excitement, well, it's time to wake yourself up with the help of some Costa Rica scenery and shots of chili guaro.
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Sunday, February 25, 2018
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Aboriginal Canadians,
Canada,
Canada Health Act,
determinants of health,
doctors,
health care,
health policy,
home care,
hospitals,
medical associations,
politics,
public health,
wait times
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