Tuesday, 12 February 2008

God save us from "public" health care

It’s ironic that the politician most credited with bringing health care under the control of government in Canada was also an ordained Baptist minister – in today’s secular parlance, a Christian fundamentalist. Given his strong religious convictions, one cannot help but wonder how Tommy Douglas would react to the drama now unfolding in a Winnipeg courtroom, where a Christian hospital is fighting, with the approval and full financial backing of the government (meaning taxpayers are footing the bill), for the “right” to stop caring for an elderly disabled man by the name of Samuel Golubchuk.

Surely Douglas would be mortified, and in the face of overwhelming evidence, would admit that his dream of state-run universal health care was nothing more than a utopian illusion – a sort of beauty and the beast story in reverse, where the innocent maiden suddenly discovers that her handsome lover is actually an ugly, sinister monster in disguise.

The saga of Samuel Golubchuk is as dark as it is tragic.

Four years ago Sam had an accident. He fell down a flight of stairs and hit his head, sustaining injuries that resulted in his becoming both physically and mentally disabled. Confined to a wheel chair, he requires assistance for the most basic of needs. Communication with the outside world has been a challenge for Sam since he can no longer speak more than a word or two at a time, and then, usually only in response to others.

Although he has been living in a long-term care facility, Sam hasn’t been confined to his bed. His loving family visits with him, takes him on outings, and brings him home for holidays and other family celebrations. It’s not always easy for outsiders to tell how Sam feels about these excursions, but his family always can. Every now and then he manages a smile. Recently, when his family brought him bowling, he even tried to push a ball down the lane. Some might say that he wasn’t very successful in his attempt, but not his children. For them, small acts like this bring the greatest joy.

Last October, Sam got sick. Although not serious at first, it quickly developed into a life-threatening case of pneumonia and he was moved to Winnipeg’s Salvation Army Grace Hospital, where his life hung in the balance for some time. Thankfully, with the appropriate treatment, he beat the pneumonia and began the long road back to health – at least, as healthy as he was before becoming sick.
Incredibly, that’s when his real trouble began.

Not surprisingly, given his age (84 years old) and disabilities, Sam’s recovery has been slow, unsteady, and difficult to measure. That seems to be a problem for the doctors and administrators at the Grace Hospital who have concluded that Sam is unlikely to recover at all. Even if he does, moreover, what kind of a life could he have anyway? With this in mind, they approached Sam’s family and asked for their permission to stop providing basic medical care for their father.
It’s important to understand that Sam was not being treated for disease or illness. The basic care that the doctors wanted to end amounted to providing him with food and water, along with assistance in breathing when he needs it. In short, they were asking his family for permission to starve Sam to death.

Naturally, the family refused. Sam’s progress may indeed be slow and unsteady, but he has been making progress. The hospital’s own medical charts confirm that he has been awake. At times, he’s been able to breath on his own. Surely, Sam’s children reason, their father’s life, as challenged as it may be, is as valuable as the life of anyone else who is not disabled, isn't it?

Too bad, said the doctors. In Manitoba they, and only they, have the final say in whether a patient lives or dies. And so the decision was made to stop caring for Sam anyway – virtually condemning him to a prolonged and painful death.

Stunned, the family obtained, ex parte, a Court Order forcing the hospital to continue Sam’s care. That should have been the end of it, but it wasn’t. Stung by the Court’s decision to restrict doctors’ ability to play God, the hospital challenged the decision. On February 13, a Judge ruled that the injunction would stand unless overturned in a civil trial.

The controversy that Sam and his family unwittingly stumbled into raises important moral, ethical and legal questions. What’s the use, for example, of a living will or assigning power-of-attorney if decisions on care and treatment rest exclusively with the doctors?

More fundamentally, it raises important questions about the true nature of Canada’s state-run health care system and its capacity to provide ongoing, basic care to the most vulnerable in our society, the aged and the disabled.

The intent of Canada’s public health care architects was noble enough. They wanted to ensure that everyone had access to proper medical care regardless of their ability to pay. The belief that the best way to achieve this objective was by making taxpayers responsible for everyone’s medical bills, instead of individual patients, turned out to be a colossal mistake though. By detaching consumers – that’s what patients are, after all – from the cost of their consumption, government control only succeeded in setting off an explosion in demand, causing health care budgets for all governments to spiral out of control.

Absent the restraint that would have been imposed on the health care market had it been permitted to operate and develop freely, government was forced to assume the role of disciplinarian. Hard caps on spending were established and strictly enforced at the same time that advances in treatment and an aging population began to exert their own pressure on the system. The results were predictable.
Because the availability of medical services was (and is) now related to the amount of money set aside by government to pay for those services, demand quickly overtook supply creating critical shortages.

It’s uncanny how closely Canadian health care has come to resemble the planned – and failed – economy of the old Soviet Union, where consumer goods were chronically scarce and store shelves often empty. Consider that most Canadian cities have fewer MRIs than many individual American hospitals have. Ontario, Canada’s wealthiest and most populous province, boasts a grand total of just nine PET scanners for the whole province, and according to a recent report issued by the Cancer Advocacy Coalition of Canada, some of these scanners – a basic diagnostic tool – are actually sitting idle.

In Canada, people wait long periods to see specialists and get treatment. A friend of mine who was suspected of having prostate cancer was told that it would take six months for him to see an oncologist and quite possibly another six months before he could have surgery, if necessary. Aware that a year’s delay could amount to a death sentence, he decided to contact a hospital in the United States. In six weeks he had been fully tested, properly diagnosed, and his cancerous prostate gland removed. Six weeks! When I asked if the whole process had been expensive, he answered simply: “Define expensive when you’re paying to save your life.”

Good point, but isn’t this exactly the situation that Canada’s heath care system was supposed to prevent?

In Canada, the need to economize has fueled a relentless drive to eliminate any duplication in the system. Many services available in one hospital were done away with in others in the same geographical area. Meanwhile, those communities with more hospitals than their size justified (according to some bureaucratic standard) were forced to merge some and close others. As the former chair of Toronto’s Hospital for Sick Children, the late Duncan Gordon once observed: “Look at the number of communities we have in Canada that have a Catholic hospital on one block and a Protestant one on the next, each trying to outdo the other. No one ever questions whether a town of 50,000 really needs two hospitals.”

Not until health care was nationalized and the government started paying the bills, that is.
Gordon’s quip is an illustration of how deeply entrenched the dogma of so-called “public” ownership of health care is in Canada. Instead of wondering why so many small towns should have more than one hospital, he should have been asking how those hospitals came to be built in the first place, and how they could have survived without ever turning away patients who could not afford to pay, all without government assistance. It simply never occurred to him that the people of those small towns were being better and more affordably served precisely because there were two hospitals duplicating services in an attempt to outdo one another.

Now, instead of hospitals competing with one another for patients, patients often have to compete with one another for hospital care.

That is the real legacy of “public” health care in Canada: patients competing for artificially limited resources while a government bureaucracy struggles to distribute those resources as fairly and effectively as possible. In that environment, how long will it be before patients have to satisfy bureaucrats that they have a reasonable chance of survival, let alone full recovery, in order to have access to basic services?

If you ask the family of Sam Golubchuk they’ll tell you that for them, the future is now.