Health Care Strike-Outs

By: Ted Mitchell
Published: 2007/08/02 (Category: Health)

The past week has seen two health care issues come up. Both sideswipe core problems and reduce to superficial, unproductive muds linging.

Strike One: Ontario announces funding for HPV vaccine.

You will hear many opinions on the effectiveness of the vaccine, the outrageous cost of this preventive health program, moral outrage at being seen to encourage promiscuity, and so on. I don't care to weigh in on these issues.

But there is something you likely won't hear in the mainstream press, even the "socialist" CBC. Why are private drug companies allowed to market these hyper-expensive vaccines that can only be used for preventive medicine?

Vaccines for HPV, chickenpox, pneumonia and meningitis are expensive, privately produced and publicly funded. Preventive medicine applies by definition to a population. It is not individual care, even in a totally private health care system. That means it should be publicly funded if possible.

This is a very different situation from simply making blood pressure pills. In that case there is cost competition and lots of choices for both the physician and patient.

In a vaccine program, there are often no competitors. Public funding is desirable because high rates of uptake are crucial to ensure the vaccine has the maximum benefit. There is even a side benefit called herd immunity, which even protects the unvaccinated.

So perhaps, such medicines should be publicly developed and manufactured in internationally cooperating government research labs so that the maximum number of people can safely benefit from their work at the lowest cost.

The present situation, which works just fine for blood pressure pills, for these vaccines is a horrible example of market failure and squandered resources.

Strike Two: The Canadian Medical Association announces "Medicare Plus".

What you see here is more of the endlessly predictable demand for more doctors, shorter waiting lists, the need to discuss private supply and funding and so on. Again, I don't wish to weigh in on this debate.

What you don't see is far more interesting and applies equally to both public and private systems: practicing smarter, more efficient, responsible medicine that could save dollars and enhance health in the short and long term.

Nothing in the CMA's initiative will provide any efficiency performance feedback for doctors, patients and politicians. I'm not surprised, this is just more evidence of the no feedback society.

There is a lot of opportunity to improve, for example:

Reduce waste by eliminating unnecessary tests (bring some sanity to bone density and MRI overuse)
Engage physicians, pharmacists, patients and families to reduce overmedication (or is it OK to have a nursing home patient on 40 different medications?)
Setting up programs to eliminate sending patients on wild-goose-chases of multiple consultations, inter-hospital transfers and generally passing the buck
Allow medical research on public health issues to have an actual impact on political decision making, as illness and health care cost of planning decisions are often far more significant than politicians care to admit.

Don't be sucked into superficially taking sides on these issues as presented, because the mainstream media often miss the boat. The really important issues are under there somewhere, and they need to be brought to light.

Dr. Ted Mitchell is a Hamilton resident juggling life as a physician, parent, and mechanical engineering student at McMaster University. He previously wrote an op-ed for the McMaster Silhouette on Red Hill economics.

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