Providing quality health care is not about sacred packages of philosophy which must not be tainted! You need to listen to feedback from the public and community physicians.
By Ted Mitchell
Published September 11, 2008
I attended Monday's special meeting of the City's Board of Health purely as a spectator. Here are my impressions on the current state of Hamilton's hospital restructuring soap opera.
Council called this meeting to have the Hamilton Health Service (HHS) "Access to the Best Care" proposal further explained and answer some questions and concerns that councillors have been hearing from their constituents.
So far, this story has been about the content of the proposal. Content is no longer the problem. Transparency is absent, and dark opacity has started to infiltrate the hallowed halls of HHS administration. I felt like I was watching Lord of the Rings, and something really evil was about to happen.
Let's recap and shed some light on the events of that evening.
First order was a motion to allow two five-minute presentations from community speakers, both of them experienced older physicians: Dr. Ken Ockenden of the Ainslie Wood Westdale Community Association, ex emergency medicine, and Dr. Bob James, a family physician from Dundas.
Both of these gentlemen had prepared a script and clearly had warning of this meeting, yet council still needed to pass a motion to allow them to speak. But get this: two councillors actually registered as opposed to allowing their delegations. Pardon? Was I in China?
Then I took a deep breath and settled into the 65-minute-long Powerpoint presentation by about eight fancy-suited members of the HHS, who, of course, were allowed to speak first and without time limit.
It is truly astounding how many words these people can say without conveying any actual information. I thought that politicians were good at that, but HHS admin takes it to a whole new plane. There is even a medical diagnosis I will offer: Receptive aphasia: gobbledygook speech that superficially sounds normal but makes no sense.
Sorry, this rhetoric is rubbing off on me; I'll get back to the point.
In that long presentation, all HHS representatives spoke in generalities. Not once in an hour did anyone actually mention that McMaster would be closing to adult patients, although that was the elephant in the room that drew a capacity public audience.
The only new bit of information that had not been put forward before, and the only direct fact I could identify, was a decision to relocate the proposed Urgent Care Centre from the west Mountain to the family practice building on Main Street West by Hwy 403.
So, an hour was wasted in rhetoric that all the councillors had surely heard before.
Then our two community doctors were allowed to speak. They raised several important concerns, similar to points I've made on this site, and together conveyed more information than everyone in the entire previous hour had managed.
There was a brief attempt by an older gentleman from the audience to speak, and he was shut down promptly.
Councillors then questioned members of the HHS on the plan's specifics. Here I was pleasantly surprised by council's pointed questions. I was unimpressed by the answers, if you could call them that.
If I am asked a question, you will get a yes, no, maybe, it depends, or I don't know type of answer. Nobody from the HHS seems capable of giving answers in that form.
For example, a couple of councillors asked what impact the McMaster closure would have on ambulance services in the City, which is doubly important because the City foots the bill for this.
The best that CEO Murray Martin could come up with, I think (heavily interpreting rhetoric here), was that they didn't look at that specifically, but it should be about the same, and there are several ways it could decrease demand, and many patients already go directly to the most appropriate hospital, bypassing McMaster.
Nobody even acknowledged that patients west of the 403 will have to travel several extra kilometers to the General, St. Joes, and Henderson, which I think has a pretty clear effect on demand for ambulances. Reducing four adult ERs to three, without creating any extra medical beds, also has a pretty clear effect on ambulance offload delays.
Councillors also made clear that the concerns of their constituents have not been addressed by HHS. In answer to this (again, heavily interpreting) was that basically HHS has ignored them, because we have a fundamental difference in philosophy, and the opposition to it was just from people who can't deal with change.
What the hell! Providing quality health care is not about sacred packages of philosophy which must not be tainted! Whatever the details of the plan, if you do not ask for or listen to feedback from the public and the majority of community physicians, you are going to fuck up.
Something this complicated cannot be trusted to a bunch of powermonger administrators. They will get many of the details wrong, and having burned bridges, are going to have a hell of a time fixing it.
And don't even get me started on change. I thrive on change. But it helps if the change is positive, and HHS does not appear to have considered that their plan could be anything but uniformly positive.
So the night went: an obviously biased format in favour of HHS, shutting out the public and even preregistered delegates from asking any questions of HHS, and nothing resembling a debate on the plan's specifics.
I listened hard for even one thoughtful, objective remark, admission of negative consequences, or problems yet to be ironed out. There were none: complete positive endorsement from all members. HHS is steadfast in pushing forward this package as is, without amendment. Solidarity!
Now, the proposal goes to our Local Health Integration Network (LHIN) for approval or rejection. I have no idea what that entails.
The ballsiest councillor, Russ Powers of Dundas, stated that HHS had been given the opportunity but could not provide enough answers or reassurance to his constituents that this was a positive plan for Hamilton, and he would bring these concerns to the LHIN. Martin and his disciples were for once without a reply to that.
So the questions I have to ask HHS admin are these:
Good people can have bad ideas. But good people do not resort to these kinds of bullying tactics to get their way. Good people listen, and give honest, understandable answers. I think the fascist methods of HHS administrators need to be exposed, and so I am issuing a challenge:
Will the HHS accept a moderated, publicized debate, Cable 14 style, where the "Access to the Best Care" plan can be challenged by a panel of concerned physicians and members of the public?
Bring it on. Compared to these fancy administrators, I am nobody. But I am absolutely sure I can skewer the HHS's finest orators on this topic, because honesty and respect for the community still matters.
By Bleeding Heart (anonymous) | Posted September 12, 2008 at 13:23:13
Dr. Ted's suspicions are supported by the HHS mantra that Hamilton citizens must choose between proximate care and quality care, a public relations technique designed to limit policy options to existing administrators' level of competence. Call me weird, but what I want, when I keel over shovelling the snow or sever an artery with a home power tool, is the best care close at hand.
It appears that as city council shifts toward developing a municipality of diverse communities, HHS still sees emergency vehicles racing across town on inner-city expressways. How will ambulances get from central Dundas to General or St. Joe's emergency wards when Main St. and Victoria or James St. have LRT tracks running up and down their middles?
City boards of education, which spend hundreds of millions of taxpayer dollars annually and whose decisions effect the shape and development of the city and its communities, are publicly elected. Isn't it time that the boards of local health services be selected the same way?
By Ted Mitchell (registered) | Posted September 12, 2008 at 13:59:00
As I see it, the unelected LHIN is of no present concern. What they decide to do is much more important.
They have 3 choices:
Rubber stamp the HHS plan. I can't see this happening, the public will say they are in bed with HHS, unelected etc, and crucify them.
Call for further public input. This is what I expect, but if it is not heavily covered by the media most people will take a pass, and it will degenerate into bureaucratic uselessness and just delay the plan's implementation.
Set up publicized debate to delve further into the rationale and evidence for this proposal. This is the ideal, when people start to see it for what it is, and the easier and cheaper options to accomplish the same thing without such disruptions, the whole thing will go back to the drawing board, as it should. And again, like in B.C., Mr. Martin will be looking for a new job.
By stonesthrow (anonymous) | Posted September 18, 2008 at 20:10:03
So it seems we are going to get door #1. Requests by our councillors to try for door # 2 have been rebuffed, leaving the paying public to "howl at the moon" as the only option.It seems a public rally is being organized for Sept 25th from 6-8pm at the Dalewood rec center.
A recent letter to the editor about this process in the Hamilton spec paints this as a "done deal".
What kind of a decision making process is this anyway??
By Chris Ecklund (anonymous) | Posted September 20, 2008 at 00:54:13
I have opened a website, which has a facebook group as well.
Lots going on stay tuned.
By A Smith (anonymous) | Posted September 27, 2008 at 18:21:07
Anything the government provides for free will ALWAYS be in short supply.
Therefore, the only way to reduce health care shortages, is to make people purchase their own care.
Governments have tried to outsmart
the law of supply and demand, but its time to give up the fight, admit defeat and allow the market to do what nothing else can, namely to provide a wide range of services for all income levels.
By allowing for inequality of care, you would actually increase the quality of care for all.
All you have to do is compare food lines in the former USSR, with the food available to the poorest in North America at the same time. While it was true that the rich could afford to eat better then the poor, it was also true that the poor in North America ate better than the middle class in the USSR.
By allowing firms to make money by providing care, you create a huge incentive for businesses to build new facilities. Just look at the number of firms that offer laser eye surgery. This free market competition for consumer dollars would force health care providers to provide greater care, at lower costs.
Currently, the health care providers in Canada have ZERO incentive to become more productive in providing their care. Since their numbers are restricted by government funding, they basically dictate to the patient how they will be treated.
Allow the market to work, because otherwise, we will still be discussing health care shortages fifty years from now.
By Dr Downtown (anonymous) | Posted September 29, 2008 at 09:48:32
You are full of Crap, Smith. You literally have no idea what you're talking about. Countries that have public health care have THE MOST PRODUCTIVE HEALTH CARE SYSTEMS in the world, dollar for dollar. They spend the least amount of money but provide the most full, most effective coverage to everyone. They are the most well supported by their publics. We all get it, you live in this masturbatory free market fantasy world where everything the government does is wrong and everything private capital does is sunshine and frolicking bunnies so this must be really hard for you to understand but the numbers just don't lie. If you want to see what happens when you have private health care for profit, just look at the ONE COUNTRY in the OECD that has private health care for profit, the USA, where 50 million people are too poor to get coverage but not poor enough to get it for free. Look at all the people getting turned down for coverage because they had cancer once, or have high blood pressure, or had a freaking yeast infection. It doesn't matter how much momey they have, they can't get coverage because it's just not worth it for the private companies to ensure them at any price. Sorry, but you are an idiot, an educated idiot to be sure but an idiot none the less. I'm sure you'll come back whining that you're being picked on, but if you can't be bothered to do the most BASIC RESEARCH WHAT SO EVER on something as braindead as public health care you don't deserve to be treated with much respect.
By A Smith (anonymous) | Posted September 29, 2008 at 17:31:22
Dr.Downtown, your intelligent arguments have swayed me, we should let the government run everything.
That way, we can all get lean when we develop shortages in food, gas, and every other good thing produced in surplus quantities by the free market.
Furthermore, in most countries that offer public health care, they also have competing private sector care, unlike Canada.
Therefore, if you want to be consistent, the private sector should be allowed full access to offer all medical services to the Canadian public.
By Dr Downtown (anonymous) | Posted September 29, 2008 at 20:32:29
Haha, you're pretty funny, Smith. I pointed out that public healthcare is cheaper and better than private health care so OBVIOUSLY I think "we should let the government run everything" and turn into the USSR. Haha, you fail at arguing.
By A Smith (anonymous) | Posted September 29, 2008 at 22:54:15
Dr.Downtown, the only areas of the economy where there are shortages is where government has a monopoly.
My point, is that if you want to get rid of shortages, you need to increase supply and decrease demand. The only way to do that is to let the market work.
Compare toll roads to public highways and you will see this effect clearly. Toll roads run smoothly with little to no traffic congestion, whereas public highways always have traffic congestion.
Your example of the USA as an argument against private health care is confusing, especially since the American government spends the same amount as a percentage of GDP ( approx 7% of GDP) as does Canada. The only reason why their overall figure is higher is because they don't limit private expenditures.
The great thing about living in the USA, however, is that if you want an MRI for your child, you don't have to wait weeks while time is a precious commodity.
Consumers are allowed to decide what they will spend their money on, not the government.
As to your point that there are fifty million people living in the USA without health insurance, this obviously isn't affecting them too adversely, because life expectancy in the USA is about the same as in Canada (78.06 USA vs 80.2 CAN)
As a point of comparison, Germany spends more on public health care and more overall than Canada, and yet has a shorter life expectancy than Canada.
The main point I was trying to make was that shortages are the result of government price controls (which is what free health care is) and that only way to get rid of shortages is to price according to the true cost of the service being consumed.
If you dispute this argument, stop resorting to calling people "idiots" and start using some numbers to back up your assertions. If you can't do this, then you'll be ignored.
By Ted Mitchell (registered) | Posted September 30, 2008 at 21:05:04
PLease keep subsequent posts related to the ABC topic.
As for A Smith, you're the Sarah Palin of trolls, all anyone needs to do is give you a rope.
It is interesting to compare life expectancy of countries. One of the highest is Cuba, at 77.3 years, despite a GDP in the $3000 range. This figure outperforms every country in central and south america and eastern europe. Most of those countries have a much higher GDP. You tell me what the difference is, the great secret that gives Cuba this huge edge.
By A Smith (anonymous) | Posted September 30, 2008 at 23:05:20
Teddy, I love it when your only counter argument is censorship and name calling.
It highlights the shallowness of your thinking and is a sure sign of frustration.
Rather than embarrass yourself in this manner, why not try to rebut the specific points I make, unless you are unable to.
As to your statistic regarding Cuba's excellent life expectancy, I have no idea why this is. However, it supports the notion that less funds need to be spent by government in order to secure a healthy population.
In the future, maybe you can write an article promoting less government spending on health care. If Cuba can spend very little, then its obvious our tax dollars are not being spent wisely.
By Ted Mitchell (registered) | Posted October 01, 2008 at 11:36:07
A Smith, there is nothing in error with your points on market forces and government spending, intellectually I agree with them.
The problem is, they indicate an antisocial personality disorder.
If you let the market work in health care, this is great unless you can't afford the most basic coverage. Any serious illness, like cancer, MS, type 1 diabetes, i.e. unavoidable diseases of bad luck; in a market system treating them would mean losing your shirt, your car, your house, your savings, and perhaps those of your family as well.
Letting the market work in those situations equates to crimes against humanity.
But the economic sustainability of health care is a critically important issue (reminder: not related to the topic of this column) and I'm sure the editor would welcome a submission from you. It would certainly be more constructive than reams of cynical, narrowly focused posts extolling the virtues of the market and the many failures of lefties which are so obvious when using this scoped freemarket model of reality.
By A Smith (anonymous) | Posted October 02, 2008 at 00:21:13
Ted, do you believe that most Canadians are generous people?
If you do, then there should be no concern whether or not society can deliver care to those with limited means.
If you don't think people are generous, then you are condoning theft in order to satisfy your conscience.
The second scenario also leaves the door open for anyone to steal anything, as long as they have a good enough reason in their own mind.
By moving back to a society in which people give from their hearts, rather than from fear of prosecution, we regain what it means to help others in need.
The bitterness that comes along with "having" to pay our taxes, is replaced with feelings of pride and joy in being able to share our wealth with others.
I have faith that most people want to do the right thing, so that is why I believe the free market will help us get there faster.
By Ted Mitchell (registered) | Posted October 02, 2008 at 19:20:32
Americans have lots of faith too, but so far it hasn't translated to donating to people too poor to get basic heath care.
Unlike the generous A Smith, they evidently don't want to do the right thing.
That's why Cuba, with socialized health care, and a GDP less than the average American spends on heath care alone ($4000/yr)has a life expectancy that is within one year of the US.
That's why Canada has a L.E. 2 years greater than the US despite spending 1/3 less on health care but covering everyone.
Socialized medicine works, because the free market is nowhere near complex enough to capture all the realities of the human predicament. Yes, it means that a lot of waste occurs, but nowhere near the amount of waste in the American system. By waste I mean administrative costs, profit, and unnecessary testing.
Any doc south of the border could give you more details on those inefficiencies, and it's why many Canadian docs who have left for those greener pastures eventually move back here.
By A Smith (anonymous) | Posted October 02, 2008 at 23:39:29
Ted, rather than get bogged down in issues like US medicaid, emergency room treatment for the poor, etc, I am going to propose something radical, more taxes.
If Canadians WANT more health care and we are not allowed to buy it on the open market, governments should do what is responsible and double or triple the health care premium Ontario now has.
By doing this, they will be able to provide more health care services, while spreading the cost equitably to all who use the system. People will bitch and moan about the taxes, but nothing comes for free, including health care.
I prefer the pay per use of the free market, but if the only alternative is to jack up taxes, then just do it until we have so much health care investment, we'll all have our own MRI.
Either way, lets just get it over with and stop whining about shortages all the time.
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