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If Medicare is a political sacred cow, what are we sacrificing?
Shortages like these result in last-ditch efforts as happened in the wake of the H1N1 flu pandemic in 2009. In order to avoid criticism for inaction, the federal government sent body bags to rural native communities in lieu of medical assistance.
The doctor shortage, like so many problems facing Medicare, is not solely to blame for a body-bag-delivery health care system.The problems are multi-faceted.
If the government wants to reduce wait times, Medicare should cover alternative health care methods, says Rosenberg. “We keep bringing back patients because [doctors] want the money, but then it bogs the system down. Get [patients] out of the waiting room. Say you have someone with chronic back pain. Instead of bringing them in and medicating them, pass them along to a chiropractor or a naturopath.”
However, when patients ask that their test results be faxed to a naturopath or other health care practitioners, many doctors do it grudgingly, she says, and they charge you for the privilege.
While many would think doctors avoid alternative health care and are motivated to medicate by big pharmaceutical companies, Rosenberg clarifies they medicate to avoid accusations of malpractice.
These issues of entitlement to a free system where doctors are threatened with reports to the Royal College of Physicians—a monthly occurrence at Rosenberg’s busy downtown Toronto medical office—also play a role in the fear Canadians have about changing Medicare.
Medicare is “a political sacred cow,” says Dr. Doig. “Because it is a [fundamental social] value, it has become something that everyone’s afraid of tinkering with.”
Fear of change is yet another part of the puzzle in what’s left of Tommy Douglas’ original vision. “We haven’t lived up to [Medicare’s] potential,” says Dr. Doig.
In reference to the system, Dr. Wong-Rieger says, “It takes tragedies to get changes.”
The tragedy with Medicare lies in the external costs incurred for our “free” system: expensive medication, long wait times, and the absence of preventive health care.
According to a U.S. report from the National Library of Medicine, Economic Incentives for Preventive Health Care, if health care is to provide collaborative quality care, care management and effectively prevent and manage chronic disease, the system requires major re-engineering.
The report can be applied to Canada since few Canadian doctors deal with preventive medicine, says Rosenberg. And the Canadian Institute for Health Information reports 64 per cent of Canadians do not seek preventive health care.
In all examples cited in the report by the Library of Medicine, preventive health care addressed the gaps between the high cost of preventable disease and deaths and the actual prevention practices of health providers and consumers.
“We should be very much proactive in identifying patients ahead of time. Does this cost more? No,” Dr. Wong-Rieger says.
In Canada, the care system is just that—a system. “We expect you to adapt to the system, we don’t expect the system to adapt to you. Canada’s a great country in terms of the public services available, and yet we’re pretty stupid [about service delivery],” she criticizes.
The problems with health care lie with patient, doctor, and government—no one source is to blame.
“It’s very multi-factorial,” says Dr. Doig, referring to a lack of food policy, agricultural
policy, and proper education.
As far as education goes, for Rosenberg, Dr. Doig and Dr. Wong-Rieger, diabetes, smoking and weight problems are the most prevalent preventable health issues facing Canadians.
Just under five per cent of Canadians have diabetes. Ninety per cent of those have Type 2 adulthood onset diabetes, which unfortunately is presenting more in children all the time.
As for smoking, smokers pay more for health insurance in the U.S. In terms of body mass index (BMI), all government employees in the state of Alabama who don’t live within their BMI have one year to get fit or start paying for their insurance—currently covered by the state.