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Who's doing the coping?

Stephen Gowans

who's doing the coping?

Oh, the travails of ex-premiers. Former Saskatchewan NDP Premier Roy Romanow, tagged to head the Royal Commission that will look into how the Canada Health Act should be updated to the 21st century, is said to have deep experience coping with a medical system under stress, something, it is believed, that recommends him for the Royal Commission post.

And how did he cope? By closing 52 rural hospitals and reducing prescription drug coverage while premier, says the Globe and Mail.

That's coping?

Inasmuch as the people of Saskatchewan, not Romanow, did the coping, "putting" is probably the more aptly used verb, as in, Mr. Romanow, the closer of hospitals and slasher of drug coverage, has deep experience "putting" a medical system under stress.

Hardly a comforting thought, considering Romanow will preside over the body that will recommend how the Canada Health Act is to be spruced up, if you can call trampling all over a cherished quilt with dirty boots a sprucing up.

That the country's newspaper of record could call Romanow's taking a chain saw to his province's health care an exercise in coping with a stressed medical system, is emblematic of the daily's perspective: fixated on the problems of those in charge to the exclusion of the problems of most everyone else, while seeing the proactive, deliberate choices of leaders as good and necessary reactions to the inevitable pressures of the outside world, the desire of corporations to fatten their bottom lines being one of those inevitable -- and important -- outside pressures.

So it is that a premier who degrades a province's health care system to cope with a deficit is said to have deep experience in coping with a stressed medical system, with nary a mention of the people who've actually had to do the coping.

And so it is, too, that health care systems are always said to be stressed by rising drug prices, and aging populations, and the prohibitive costs of new technologies and deficits, but never by the proactive decisions governments make, to, say, pitch-fork government revenue into income tax cuts for the wealthy, or plow surpluses into debt reduction (to the benefit of the well-to-do who hold government debt,) or lay off nurses to save money, or to pass drug patent legislation that allows drug prices to soar.

Anaemic funding is ruled out of bounds as the cause of the stress, the aphorism "you can't solve this problem by throwing money at it" trotted out whenever anyone has the temerity to suggest that an infusion of cash might help.

Dracula too must of had his Janissaries who could be counted on to counter complaints about the count's exsanguinary depredations. "Blood transfusions aren't going to make you feel any better. Look at Vlad. He has less blood than Rokan, but he says he feels fit as fiddle, while Rokan says he feels dragged out in the afternoons."

And then there's the new mantra -- sustainability, as in, health care in its present form is no longer sustainable, memories of Himalayan surpluses and excesses of government revenue hidden away in contingency funds having been safely consigned to the memory hole. We're now in that most cherished of states -- having too little money, in rhetoric, if not in fact, to turn thumbs down on every public demand. Canada might as well change its name, political commentator Dalton Camp once said, to Can't afford it.

So, how stratospheric have health care cost become? If you had to use a metaphor to describe the trajectory of health care spending in this country, you'd do best to think of Russian satellites plunging into the Pacific. Because contrary to the hokum about sustainability and rising health care costs, health care spending has been falling.

Gordon Guyatt, professor of medicine at McMaster University in Hamilton, points out:

A. Canada spends 9.2 percent of GDP on health, down one percentage point from 1992.

B. While Ontario's health care spending rose from $17.7 billion in 1995 to $18.4 billion in 1999, real spending per capita (what Ontario really spent per person after adjusting for inflation) fell almost seven percent.

C. Canada spends 50 percent less per capita than the United States.

"In relation to the rest of the economy, health care spending has contracted," says Dr. Guyatt. Still, claims of out-of-control health care costs zip around frenetically, like steel balls caroming off bumpers in a pinball machine.

Doing its part to shovel muck into already turbid waters, the Senate, showing itself to be comprised either of doddering old fools or crafty sophists, declared flatly that more money won't fix Canada's health care woes. After all, Canadians live longer than Americans, but spend less per capita on health care.

Indeed. But by this moronic reasoning we might expect Somalis and Haitians and uninsured Americans living in the slums of Washington DC to shuffle off to their dotage in greater numbers than Canadians, being freer from the burdens of expensive health care.

One country the Senators (not to be confused with the hockey team which actually does contribute something to the country) might have looked at, but didn't, has a lower infant mortality rate than Washington DC does, but is a Third World country, therefore trailing the US badly in terms of per capita spending. That country is Cuba.

Cuba spends less per head on health care than the US does, but since all heads aren't equal in the US, and tend to be more so in Cuba, the comparison is hardly meaningful.

But it's more meaningful to compare how much is spent per capita on health care in Havana, with what's spent per capita in the slums of Washington, a Third World place, in a First World country. The outcome, as you might guess, doesn't favour the Americans.

A few years ago, filmmaker Michael Moore's TV Nation, a humorous newsmagazine with a definite left slant, ran a feature called the Health Care Olympics, in which Moore had the Canadian, American, and Cuban medical systems go head to head in a mock Olympics.

The event: a leg injury.

Film crews followed three patients, one from each country, as he or she visited a hospital for a cast, crutches or a bandage -- whatever it was that was necessary to get the patient back on his feet. Points were given for how long patients had to wait, and for out of pocket expenses.

Canada was declared the winner. Cuba took silver. Or at least, that was the outcome announced on air. And the high-spending Americans came last -- a point the Senators would no doubt emphasize.

But, according to Moore, Cuba took gold. The Cuban patient was treated immediately (no wait) and he paid no out of pocket expense (health care is free.)

Yet just as the idea that anaemic funding as the cause of Canada's health care problems is ruled out of bounds, the idea that Cuba could best the US at anything was ruled out of bounds, too. Hence, Moore's network put the kibosh on declaring Cuba the winner, and insisted that Canada be given the prize.

The problem with comparisons based on per capita spending is that what's spent per head, and what's earned per head, tells you nothing about how spending, and wealth, is distributed, whether seven percent of the population enjoys 83 percent of the wealth, or whether half the population gets 90 percent of the health care dollars.

It doesn't really matter to the woman who cleans the offices at Microsoft that the software firm is one of the richest in the world, and nor does it really matter to the uninsured slum-dweller than the US spends more per capita on health care than any other country. The important point is that the US doesn't spend more per capita on health care on his head -- far from it. Prison spending is where he comes out on top.

In his novel Hard Times, Dickens' had his character Sissy Jupe pierce the meaninglessness of per capita GDP figures. England might be wealthy, she observed, but the question is, How much of the wealth belongs to you?

Canada's health care system has been undergoing a passive privatization for years, one in which the wealthy are able to arrange for better care than the poor.

Go down to your local medical laboratory, where people get blood tests and x-rays and ultrasounds, and listen to how often the receptionist says something like, "I'm sorry Mr. Jones, but the province no longer covers the test your doctor has ordered."

If you're well-off, no problem. You pay. But if you're having troubles making ends meet because your minimum wage job leaves you short every month, what do you do?

If you're an Ontarian having problems focusing on what you're reading and think you need a new lens prescription, you'll have to pay for your visit to the optometrist yourself if your last visit was less than 24 months ago -- or put up with blurry vision. The province will only cover visits two years apart, no matter whether your lens prescription works or not. You can be sure that there are more low - than high-income residents of Ontario with blurry vision.

But alas, into this quagmire of an insidiously growing US-style, two-tier system of health care has been thrust Roy Romanow, the man who was Tony Blair before there was a Tony Blair. Surely, he'll pull us out of this mess, won't he?

Romanow apparently has a personal 1-800 line to the long dead Tommy Douglas, social democratic God, and father of Canada's medicare system. Romanow is forever invoking the sainted Douglas's name, as in. "Tommy, would have done this", or "Tommy wouldn't have done that," as if Romanow alone knows what Tommy would or wouldn't have done. As if what Tommy would or wouldn't have done really matters, or takes precedence over what living and breathing Canadians want today.

You'd think the Uke, as he was once affectionately known, was trying to start his own WWJD movement (What would Jesus do?) with Tommy as a stand in for the anointed one.

For the moment, we'll have to settle for what would Tony (as in Blair, not the Tiger) do?

Look at what Blair (the second) has done to rescue Britain's National Health Service.

Heck, look at what Romanow did to cope with a stressed out Saskatchewan medical system.

Steve Paikin weighs in

The estimable Steve Paikin, host of the Ontario government subsidized TV Ontario weeknight newsmagazine, Studio Two, has his own views on health care, or rather, his own view on the cogency of someone else's view -- Liberal Senator Michael Kirby's, a not so behind the scenes operator in the last Trudeau government, and now head of the Liberals in the Senate.

It seems that Paikin thought Kirby had been making a good point about health care, so good in fact, that it needed to be shared with party windbags on one of Studio Two's regular Friday night political panels.

Kirby, Paikin announced, was studying the thinking behind the establishment of Canada's health care system back in the 40's, and was astonished to find that the creators of the system never intended it to be as encompassing as it has become. Were the system pared back, we'd be right back where the founders of the system intended us to be.

The same argument could be made for the return of slavery in meridional America. The founders of the southern States never intended Africans and their descendants to be free, either. Does that mean freedom is just an aberration that got away from us, and should be reined in, because that's what the founders would have wanted?

What the founders of medicare defined as the scope of the system hardly matters. What matters -- or should matter in a society with pretensions of being a democracy -- is what Canadians want, now -- not what bureaucrats and politicians wanted 50 years ago, or what their successors want today, but won't say so in so many words.

Paikin broached Kirby's argument after Ontario's new health minister, Tony Clement, nodded his head vigorously in agreement with another panelist who opined that a revamped health care system should be a single-payer, single-tier, system. But he added, for a select body of services.

That's like a neo-segregationist saying, "Absolutely. I'm all for integration, for a select body of places. But not lunch counters, or swimming pools, busses or schools."

Of course, Clement, is too wily to speak the unspoken parts.

Are your doctor's parents rich?

Ever since Clement's cabinet colleagues allowed Ontario's universities to deregulate tuition fees for graduate and professional programs -- including medicine -- tuition fees have soared, and with the expected -- and regrettable, if you're not rich -- outcomes. Professional and graduate programs are increasingly becoming the preserve of the well-to-do.

A survey conducted by students of the University of Western Ontario's medical school, found that the average gross income of parents of the university's med school students was $140,000 in September, but $60,000 less just two years before.

Over the same period, yearly tuition fees more than doubled, jumping to $10,000 from $4,844.

This is accessible and affordable higher education, for a select body of people.


Steve Gowans calls himself a radical, but others just call him contrary and a pain-in-the-ass. He can be reached at sr.gowans@sympatico.ca.

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