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Friday, June 12, 2009

What's in the news: Jun. 12 -- Stoking American fear of Canadian healthcare

Expatriate MD warns of "deadly" Canadian healthcare
Dr David Gratzer (right), a physician who left Toronto for greener pastures in New York, published an op/ed in the Wall Street Journal earlier this week, describing the supposed folly of the Canadian healthcare model and explaining why the United States should not follow suit. [Wall Street Journal] He wrote:

"Not long ago, I would have applauded this type of government expansion. Born and raised in Canada, I once believed that government health care is compassionate and equitable. It is neither.

"My views changed in medical school. Yes, everyone in Canada is covered by a 'single payer' -- the government. But Canadians wait for practically any procedure or diagnostic test or specialist consultation in the public system."
Dr Gratzer, who is affiliated with the Manhattan Institute think tank, is promoting an argument riddled with holes. He not only commits the error of illustrating his points with anecdotal stories (these happen in every country) but also presents a distorted picture of the difference in overall health outcomes produced by Canada and the United States by selecting only limited examples of rationing. Other misleading assertions: that the 2005 Chaoulli decision, which overturned the Quebec government's right to outlaw all types of private insurance in all situations, indicates a wholesale repudiation of the public healthcare model that is employed with minor variations in every province; and that the Canadian Medical Association's recent predilection for electing reformist presidents is an indicator of much more than the organization's role as a lobbying body on behalf of the interests of physicians. (Plus, how does this part of his argument account for the CMA membership's 2009 election of Dr Jeff Turnbull, whose basic philosophy of the role of private healthcare funding in the public system is anathema to those of Drs Brian Day and Robert Ouellet?)

The real problem, though, is that his logic is essentially as follows: the Canadian healthcare model has serious problems, ergo giving the US federal government a larger role in healthcare insurance is a potentially "deadly" proposition. Few people would dispute the premise of Dr Gratzer's argument -- that Canada is struggling to provide necessary healthcare services to all its residents within a reasonable amount of time -- but that is far from sufficient to justify his conclusion.

For more, read the comprehensive takedown of Dr Gratzer's argument by the left-leaning watchdog organization Media Matters for America. [Media Matters for America]

And, similarly, New York Times columnist Nicholas Kristof recently endeavoured to discredit the popular criticisms of "government takeover" and "Canadian-style" healthcare, in light of an advertising campaign designed to combat proposals to establish a system of universal healthcare in the United States. [New York Times]

Physicians vs New Brunswick
The rolling boil of the dispute between New Brunswick doctors and the provincial government is on the verge of boiling over into full-scale war.

Doctors are still smarting from the government's threat to implement legislation to prevent the province's doctors from receiving the modest raises they agreed to provide them with just last year. [Canadian Medicine] On Friday, the New Brunswick Medical Society is holding an emergency meeting to determine what to do next; things have gotten so bad that the union's leadership has been openly speaking about the prospect of "job action." "All options will be on the table," president Dr Ludger Blier said. "We are not ruling out anything yet." [Fredericton Daily Gleaner] (You can read Dr Blier's recent statement on how the crisis arose here.)

The dispute has some doctors actively opposing the governing Liberal Party. "Doctors have certainly lost all trust in Minister Murphy and have probably lost faith in the governing provincial Liberals," said Saint John Medical Society president Dr David Iles. "We're going to counsel our patients not to vote Liberal... There's a lot of anger among medical society staff and doctors across the province about how we've been treated." [St John Telegraph-Journal]

In his public statements, Health Minister Mike Murphy has sounded only partly cognizant of the effect his tactics have had on the medical community. He has offered to negotiate some "non-monetary" aspects of doctors' contracts. "I do recognize that that leaves a very bad taste in physicians' mouths for years to come. I'd like to see that avoided," Mr Murphy told CBC News. "I certainly hope that I'll receive a phone call, and I certainly invite that phone call, and we would have some discussions as soon as possible to see if we can get to that common ground. I think we can. I'm sure we can." [CBC News]

The rapidly escalating war in New Brunswick is, in essence, the result of the current recession's deleterious effect on government revenues. Explaining the rationale for reneging on the collective agreement the government and the doctors agreed on last year, Mr Murphy said simply, "Things dramatically changed." [Moncton Times-Transcript]

The decision of the New Brunswick Medical Society about what to do next was to have been announced at a press conference Friday evening.

eHealth Ontario boss fired
Sarah Kramer, the embattled CEO of the eHealth Ontario agency tasked with developing an electronic health records system for the province, has been fired in the wake of news reports detailing questionably distributed consulting contracts. [Canadian Press]

The opposition has called for Health Minister David Caplan's head but Premier Dalton McGuinty has backed up his minister as well as eHealth Ontario board chair Dr Alan Hudson, who is also responsible for the province's wait times strategy. [London Free Press] [Canadian Press]

Ms Kramer's severance package amounted to $317,000. [Toronto Sun]

Healthy new faces in BC cabinet
Premier Gordon Campbell, fresh off yet another election victory last month, has named a new health minister to his cabinet. Kevin Falcon, who had been transportation minister before the writ was dropped, will take over the job from George Abbott, who had been the longest serving provincial health minister in the country, and will now head the Ministry of Aboriginal Relations and Reconciliation.

Dr Margaret MacDiarmid, an ex-president of the BC Medical Association who won a seat in the legislature for the first time, was named minister of education.

Dr Moira Stilwell, a radiologist and nuclear medicine specialist and UBC lecturer, was also elected to the legislature for the first time. She was assigned to cabinet as well, as minister of advanced education and labour market development. [Government of BC news release]

MB First Nations struggling with H1N1 flu
Garden Hill First Nation, in Manitoba, is having a tough go of it in the fight against the H1N1 flu pandemic. In the past week, The Globe and Mail reported, 11 residents of the small community have had to be airlifted to better equipped facilities. "We are in a war with no artillery," Chief David Harper said. "I'm looking at several medevac planes, but still no masks, no hand sanitizer, no new equipment to speak of. I've been asking for this stuff for over a week and nothing has improved." [Globe and Mail]

Will Alberta's centralized health governance model work?
Globe and Mail health columnist André Picard wrote, "The single most important person in Canadian health care today is someone you have likely never heard of: Stephen Duckett, the new chief executive officer of Alberta Health Services." [Globe and Mail]

QC will screen for colorectal cancer
Quebec Health Minister Dr Yves Bolduc announced that his province will begin to provide screening for colorectal cancer. [Montreal Gazette]

Psychiatrist loses licence for sex abuse
An Ottawa psychiatrist, Dr Samuel Malcolmson, had his licence to practise revoked by the College of Physicians and Surgeons of Ontario for sexual abuse. He had sex with a patient of his over a two-year period, both in his office and elsewhere, gave her money, and even fathered a child of hers. Dr Malcolmson pleaded no contest. [Toronto Sun]

A public-private medical school?
Reading two health officials' call for a new medical school in the Fraser Health Region of BC [BCMJ], Vancouver Sun health reporter Pamela Fayerman heard an appeal to consider a public-private partnership model to build it. [Vancouver Sun: Medicine Matters]

Q&A
Health policy expert Steven Lewis interviewed outspoken former BC deputy minister of health Penny Ballem. [Healthcare Policy]

Mind doesn't matter for BP: study
Psychological treatments for high blood pressure are ineffective, a new University of British Columbia study revealed. [Open Medicine]

MD arrested for attacking police car

Dr David Henry, of Fort Erie, Ontario, was arrested and charged with mischief under $5,000 after he kicked and punched a police car during a protest at the local hospital. Dr Henry was among a group of people angry about the closure of Douglas Memorial Hospital's emergency department. "It's a crime being perpetuated by the NHS under the (Local Health Integration Network) and supported by the provincial government," he said. "(Thursday) night was a rally showing our frustration." [St Catherines Standard]

Nova Scotia docs get a new leader
Halifax orthopedic surgeon Ross Leighton was elected president of Doctors Nova Scotia. "The doctors of the province have identified emergency medicine, long-term care, recruitment and retention of physicians, health promotion, and electronic medical records as priorities," he said in a release. "The system needs to undergo dramatic change and improvements. To do that effectively doctors need to be involved in developing solutions."

Montreal hospital workers boycott dress code
Employees of three Montreal hospitals are refusing to follow a new dress code that forbids them from wearing jeans, short skirts, or from displaying tattoos that management judges to be in poor taste. On Monday, when the dress code was to take effect, many employees arrived at work wearing jeans. [Radio-Canada]

Grand Rounds
The latest edition of Grand Rounds is online. [The Jobbing Doctor]

Photo: Manhattan Institute

3 comments:

  1. There is one key "universal" good applied to all levels of healthcare provision in the U.S,

    i.e. "time is money"

    All we have to do in Canada is learn how the real power behind that principle can be more "equitably" ( not equally) distributed ...in terms of "saving $"( perspective of funder) and " generating $"(perspective of worker).

    Time to look at the " golden ratio" :)

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  2. RE: the challenge for Stephen Duckett

    As CEO, Alberta Health Duckett is espousing the promotion of "ingenuity" ( versus the European ,especially UK , "innovation" approach )

    Intrinsic to this "CEO level "persective is the " constant-satisfaction requirement" described more fully by the works of Thomas Homer-Dixon:

    http://www.homerdixon.com/index.html

    To complete the picture he views his operating field as "inter" disciplinary ( versus"intra" as in the past) and proceeds within the realistic paramaters of gleaning the necessary ideas and efforts of every category of health care provider
    [ Thus you see the seeds of the " diagonal approach" espoused by Fleck (Harvard) which evolves into a naturally collaborative environment....which includes enduser as participant ]

    A pitfall:

    If there is a "private" sector version of "ingenuity" introduced into the mix he will be brainstreaming/storming with proponents of Jim Clemmer :

    http://www.jimclemmer.com/

    In Jim's Firing on all Cylinders you see the private sector recognition that to fulfil the "constant satisfaction requirement" you must recognize the "im"ploding effect of ingenuity as the satisfaction requirement is viewed as constantly moving into a "product support" range versus" things that astound and delight" where all monies and energies to fulfil the constant satisfaction requirement create a race for window dressing innovations.
    This is a race into oblivion for health care redesign.

    Summary

    The language, worldview, purview of the private sector involvement in healthcare in Canada must not be viewed as benign... nor malignant.
    It's problem is not that it is wrong.
    It's problem is that it is misplaced..and even when benign in nature, grows to "obstructive" levels rapidly ( which also kills).

    Q- What happens to an ingenuity approach in Homer Watson-Dixon's world?

    A- Inclusion, participation, involvement, autonomy with an appropriate "governance" approach

    Q- What happens to an ingenuity approach in jim Clemmer's world?

    A constant focus on the development of "new" where cells of innovation at various stages of "product rise and demise" ...float loosley in a circulatory system that sees enduser as customer ...not participant.

    In the declarations of Ron Liepert :

    http://www.health.alberta.ca/documents/Speech-June8-09-Rotary-Club.pdf

    .......I see the " constant satisfaction" of ingenuiity requirement following the right path: interdisciplinary, collaborative, skill enhancement and full utilization of scope

    Economies of scale....... and scope.. without vertical integration..... now this is something to watch...and replicate.

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