It’s Time to Put Medicare to Sleep
My body starts convulsing; my blood pressure continues to drop. I’m exhausted and weak. This is it I think to myself. I’m not going to make it. There’s a call for help and a doctor rushes into the room. Her voice booms orders as she takes control of the situation, “OK guys, ABCs,” she says as she proceeds to direct the medical resident and the nurse to start an oxygen mask and IV. A hot air mattress appears and quickly covers me. Another person enters the room and takes a poke of blood from my foot. I hear them talking about crossmatching and a blood transfusion. I turn my head to the side and look across the room at my husband holding our new baby and think – there is the family that I’ve always dreamed of having and now I’m not going to live to enjoy them. The doctor starts asking me questions, “What are you going to name your baby? Are you cold?” A wave of tiredness consumes my body and my mind. It’s a strange type of tiredness, one that I’ve never felt before and that causes me to fully expect death to follow. Yet, each time this doctor speaks her voice is like a lifeline. It’s unlike the other voices, the one that denied my requests for my doctor, the ones that left my care in the hands of a medical resident and a nurse seemingly borrowed from another floor. This doctor’s voice exudes a confidence that comes from critical thinking and skill. It owns a competence that can only be acquired from years of education and training, years of experience and dedication. The voice belongs to an anesthesiologist.
A stillborn death at Victoria General Hospital last August brought public attention to the issues surrounding hospital anesthesia services for expectant mothers in British Columbia. Following months of failed contract negotiations over fees and workloads, a few anesthesiologists spoke openly about their concerns over the death. In December 2011 the president of the BC Anesthesiologists’ Society announced their intention to withdraw services starting April 1, 2012. Both the BC health minister and the British Columbia Medical Association (BCMA) scolded them for trying to bargain outside of the box and for shaking up the confidence in our public health care system. The government and the BCMA worked quickly to reach a deal that would help prevent the strike.
When contract negotiations with government are not going well the focus often shifts to patient safety concerns which then continue to grow in silence after the contracts are signed. In November 2010 failing contract negotiations in Newfoundland and Labrador spurred its medical association to hold lengthy press conferences about the resignation of more than a dozen specialist doctors and its impact on patient safety. When they finally settled the dispute all but one of the resignations were rescinded as part of the deal.
Is it about money or patient safety? It’s about money, patient safety, doctors and patients. It’s about the realities of a government monopoly on health care that stifles performance, competition and innovation. It’s about a government-run health care system that breeds the type of incompetence that ultimately jeopardizes the safety of every patient. One of the most telling paragraphs from the Vancouver Island Health Authority’s review of the stillborn death in August 2011 at Victoria General Hospital is this one:
“Finally, neither the patient-focused review nor this system-focused review were conducted with the purpose of evaluating the performance of any of the healthcare providers or administrators; to do so would be inappropriate and not in accordance with the philosophy of systems analysis. Any decisions about conducting performance reviews are left with VIHA. Furthermore this review will make no comment on whether or not any type of performance review is necessary.” p.3
This is just another report following another review following more committee meetings resulting only in more recommendations and guidelines. It’s a pattern replicated throughout the Canadian health care system. In the meantime, are expectant mothers waiting for anesthesia services in hospitals in British Columbia any safer today than they were yesterday? Will they be any safer tomorrow than they are today?
Despite what supporters of the status quo tell us, a publicly-funded universal health care system based on need is a fallacy. Reality shows us that our system is neither universal nor based on need. Reality shows us that it’s time to put Medicare to sleep and usher in a new health care system that promotes and protects the medical freedoms of patients and doctors.