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.

One of Saskatchewan’s former premiers, Roy Romanow, recently spoke out about the federal government’s plans regarding future health care funding for Canadian provinces. With limits being set on the federal dollars available for health care, provinces will be forced to explore and expand alternatives to government delivery of medical services.

Romanow’s staunch defence of a universal, government-run health care system includes the die-hard notions that Medicare is a social good, a necessity for national unity and a part of our Canadian identity.

Perhaps he should ask the patients receiving hallway medicine in his home province of Saskatchewan if they agree that it’s just part of their Canadian identity.

Do you think hallway medicine is part of our Canadian identity?

One of the dangers of socialized medicine is that population health and minimizing public health care costs always trump what’s best for individual patients.

As part of its harm reduction program the Vancouver Coastal Health Authority is now handing out crack pipe kits to drug addicts in Vancouver. This is in addition to funding and operating a supervised injection facility for drug addicts. Insite costs around $3 million a year and provides drug addicts with clean needles and other supplies for injecting their drugs all under the guise of a harm reduction program aimed at – you guessed it – improving population health and minimizing public health care costs.

Supporters of Insite claim it reduces the number of deaths by drug overdose and the transmission of certain diseases. That may sound good for population health statistics, but what about the individual health of these drug addicts? Prolonged drug use impacts the brain and body and can lead to various chronic conditions, heart disease, strokes and organ failure. I wonder what family members and former employers of these individuals have to say about the impacts of prolonged drug use on quality of life?

How did such a place come to be? In 2003 the facility received an exemption from Canada’s federal drug law, the Controlled Drugs and Substances Act, for the purpose of scientific research. Drug addicts serving as research subjects explains the avid support Insite receives from the academic and research community.

Supporters of Insite say that we must take care of the needs of the most vulnerable in our society. A line often used to try and guilt us into embracing ideas like this one that serves to transfer all personal responsibility for using drugs from the drug addicts themselves on to the rest of us. If the family members or friends of a drug addict were providing them with needles for injecting drugs or pipes for smoking crack wouldn’t they be called enablers?

Since drug addicts face no legal consequences for their drug use at Insite and no financial consequences for the services provided to them at this facility they really have no incentive to stop using drugs. How can a drug addict get clean without quitting drugs? How many drug addicts have been cured of their drug addiction through Insite?

Last September a decision by the Supreme Court of Canada mandated Insite’s continued exemption from the federal drug law. However, the original exemption only allows for injecting drugs not inhaling them so Insite’s new inhalation room for crack addicts will have to stay empty for now.

What’s next? Will the government start providing the drugs to drug addicts as part of its harm reduction model? It’s already happening under the banner of scientific research. Enrollment for the latest study started on December 19, 2011.

A few weeks ago the public health director in Montreal and the provincial minister of health put out the call for new safe injection sites in Quebec as a harm reduction measure aimed at improving population health and minimizing public health care costs.

Another danger of socialized medicine is that it makes all of us more vulnerable. I’d like to recommend a harm reduction measure for the law-abiding, taxpaying citizens footing the bills for safe injection sites and crack pipe kits – just say NO!

An editorial on Parking-centred health care recently appeared in the Canadian Medical Association Journal. Dr. Rajendra Kale, a neurologist in Ottawa, shares his views about the unfairness of patients having to pay for parking while at the hospital. He believes that parking fees are a barrier to health care and can interfere with the quality of care. Does the pay parking barrier stop people from accessing their places of employment? Does it stop them from accessing businesses located in city centres? Does it stop them from attending movies or concerts?

A much bigger barrier to health care is patient waiting lists for access to diagnostic tests, specialists and surgery. Is waiting on government imposed lists for medical care fair to patients?

If hospitals don’t charge for parking then where will the money for maintaining the parking lots come from? As a patient, I’m willing to pay for access to a hospital parking lot because patient-centred care doesn’t require free parking. There is no such thing as free parking just as there is no such thing as free health care.

Last week the Canadian Medical Association released its Voices into Action report summarizing the feedback it received at its public town halls on Medicare. The same three questions provided a framework for discussion at each of the six town halls. The first question asked about broadening the Canada Health Act, the second about good value in health care and the third about patients’ responsibilities for their health now and in the future. None of the questions addressed health care funding or spending. Money is the elephant in the Canadian health care system.

Patients aren’t the only ones left in the dark when it comes to knowing the cost of medical services. Last year at an appointment with a specialist, my husband inquired about paying directly for an endoscopy rather than spending months on a waiting list. The doctor told him that he could get one outside of the country for around $20,000. I found a facility in British Columbia that offered one for $2,000.

It only makes sense that each of us should be responsible for our own health. Each of us makes personal choices affecting our health every day. If I’m going to be vigilant about my health then it’s also important to be vigilant about the health care I receive. Provide me with service and price information. Let me spend my own money on my own health care that way I can compare quality and price and make sure that I am getting good value for my health care dollars. 

Despite decades of political promises, billions of taxpayer dollars and a constant tweaking of Medicare, our access to care continues to decline and the quality of care continues to deteriorate. It’s time for a new competitive and innovative health care system. It’s time for consumers of health care to become customers of health care. It’s time to start talking about the elephant in the Canadian health care system.

The Canadian Medical Association partnered with L’actualité magazine to host a town hall discussing the future of Medicare on June 2, 2011, in La Prairie, Quebec. Panelists included the heads of the Quebec Medical Association, the Quebec Federation of Senior Citizens (FADOQ), the Council for the Protection of Patients, and the Priority Cancer Coalition.

Some of the same themes from previous town halls emerged at this one, including a call for government to provide more long-term care, home care, and pharmacare. However, when it came time for comments from the audience there were a few things said that I had not heard at the other town halls. A man at the microphone telling us about paying for a surgery and receiving it the next day rather than waiting on a list for a year in the public health care system. A woman suggesting that the Canada Health Act be modernized and people start saving money for private care so they can be treated quickly. Other women and men expressing their disbelief that we are getting value for money in public health care. 

Our senior citizens, often the staunchest defenders of government-run health care, are beginning to really question Medicare and with good reason. For behind its false sense of security lies a stark reality – when it comes to cutting costs in government health care the knife is more likely to fall closest to those nearing the end of their lives.

It’s time for old and young alike to embrace a new health care system. The first step to overcoming the fears that tether us to Medicare is to look not at its intentions but at its results.

Last week I attended the Vancouver town hall on rebuilding Medicare. It’s one of five public events, make that six with the recent addition of Québec City, being hosted by the Canadian Medical Association and Maclean’s magazine.

Many people, including some doctors and nurses, are calling for an expansion of Medicare to provide coverage for pharmaceuticals, long-term care, and a growing list of other things. As it stands, our health care spending accounts for almost 43% of provincial budgets in a system with government price controls and rationed care.

At the last town hall held in Edmonton a member of the audience asked a great question
“Governments are not good at running businesses especially health care, isn’t this where the conversation should start?”

I agree. Millions of Canadians are without a family doctor and hundreds of thousands of patients are waiting on lists for access to diagnostic tests, specialists and surgery. I’m not advocating for Medicare or any expansion of the Canada Health Act. Based on my patient experiences and what I’ve learned about our single-payer system, I stopped considering government as my best advisor for health care many years ago.

You can listen to what I had to say at the Vancouver town hall on the Cable Public Affairs Channel (forward video to 39:27) or read it here:

Our health care system is failing both patients and providers.

It’s time for politicians, doctors, and patients to acknowledge that government cannot provide for all of the health care needs of all of the people all of the time.

We have outgrown Medicare, yet a government monopoly leaves us trapped in a health care system where politicians and health care bureaucrats make decisions regarding our access to health care and the type and quality of care we receive. Ultimately, it is patients who are left to bear the greatest costs for its failures.

It’s time to usher in a new health care system that promotes and protects the medical freedoms of patients and doctors; that puts patients and their doctors, not third parties, in charge of making health care decisions and that allows all Canadians the freedom to spend their own money on their own health care within their own country. Improvements in access and quality, greater transparency and accountability, and a true culture of patient-centered care will follow.

It’s time for government to return health care to its rightful owners – patients and their doctors.

How are you going to help patients usher in a new health care system based on the individual medical freedoms of patients and doctors?

The heads of the Canadian Medical Association, the Alberta Medical Association, the Canadian Nurses Association and a former president of the Alberta Union of Provincial Employees all served as panelists at the Edmonton town hall on rebuilding Medicare held on March 29, 2011. Although it didn’t turn out to be as interesting as other recent events involving Alberta doctors, there are a few excerpts of comments and questions from the audience worth mentioning.

Town hall comments that make you go hmmm…

The drug companies don’t need to make a profit. (nurse)
Really? If drug companies don’t make a profit how will they continue to research, develop and produce new and existing drugs? Let’s not forget that nurses make a personal profit from health care each time they cash a paycheck. Are they willing to reduce their personal profits?

Private business isn’t always more efficient. (president of Health Sciences Association of Alberta)
Private businesses competing in a free market are forced to pay attention to their profits and losses. They are made to be more efficient in order to remain competitive and profitable otherwise they lose customers, money and eventually go out of business.

Town hall questions that make you go hmmm…

Governments are not good at running businesses especially health care, isn’t this where the conversation should start? (man)

What can doctors do now to help fix the political system that they were complicit in establishing? (woman)

These questions didn’t receive much attention but are very telling. Patients are tired of being powerless pawns of a government-run health care system used for election purposes and contract negotiations. The self-interests of politicians, professional associations and unions have long overshadowed the interests of patients. Public inquiries, commissions, special committees, and reports all come and go and nothing changes. It’s up to us, as patients, to represent our own best interests. The next town hall is scheduled for April 27 in Vancouver. See you there.

The Canadian Medical Association and Maclean’s magazine held a town hall in Toronto on March 1, 2011, to discuss rebuilding Medicare. The remaining ones will be held in Edmonton, Vancouver, and lastly, Ottawa also home to the first SOS Medicare conference in 1979. It’s hard to believe that more than three decades have passed and we are still looking for ways to revive this failing social program. It may have started with good intentions but we all know that good intentions don’t always lead us down the best road.

Our citizens are forced to pay for a health care system where politicians and health care bureaucrats make decisions regarding our access to health care and the type and quality of care we receive. With a government monopoly on medically necessary services, the only option available to patients is to wait on lists or leave the country to seek care.

Some say we need to focus on prevention, but rising rates of obesity and diabetes indicate that there is little incentive for people to adopt healthier behaviors when they are insulated from the true costs of their medical care. Things are unlikely to change until individuals, not third-party payers like government, assume the role of customer and start paying directly for their own medical care.

Canadian health care is not free. Would you rather pay for it directly and have the freedom to choose the quality and quantity of your medical care or would you rather have the government pay for it on your behalf and make those decisions for you?

We’ve reached the end of the path to socialized medicine. It’s time to turn around.

Did you watch the live broadcast of the Canadian Medical Association’s town hall held on January 26, 2011, in Halifax, Nova Scotia? 

First of all, the title of the event “Health Care in Canada: Time to Rebuild Medicare” makes me wonder how many members of Canadian Doctors for Medicare are sitting on the organizing committee. I thought this is about transforming our health care system?

The panel discussion included the president of the Canadian Medical Association, two local doctors, the head of the Canadian Cancer Society in Nova Scotia and the national editor for Maclean’s magazine. They seemed to agree that we need to improve system efficiencies, promote collaborative care and be more proactive in the area of preventative health care.

Around 14 members of  the audience, including a few health care providers, spoke at the open floor microphone. One man made a comment about the public needing information. His one comment best summarizes the current situation. More information is needed if the public is going to participate in a meaningful discussion about Canadian health care let alone help transform it. How do we get this information? Let’s start by asking more questions.

The next town hall is scheduled for March 1, 2011, in Toronto, Ontario.