End wait chaos with guarantees

VICTORIA - Sure it's dangerous that the courts are being asked to define Canadians' right to health care - and perhaps approve a two-tier system.
But it's also inevitable given governments' failures.
Montrealer George Zeliotis waited - in pain - more than seven months for hip replacement surgery in 1999. This week his lawyers argued before the Supreme Court of Canada that his charter rights were violated. Governments must either provide timely treatment, or allow people to go to pay for surgery at private clinics, they claimed.
The federal government and several provinces - not including B.C. - intervened, rightly arguing that allowing people to pay for speedier treatment would violate the basic medicare principle of equality.
Governments must be allowed to decide how much should be spent on health care, they said. Sometimes people just have to wait.
That's a profoundly unsatisfactory position, one that suggests Canadians have no right to treatment. If a government makes health care a priority, wait lists drop. If it decides tax cuts or education are more important, you wait longer.
It's a bizarre model. I pay about $900 for car insurance, and have a clear understanding what ICBC will and won't provide in return. We pay an average $2,800 each for health care, and have a right to the same kind of clarity.
The governments' legal position would have been stronger if they had been able to tell the court the maximum times patients must wait for different procedures, and how they had decided that those waits were reasonable.
But it doesn't work that way. If budgets are tight, health authorities reduce the number of operations being done, and people wait longer. There's no medical rationale for the delay, or study of the economic costs of making people wait. Government sets the budget, and that drives the quality of care.
It's as if you crashed your car and ICBC told you that unfortunately it wasn't fixing any more front ends this fiscal year because the budget for that had been spent.
Basically the governments are saying trust us.
But people don't. An ipsos-Reid poll done for the BC Medical Association last month asked people who they believe when talk turns to managing health care. Three out of four people said the doctors' organization was believable. Only half as many were willing to believe Premier Gordon Campbell. Almost 40 per cent said he was not at all believable on health care. (That's not overly surprising. The Liberals' platform noted patients' anger that the treatment they had paid for wasn't available when they needed it, and promised better. Instead waiting times have increased. The anger remains.)
But it's not a Liberal issue, or a B.C. one. All Canadian governments take a similar approach.
There are alternatives. The BCMA is pushing for guaranteed maximum wait times, a commitment already in place in some countries and being introduced in a rudimentary form in Saskatchewan. If the government can't fulfill its guarantees, the doctors say, it should have to pay for a procedure in a private clinic or another jurisdiction
Governments could provide the guarantees. The health ministry knows, for example, that about 2,500 hip replacements will be done this year, not enough to keep up with new diagnoses, let alone reduce the 2,900-person wait list. It could calculate a reasonable guaranteed maximum wait.
Government has the right to decide that the $25 million needed to clear the backlog would be better spent elsewhere. But patients have a right to some guarantee of service. Perhaps an urgent case is promised treatment in seven days; moderate no more than five months; the rest no more than 18 months. You're assessed, and you know what the future holds. (Today many surgical patients are convinced the wait is endless.)
Governments have paid attention to their need for flexibility.
But they've ignored the need for commitments and accountability in return. That's hurt patients, and undermined an honest debate about what we can expect from our health care system.
- From The Vancouver Sun