Tuesday, July 14, 2009

IHA chair thinks two-tier care just fine

The Interior Health Authority chair, responsible for an organization delivering care to 720,000 British Columbians, believes two-tier care should be allowed in Canada.
And he doesn't see why the health care system should be providing residential care for frail seniors who can't live on their own any longer.
You have to admire Norm Embree's candour in raising such radical positions.
And he made it clear he was expressing his personal opinions.
But it's hard to see how most people living in the interior could feel comfortable with Embree as the health authority chair.
There are some big challenges ahead for all the health authorities. Provincial funding isn't enough to meet the care needs. The five regional authorities have to cut $320 million.
Embree's comments raise doubts about his commitment to the basic values and functions of our health care system.
His opinions are legitimate, if extreme, contributions to the discussion on health care. But they raise questions, coming from a B.C. health care leader.
In an interview with Don Plant of the Kelowna Daily Courier, Embree said it might be time to abandon the principles of medicare and allow people to pay for faster, better care.
"We're already multi-tier - we already go to Washington for private care - why not have it here,'' he asked.
Embree, to his credit, took the same position a few days later in an interview with Robert Koopman of the Kamloops Daily News when the issue of two-tier care came up.
"I have no problem with it. We've had two tiers for years, but nobody wants to admit it," he said, citing the ability of patients to the U.S. for speedier treatment.
Not every could afford that, Embree acknowledged.
"That's the nature of two tier - if you can, you do it. If you can't you hang in there," he said. "I've got nothing philosophically against it. As long as we maintain universal access and portability, I've got no problems with it."
That's one view of health care.
The Canadian view, expressed in the Canada Health Act and B.C.'s Medicare Protection Act, has been that your income shouldn't determine the kind of health care you receive.
If two little girls are sick, each should get the same care. The fact that one had poor parents wouldn't put her at greater risk. Embree's approach would see the poor child "just hang in there."
Embree's views on residential care for seniors raise as many questions.
"The Canada Health Act doesn't say anything about providing housing for everyone," he said. "Now everyone expects the health-care system to provide a room and a place."
It's true. The Canada Health Act doesn't include residential care and intermediate level nursing home care in the category of covered services.
But more than 5,500 Interior residents are in residential care or assisted living beds. If providing that care is not considered part of the health system, how are they to afford the $4,500 a month for a private care home? Pensions are a fraction of that amount and savings would quickly be exhausted.
So what becomes of the people who can't care for themselves and need help with meals or medical care or bathing?
They get worse and worse, I suppose, until they are admitted to an acute care hospital bed. That's a far more costly option, poorer for the senior and those beds aren't available for the patients who need them. (Between 10 and 15 per cent of acute care beds are already occupied by people waiting for long-term care.)
Embree's comments follow Health Minister Kevin Falcon's musings about allowing two-tier care in an interview with the Vancouver Sun. He later said he only meant for non-essential treatment.
A full debate on health care is welcome. But it's hard to see how the public can have confidence on a government-appointed health authority board chair who doesn't support the most basic principle of Canadian health care.
Footnote: Kelowna radio station AM 1150 tried to find out what Falcon thought of Embree's comments. They were told the minister was not available for comment on the topic "today, tomorrow, next week or indefinitely."


Dawn Steele said...

It appears pretty clear that Mr. Embree has volunteered (or been volunteered) to go out and float Mr. Falcon's 2-tier water balloon for him, so that in case it pops in his face, the Minister and his boss get to keep their Guccis nice and dry.

It is not plausible at any level to imagine that the boss of a Canadian health authority would not know the answers to the questions he's asking. Which leaves only one alternative: he's testing the waters to see how many ordinary people out there don't know these answers, and/or how many more do know the answers but are prepared to overlook them because they don't care.

With the US now seriously pursuing universal healthcare, BC would be isolated among jurisdictions in the developed world in seeking to return to the old-world savagery of "survival of the fittest" in health care. But that would be entirely consistent with the BC Liberals' broader strategy of pursuing cuts to government spending while the rest of the world is cushioning the blow of the Great Recession via massive public stimulus.

DPL said...

All the talk might have something to do with the story of today telling us that the health units have a short fall of well over 300 millions and none of it will be replaced by funds from our so recently re-elected government. Cuts in staff for sure but each time a health authority talks, its some one we hardly ever heard about and I rather doubt many of them make less than 150,000 and up to around 450,000. Nice work if you toe the liberal line of BS

Anonymous said...

It’s easy to be a critic but the facts speak for themselves. There are more doctors and nurses in training. More surgical procedures getting done; more care homes being built and more importantly there is more money going into the bottomless pit of health care each and every year.

The funny part is how the critics constantly just sing the tunes of “underfunding” and ignore the realties of funding increases. Funding increases that cannot keep pace with increased spending. Every time someone suggests we might want to consider that the current practice of spend, spend, spend is unsustainable the same people crawl out of the woodwork with the same hollow claims and fear mongering.

This is not just a BC problem; it exists throughout Canada and yet so many continue to keep their heads buried in the sand and try to turn this into a partisan political football. Once again usually the same people.

Anonymous said...

Re: anon 8:19, I am happy to see the PABbots up early this morning.

The refrain from the Libs is always the same, ain't it. We can't do better. Doesn't matter what the issue is - homelessness/poverty, the forest industry, health care. The answer is always the same. We can't do better.

It's bullshit, of course, but they have successfully lowered expectations so that we accept whatever morsel they give us.

Anonymous said...

To 9:43am. I didn’t once mention any political party in my post as my post was not intended to sound politically themed. I was only pointing out that which is factually true. More and more money is continuing to be spent in the bottomless pit of health care and yet the increased health spending cannot keep up with the demands of the system.

Nowhere did I suggest we cannot do better; that was not the purpose of my post. Only to point out that by all measures we are spending more; and doing more and yet at the same time we seem to be falling further behind.

If you have any ideas on how things can get better or be improved; aside from the usual chants of spend more money I am certain most everyone would be happy to hear those suggestions.

On an aside you also proved my point how many interest would rather politicize the discussions (as you just did) rather than offer any meaningful, constructive or non-partisan suggestions.

Anonymous said...

Yo 10am

No, you didn't mention any political party. You just repackaged the line the Libs and their supporters repeat ad nauseum whenever the issue of health care cuts comes up. You say "bottomless pit" and then accuse government critics of wanting pour endless amounts of money at the problem.

FWIW (although you aren't interested in solutions), of course endless amounts of money aren't the solution, but sometimes more money is required and the cuts in spending are going to result in significant cuts to services.

Finally, the primary reason the Libs should be criticized is that they promised during the just-completed election campaign that they would protect health care funding. That is a broken promise on an issue that, time after time, Canadians say is the single most important social program we have.

So you can stuff all your pooh-poohing of the mean critics. It's time for the Libs to back up what they say.

Anonymous said...

11:21 I do not believe I have stated anything that is not factual. Health Funding has increased. More doctors and nurses are in training. More care homes have been built and yes more surgical procedures are being done each year. In other words we are spending more money and arguably getting more health care services and professionals to provide those services. I don’t believe these points are in dispute but perhaps they are.

And yes, I am interested in solutions. I think we all are. You suggest that “sometimes” more money is required to avoid cuts to services. You neglect the fact that ALWAYS (not sometimes) more money IS going into Healthcare. Even with MORE money going in all the time; we still have to either cut services or put more money on top of the extra money we are already putting in. It is not a case of sometimes as you suggest, but all the time. The only real question is how much more on top of the increases we are already putting in is enough? Apparently this year alone over 300 million is needed on top of the added (is it) $ 70 Million increases ? In two years health spending will hit something like $ 15 Billion A YEAR. And I have no doubt even when it hits $ 15 BILLION there will be a need for more money. Does anyone doubt that?

As for the political comments made during the last election it was my understanding that Health and Education would be the only two Ministries that would see funding increases (and not decreases like other Ministries) to date the increases have been “protected’ and yet the increases clearly need to be bigger increases. Hence my comments that the answer is always more money. Where am I wrong in this thinking?

RossK said...

I for one, would be interested if a member of the media might like to contact the Public Affairs Bureau to ask them if they have decided, as a matter of policy, to have members in their employ, participate in the 'discussion' on local blogs, especially on matters of considerable import to the government's current and/or future initiatives (and/or water/trial balloons).

Perhaps Mr. Willcocks might even consider doing so.

Asking the PAB I mean.


Dawn Steele said...

To simply state that funding has increased is entirely meaningless. My cable bill has doubled since 2001. Buying my house today would cost 3 times more than it cost just a few years ago. I'm paying twice or three times as much for gas as I was 10 year ago. Most British Columbians are now paying hundreds if not thousands of dollars a year to keep up with new technology (laptops, big TVs, I-pods, cell phones, etc) that none of us even knew we needed a generation ago. The health system is subject to the same cost pressures. Doctors and nurses salaries have gone up; So have other operating costs.

So what? Is anyone proposing that we privatize Big Oil or suggesting that the market system is a failure because housing costs are syrocketing?

Seriously, what do we expect will happen to health care costs given that the population is aging, that technology keeps changing, that drug companies keep investing fortunes in new products that will keep us alive longer, younger-looking and more virile than ever, and that salaries and other operating costs keep rising to cover the cost of living.

How is 2-tier or privatized health care going to stop costs from rising, given all these factors? It won't. All it will do is cut off medical care for those who can least afford to look after themselves, for the benefit of the wealthy, and anyone who thinks that Canadians can't figure that out has sorely under-estimated our intelligence. Especially right now, with all the research being bandied about down in Washington affirming that the costs of their privatized health care system are way higher than ours.

Finally, you can't look at health costs out of context - you need to look at them as a proportion of GDP, or per capita GDP to get a more accurate picture of affordability trends. And when you claim it's unaffordable, you have to explain - unaffordable compared to what? How much has per capita spending on health care risen compared to per capita spending on electronic gadgetry and if we had to choose between the two, which one do we really need?

Most major surgeries cost less than your average car, and far less than your average pimped-out SUV or pickup, your imported luxury sedan or your politically-correct Hybrid. And you just need to drive down the street to know that the people who do the most complaining certainly aren't facing an affordability crisis.

I would challenge Mr Embree, his boss Mr Falcon, and his boss Mr Campbell to stand up and explain this: If they are claiming that we can't afford universal healthcare, while clearly many British Columbians can still afford to own luxury cars, who decided and when that being able to save the life of every BC child who needs medical care less important than someone being able to drive a shiny new BMW?

Anonymous said...

Falcon Should Choose Freedom and Openness

"I think choice is a good thing actually -- reducing choice I don't think is a good thing." - Health Minister Kevin Falcon, June 24, 2009. [source]

So why would BC enter into a contract with IBM to potentially spend millions developing a proprietary electronic health records management system? Why would BC condemn itself to forever being locked into a sole source supplier - who may charge whatever they feel - when there is a proven FREE alternative available?

VistA (Veterans Health Information Systems and Technology Architecture) is a freely available technology that has been developed over the last 25 years and is successfully deployed through hundreds of hospitals and other health facilities around the world. And it can be modified and customized by anyone - no more lock-in.

A ministry that is being ordered to cut a million dollars a day from its budget could do worse that look at what it pays per year in software licensing fees and examine what free and open alternatives are available... that would be a good choice for Falcon to make.