Change, Along with Money, Will Improve the Health Care System

It was Winston Churchill, the renowned wartime Prime Minister of England, who stated “Democracy is a terrible system, but it is the best there is”.

In the field of health care the inadequacy of the democratic system is very apparent. Politicians will not make the decisions to repair a badly flawed system because they are unwilling to fight the status quo encompassing doctors, pharmaceutical companies and even the public to bring in a system in tune with the technology improvements of the 21st century.

Health care is too important an issue to be left solely to politicians. They are afraid to institute a long-term strategy that will inevitably create turmoil as the new methods of delivering health care are implemented. Their primary interest is in the next election and staying in office. The solutions proposed by the Roy Romanow Commission are solutions for politicians, with no real change. The politicians answer for the improvement of health care is to spend more money. Health care spending in Canada rose from $78.5 billion in 1997 to $121.4 billion in 2003, yet the system is in a steep decline. The waiting lists for health continually grow.

Dr. Max Gammon, a British physician, studied the relationship between money and health care in the British system of socialized medicine. After an extensive look, Dr. Gammon formulated his law, aptly called Gammon’s Law. “In a bureaucratic system increase in expenditure will be matched by a fall in production.” You cannot over-spend your way into better health care.

But why do we have a problem? Seniors use a disproportionate amount of the health care budget. The percentage of seniors is increasing quickly and they are living longer. In addition, the great advances in modern medicine use very high technology and are very, very expensive.

Between 1994 – 1995, 32,147 hip and knee operations were performed, while between 2001 – 2002, there were 44,792 such operations. A seven year change of 39%. Today we can perform kidney transplants, liver transplants, install artificial hearts, do bi-pass operations and use diagnostic equipment, only recently available, such MRI’s and cat scans. These expensive tools will continually grow in use.

Today we have a major problem with the new drugs that are prescribed by physicians. Most of the drugs are equal to but no better than the drugs available twenty years ago. Only one of eighteen new drugs on the market yearly is of great significance. I suggest that duplicate drugs not be covered by the government drug plans, but that the government gives large tax break incentives to drug companies to continue research. Medical research in universities should be funded solely by government and when new discoveries are made by the universities, the drug should be licensed to a major drug company.

To make an omelet you have to break an egg. To improve the health care system you have to find ways to compensate for the higher cost of hi-tech health care and ever increasing number of seniors without lowering the standards of care.

I was a pharmacist before I retired and over the course of my professional life I must have advised thousands of people about their minor ailments, coughs, colds, allergies, hemorrhoids, headaches, etc. That is the bulk of the work done by general practitioners. You cannot lower the fee for general practitioners but you can, over a reasonable period of time, phase out the simple work they do, and replace them with nurse practitioners and pharmacist practitioners at a much lower cost. These people would be the entry into the system and when the problem is beyond their expertise they would send the patient to a general practitioner who would now exist in far fewer numbers and they in turn would recommend a specialist, if necessary.

As they say, the devil is in the details, but a system devised by people can be adjusted by people. The courses of study in the university for these newly enhanced professionals would have to be changed to reflect their new jobs. It is not inconceivable that nurse and pharmacist practitioners could work together based in a drug store setting.

Small remote communities in Nova Scotia on Brier Island and Long Island have shown the way. They were unable to get a local doctor and eventually settled on a nurse practitioner, Kim Lamarche and paramedics. She works in conjunction with physician Roy Harding in Digby. And to quote Ms. Lamarche “they now have the best health care they have ever had”.

The question of public vs. private health care is always present. If you have both systems in one country “money talks” and people with money will get better service. If you can lower costs by using less expensive personnel and medicines and increase services, there will be no need for private health care. People do not go to the U.S. for better care, but go for faster care.

The changes must come carefully and slowly over a period of time to create as little dislocation as possible, but if we can save money as easily as we spend it we all will have a better health care system.

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