No, NOT a rant about my aging or failing muscles. NOT THIS TIME anyway but it seems to be a favourite topic these days amongst the 65+ ‘local folks’ and friends so I’ll get back onto that rolling hospital bed soon enough. This topic is different. This is about the Health Care INDUSTRY, the business of it all, the politics of it all and, like so many things I think about these days, the sheer madness of it all.
Is everything stupid?
Canada has a medicare-style healthcare system. In theory, you don’t have to pay to get treated for sickness. In practice, however, a great deal of money exchanges hands and, of course, the patient pays directly and indirectly. In Canada, we have chosen to assume the ‘insurance’ model where everyone pays in one way or another and then those poor unfortunates needing service can claim it without having to sell their home or go without. It’s a concept I support and happily pay my share. I like the concept.
But, it is essentially a ‘basic’ service and all sorts of things NOT covered are just as essential for good health. So it is greatly wanting. Like prescriptions, eyes, teeth and receiving expedient treatment. And, more and more actual medical ‘tasks’ are being left off the free list, too. Socialized medicine is not always the answer and, to be frank, it is all unnecessarily expensive in the aggregate. It’s a huge drain on the society where it does not have to be. That part is disappointing.
No, the American system is worse.
That ours doesn’t work all that well is also mostly acceptable to me (except when it doesn’t work for ME!) because, for the most part, I am relatively healthy and inclined to self-medicate, self-diagnose and even self-treat much more than many do. It’s not that I have the knowledge so much as the experience. Plus I have diminishing faith in the system. At 70 I am suffering more and more from things I have suffered from before. New bloody cuts and burns are going to be treated like old bloody cuts and burns were treated and so I kinda know what to do by the fifth or sixth time breaking or wrecking some new parts in the old familiar ways. Seen twenty stitchings, seen ’em all.
No, once again, this is NOT about me.
OK. Maybe a bit. At 70, I have finally found a good, competent and – get this – CARING doctor. CARING. SHE CARES!!! Can you imagine that in this system? She calls to inquire as to my improvement after an appointment. She reminds me of issues I raised before. She does her part promptly, efficiently and uses common sense. And she’s very intuitive. A great diagnostician. She’s GREAT!!!!!
But she’s leaving.
Family ties are calling her home and that is very far away. She’s going. The best doctor I ever had is going. So she asked me and a few others to help find a replacement (I used to run a medical clinic in Vancouver and so it was assumed that I have something to offer the interim find-a-new-doctor committee. I don’t. I crack jokes, demand tea and avoid most of the meetings. Still, I am on the committee.)
It seems there are two ways to pay a doctor in our provincial system (same as the 70’s when I was involved in the clinic). Fee-for-service and salary. Doctors who wanna make a buck choose fee-for-service because, in that way, they can ‘assembly-line’ their so-called service and have three exam rooms the size of closets constantly filled and they can zoom from room to room dispensing drug prescriptions in under five minutes per. My previous doctor had more than three and had it down to under four minutes and all that was done while not looking up from his computer. He made money but wouldn’t be able to recognize half his patients if he bumped into them.
I grew to resent him. And the system that made him that way.
The Hippocratic Oath is left much less fulfilled under the fee-for-service system. And, strangely, it is more expensive. One example: it is much more efficient (for a business-type GP doctor) to ‘refer’ any REAL medical ‘work’ to a specialist. If my GP removes a mole, her fee is low. If she refers the minor surgery to a dermatologist the fee is much higher and requires two visits bare minimum AFTER the initial ‘peek’ from the GP. Instead of one visit, three visits are billed to the system. There are additional costs to the system as well. Two separate doctors have two separate offices and staff. Plus there is a ‘TAP’ system for those of us who use the ferry. BC MED pays my ferry fare when I go off-island. AND BC Med pays more for me to go off-island than I would pay for myself. Why? I get a senior discount on my own dime but TAP riders pay full fare. The TAP system costs the taxpayer as much as the fee for service to the GP. THAT’s insane.
And that madness permeates the system in dozens and dozens of ways.
Far and away the stupidest part of the system is thanks to the college and the BCMA and the CMA (medical associations). Like unions, they work hard to keep the ‘credentialed’ ranks small so that salaries, fees and services can be valued higher. Basic supply and demand model. Good ol’ Capitalism. “Goodbye Hippocratic oath, get my accountant on the line”. Still, that might just be normal greed at play if it weren’t for the fact that there are simply NOT enough doctors to go around. The same doctor-centric philosophy that wants to be in demand, is now announcing, “Sorry, we cannot take any new patients. We are full. We are rushed off our feet even with our four minute turnover.”
So, our doctor will leave. We will be without. She has to live her life and no one begrudges that at all (however, I intend to drive 1500 miles once a year to see her and will ‘save up’ my complaints for then). But attracting a doctor is like prospecting for gold. It is easier for a pimply-faced 17 year old geek-boy to get a date with a super-model than for a small community to get a good doctor.
And, get this: starting salary for a salaried GP that only writes prescriptions and makes referrals? $190,000. Rising with experience to $300,000. Nine to five. NO business effort. Salary. And a lot of people will flip out when I say this but, it’s true, “…..for doing what I can do at least 50% of the time. And for doing what a nurse practitioner can do 98% of the time.” I would be even more critical of the system if I hadn’t finally encountered a good doctor who cares as much as my current doctor does. Those four-minute guys? Don’t me wound up any more than I already am.
This is a system that has some kind of weird ‘do not touch’ status and it needs a great deal of ‘touching’ (maybe some slapping around). The irony is that everyone knows it. Even the doctors. It is just that no one wants to rock the boat and so the patients, the citizenry, the tax payer and the needy suffer. And that is just plain stupid.
I’d refer the matter to a group of psychiatrists but the waiting list for a psychiatrist is two years……
…..is everything this stupid now?
