Health Care

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? 

 

24 thoughts on “Health Care

  1. Yes, I agree with you. A friend taught in Lybia and at that time medical treatment was free including prescribed medications. Canada is in top ten in the entire world whereas the USA generally is shown as ranking lower that of all countries in the top ten. Canadian doctors who want to earn the big coin can go to be certified in the USA. Cuba trains many doctors for free with the understandy that once trained these doctor will serve for a time in under serviced areas such as in East LA. For some doctors medicine is a calling and they make time for each patient. Some doctors treat some patients for free, hand out free medications and make house calls. As you say levels of caring do vary.

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  2. My main point is that order and standards must apply. I get that. But asinine standards meant more for excluding other care-givers than for patient care creates a false employment environment. Plus, making doctors (or allowing) them to ‘boost their income’ by assembly line practices ruins whatever standard they are pretending at. When I ran the clinic, we had two ‘simple-minded’, uneducated seniors as ‘doctor’s assistants. They became very proficient at certain procedures – so much so that the doctor didn’t even monitor the situation after witnessing the first times (each new doctor had to ‘see’ for themselves). We had 12 ex-addicts as street nurses and they rarely ever screwed up and several times made heroic interventions. Medicine is complicated – like law can be complicated – but not all situations are complicated and so simplified. We have traffic court and small claims and the Residential Tenancy Branch just to name a few. Two months training and anyone with dexterity can put in stitches. Yes, yes, procedure, procedure but a cut is a cut. And the same is true for a huge amount of GP complaints. Nurse practitioners are now recognized as able to do everything a GP can do and the one we had at the clinic (back in the day) was the equal or the better of all but one or two of the doctors. I am NOT dissing doctors. But I am dissing the system that makes them such rare and expensive ‘nannies’ at the GP level. At the very least, have them do more minor and day surgery at the offices and lessen the burden on hospitals.

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  3. I understand your point very clearly. I have been seen by a nurse practitioner and she was excellent. Under Mao The People’s Republic of China had ‘Bare Foot Doctors’ taking basic care to rural communities. I recently was in a community of under one thousand persons, whose doctor visited once a month, and on an emergency basis a first aid attend assessed patients for possible transportation. Doctors and hospitals were two hours away. I agree that the BC medical system could find some economic efficiencies and be somewhat more streamlined.

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    • I wrote this blog and ran it by Sally. “Is this worth a blog?”
      “Absolutely. Most people don’t know this. Your dermatologist example is perfect. So is the TAP fee being the equivalent of a ‘service cost’. People need to know what a con game and waste it all is.”
      “Betcha only Sid replies. Good ol’ Sid. Always there for a comment or a curry. But, that’s not enough. I’m getting out of the blog game. The reading public have different interests than I do. I have to face the truth.”
      “Write about quilting. There are millions of us.”
      “Rather die.”
      “Then ravens….”
      “…..self immolation first,.”
      “Oh, alright then…..write about septegenarian sex. Or politics. I know you want to. Go ahead. Just leave me out of it!”
      “So….is that self-centred-septgenarian sex then? Single not dual or plural?? Or is that septegenarian sex with ravens? Or should I stick with politicians over 70 behaving badly?”
      “Fine! Quit the blog.”

      I may have to take up new sport……….
      .

      Liked by 1 person

  4. interesting topic.
    And its only going to get worse with the aging (obese, diabetic) population.
    My GP passed away sevsral years ago. He was 86. He worked until 80.
    Literally the last of a dying breed who gave a shit about their patients.
    Today?
    Medical clinics where your are pumped through as quickly as possible. Billable hours baby!
    I went to a clinic in the strip mall near my home and waited with 20 other coughing, wheezing people to see a doctor…..to be referred to a specialist….to recieve a prescription that I already had…..my prescription had expired. The Clinic Dr had the authority to renew it. Nope. Gotta go see a specialist ( 3 weeks later)…..The specialist spent less than 5 minutes and issued me my prescription. I went to the pharmacy….it had the wrong patient name on it…… I could just go back to the specialist to get the new prescription….had to go to the clinic again to be referred again.
    Its a F$$king cash grab.
    Nobody gives a Sh!T.
    The new breed of physicians are all about “billable hours” nothing more.
    The Hippocratic Oath has morphed into a Hippocratic Joke ( emphasis on Hypocrisy)

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    • I agree. But, do I blame doctors? Not entirely. The whole world is going the Trumpian way. Greed rules. Efficiency is good but efficiency that drives humanity out of the equation becomes uber greed served hard and cold. The irony? Most doctors or care givers weren’t motivated that way. They BECAME that way. Why? Because the whole world went that way. Why? I don’t know. I can’t figure it out. Why would a person sell out so easily, so quickly, so heartlessly? When you get older, the shallowness of it all is shocking.
      I partly blame Andre Agassi. He said, “Image is everything.”
      It went downhill from there.

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  5. I continue to agree with you. The medical topic is interesting and I enjoyed your views on it. One of many issues is fewer doctors want to go into family practice. Often the ones that do enter family practice are just beginning their life long learning as doctors. There is little money to be made at care clinics. Becoming a hospitalist is an aspiration for many doctors and evolving into a specialist appears to be an ultimate goal. The doctor at the care clinic depends on the parient to say what is wrong, or what brings them to the clinic. Doctors in care clinic mostly do not know the sick person as a family doctor would. At times doctors qualified off shore, are granted temporary licences for one year to practice in BC without have written a qualifying examination for BC. If after one year they fail to qualify the temporary license to practice is withdrawn. A recent case reported in the media was that one unqualified doctor was discovered to have over charged the medical system by hundreds of thousands of dollars. This might explain the haste in the examination room; the need to get while the getting is good!

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    • Sorry to hear the implication in your question….same sorta nonsense down under, I take it? Diogenes spent his whole life looking for an honest man. Had he lived 2000 years longer, he’d still die looking, I am afraid. At least amongst the ‘prifessionals’ set. Does ‘professional’ simply mean: belonging to acceptable organized crime?
      I take that back…..my current doctor is a very notable exception. Restores a bit of faith.

      Liked by 1 person

      • Coincidentally, Gabriel Winant wrote a related column in the Guardian this morning: “Why are so many professions in revolt?” His point is NOT my point but the two are connected.

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      • Yep, same sorta nonsense. The good old days where you had a family doctor who you saw for years seem to be over. Now replaced by huge medical centres that push the patients through. I spoke to a doctor acquaintance and he said that all the insurance/liability costs meant that it was impossible for small practices to make any money. They also had to guarantee that their practice would be open five days a week in order to retain their registration as a Medicare provider. This became difficult when the doctors themselves became sick and it was often not possible to to get locums/ Like you, I’m very fortunate to have had some wonderful family doctors over the years, but the good ones are well known, and it takes weeks to get an appointment!

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      • Like I said, the system is broken. We can blame individuals sometimes but, when the profession as a whole swings all wrong, it is the system. GPs for instance, should not have high medical insurance rates….a mole here, a skin-tag there, maybe some stitches…..nothing I can’t do. No lives at risk. It’s the specialists that invade the body and remove or exchange parts that need insurance. With a GP, I’d sign a waiver.
        The system needs fixing. NOT more money…..more common sense.

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  6. Read Mr Winant’s article in the on-line Guardian. Mr Winant is a Yale professor and he writes about the American experiences in the rise unionization in the professional ranks. British Columbia’s teachers have had a long experience with fighting for rights through the courts. For years teachers were not allowed to bargain, they could not form unions, they could be dismissed without cause, they were paid at the pleasure of the Crown, they did not fall under the protection of the Worker’s Compensation Board(if one were injured at school she/he was not covered) plus additional paternalistic measures restricting rights.. The arguement for having few rights was that professionals do not need a union. It was seen as unseemly for professionals to unionize. Management all had ‘professional services contracts.’ One side could negotiate its terms of employment whereas the teacher group had little power to do so. Inequality in the work place is one of many incentives to unionize. Working in an under paid professional that justifies its low wages because teaching is a ‘calling’ has mobilized many American teachers into political action.
    A friend taught in West Virginia a number of years ago for $13,000 a school term.

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    • I don’t know how exactly to respond. If living and working in an unfair and exploitative capitalistic system designed to enslave all labour to capital, then unionizing ALL labour might be a legitimate response. Forming guilds, unions or professions that pritespct SOME labour might be easier but, in the end, just marginalizes SEGMENTS that don’t organize. I accept that we employ capitalism but it doesn’t work well for most and certainly does not work for the defenseless planet it Animal Kingdom. Still, it is a natural response to a bully.

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      • You answer very well. The WCB, LRB, minimum wage laws, Charter of Rights exist for a good reason. Teachers that are employed in parochial schools often make less money than teachers doing similar work in the public system. In addition to low pay teachers, are often required to make astestations as to their moral character, their obedience to the strictures of their religion, and to other views their faith allows or prohibits. Such limitations are often framed as being part of a charmed job that is considered by many to be a ‘calling.’ Persons in professions that provide educational services or health services are at times the recipients of uninformed comments. With on-line sites such as rate mydoctor, rate myteacher the anonymous trolls have their say. Much of it is pretty unconstructive.

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      • Doctors, nurses, soldiers and teachers are still sacred cows. They are not yet revealed as ugly money grubbers. Lawyers, accountants and police have lost their sacred cow status due to too many public screw-ups and blatant thefts. But all professions have been tarnished by their separate, selfish and elitist attitudes when going after what they believe they deserve. That those attitudes are primarily aimed at and in defiance of ‘bosses’, capital and big brother rather than those inconvenienced and hurt is lost on the greater rabble because of its narrow and obvious self interest. “I deserve” just doesn’t sit well with most people so “what I can extort” is what is heard. No one, it seems, is content with ‘an equal share’.
        But the problem is not the larger labour pool of professionals, trades and non professionals. Not the hoi polloi. It is with the ‘hoarded’ capital pools, the interest bearing debt, the profitable controls and rules of bankers and financiers. We are developing and achieving increased growth but that growth is distributed amongst the bullies first. Capitalist bullies, professional ranks, unions all line up to be the next bully in line at the trough. “Well, they got theirs! I want mine! And, if you want yours, you better get a big stick like the rest of us!”. And that just plays on and on, around and around we go. And, like musical chairs, the last one standing falls by the wayside. Greed hurts everyone in the end.

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  7. How timely your post is. I just returned from an unexpected two and a half week sojourn, back to Mexico, where I had already been for a lovely holiday two months earlier. My poor elderly Mum suffered a debilitating stroke three weeks ago. So suddenly I found myself up to my eyeballs in the Mexican public healthcare system, and all that that entails, or not.
    My mother was very ill when she was found on the floor of her bedroom by a member of the family she lives with; after having not been seen since 36 hours previously. Don’t ask!
    After about an hour, the well-meaning, but totally inexperienced (in the ways of first aid) Mexican family decided to call an ambulance. Which is like a taxi service; one pays the attendant as one would pay a taxi driver. No receipt, no partial reimbursement, even though this service is supposed to be covered, at least partially, under the IMS, a.k.a. Mexican public healthcare system.
    My Mom was taken to a private hospital, where she was attended by a trio of specialists, who did nothing but over-prescribe a barrage of high blood pressure medications along with some very strong laxatives; all of which, combined, nearly finished my mother off completely. In the hospital nursing staff came to administer meds, and take Mum’s vitals every so often, and once a day some strong man type, literally hauled my fragile mother out of her bed in order to give her a shower. My Mom’s Mexican family and I did all the actual daily nursing care during her five day stay in the private hospital. Then we brought Mum home to the living room in her house. We had to buy a hospital bed, a commode, a comfortable chair, a wheelchair and everythiing else required for her on-going nursing care. It has been a brutal experience. The private hospital was clean and well appointed, but they left it up to the family to care for my mother, who never left my mother’s bedside. The specialists, did zero, other than to waltz in once a day, not touch or speak to my mother, and to charge a mere $3,000 Mexican pesos for that. Roughly $250 C. per visit. Inexpensive by Canadian or worse, American, standards.
    My Mom has been paying her monthly premium for the public health care in her adopted country for nearly forty years, yet if she had been taken to the public hospital which is supposedly covered by the public system, she would have been left, unattended in a hospital bed, or on a stretcher in the corridor, because there is no room for another patient in the public hospital. So, taking her to the private hospital was the only option. And the family has paid for everything, and I mean everything, down to the last diaper and half bottle of unused IV fluid. Out of their pocket; not too much by Canadian or American standards, but an awful lot for a middle class Mexican family to come up with. And this just goes on.
    If you want to access the public system, the subscriber must go down to the public health office and apply for assistance; if the person in question is immobile or unable to get to the office, they need to appoint someone else to go on their behalf, then maybe they will be assigned a doctor who can visit the patient at home, or a physiotherapist who might be able to visit the patient a couple of times a month. Or a nurse, ditto. Only twice in a month. Meanwhile it is up to the patient and her family to provide the on-going personal care and everything else. If you want to apply for partial compensation you must go online to do so, entering the receipt numbers, if you have been able to get the receipt in the first place. By our standards it is a fricking nightmare of bureaucracy, even worse than what we experience here in Canada.
    So, what is my point? Be prepared. Get all your ducks in a row, while you are young and strong and healthy. Choose a tough and wise advocate, and give them the power to make decisions on your behalf.
    I also have been seeing the lovely doctor that you speak of and am so sad that she is leaving us; of course I do not begrudge her needing to be closer to her family; I only hope that another doctor angel will soon show up to step into her hard-to-fill shoes. Meanwhile, I think I will be doing a lot of travelling to and from Mexico in the foreseeable future. I wonder if Air Canada does a three for the price of one deal?

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    • Air Canada? The most expensive airline in the world cutting you a break? Don’t count on that ever happening. I am sorry to hear about your mom. And I understand how you feel (my parents died in this stupid system, too). It is psychologically difficult if not impossible legally to simply get a hold of the medical paraphernalia and a few attendants and take over her care but, in my opinion, she has a better chance with non professionals who CARE than professionals who don’t. Our current doctor is a professional who cares and that is SO rare everyone out here is rallying in whatever way we can. But, seriously? I am 70 and this is the FIRST caring doctor I have ever encountered. Friends and family all care and they aren’t stupid. I trust them more than the system. They can do 90% of what needs doing. Hell, I’ve done 90% on myself before this angel doctor arrived. It’s not rocket science, it’s plumbing!
      Bottom line: we have elevated those sacred cows to a stature most don’t deserve and we have done so partially because we’re too busy to care. The system we belong to dictates that we are too busy to care and so we deligate to those who don’t. Tragedy results. If I didn’t say all that properly, what I meant was, I sympathize, empathize and share your anguish. Truly sorry.

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      • The system is broken and the beaurocrats dont want to fix it.
        They just want to hire more beaurocrats to look at the problem.
        Empire building one beaurocrat at a time.

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      • Noncon…..it ain’t the bureaucrats. It ain’t even the politicians (tho they COULD fix it). It’s the system that divides us by the selected and corrupted allocation of money. I have seen the enemy and it is us. But we have enslaved ourselves by worshipping money. Of course we need a medium of exchange but how we manage that medium gives the medium power and disempowers the people enthralled to it. People like Trump not only get wives and gold faucets, they get power over the rest of us. Money should NOT give power over essential humanities.
        But it does. That’s what the oldest profession proves. And most people work just to be able to WORK. That’s slavery plain and simple.

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  8. Guess my comment got eaten by the ether bugs. Won’t say it all again, but have you seen the video Seducing Dr. Lewis? It’s about a similar situation and how a small outport solved the solution of attracting a doctor. – Margy

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