After some (much) cajoling from one of my debate teammates, who also happens to be the Opinion editor at the McGill Tribune, I’ve started writing a biweekly column there. You can find my pieces here if you’re interested in reading them.
I had an incredibly sore throat last Friday so I went to the student clinic here at McGill – turns out I have mono! (glandular fever for the folks in Auz)
Needless to say, I’m not terribly excited. It hasn’t gotten too bad so far – just a really sore throat and some fatigue – but since the doctor told me it will likely get worse before it gets better, I have this sense of impending doom hovering over me. Trying to stay very strictly paleo for the next couple of weeks in the hopes that I can get off easy on this one.
Not sure what this will mean for posting here… On one hand, I’ll be home all the time. On the other, I’ll probably be sleeping for most of that. Guess we’ll find out!
Over the break I’ve finally had time to (get close to) finishing Jeffrey Simpson’s newish book, Chronic Condition. Basically, Canada’s healthcare system is headed for crisis, but it’s a “political third rail”, a reference to the rail carrying power for electric trains – touch it, even with the best of intentions, and you die. The book is a brilliant look at how medicare happened, how it works in Canada and other countries, how it’s broken, and how to fix it.
What it boils down to is that between 1975 and 2006, we see:
- 75.4% growth in GDP per capita
- 51% growth in expenditures on hospitals
- 98% growth in expenditures on physicians
- 338% growth in expenditures on drugs outside of hospitals
(All figures adjusted for inflation)
This might be okay if our outcomes were enough to justify our spending, but by OECD standards they are decidedly mediocre. Moreover, this spending will likely continue to grow faster than the economy. Eventually, there will be a crunch on government budgets since taxes can’t rise indefinitely. In Simpson’s words:
The first and most important lesson about health care is that simple solutions to complicated problems are invariably wrong or deeply suspect… The decade ahead will feature slower economic growth in Canada and the rest of the Western world… Choices will be inescapable and hard.
Some of his proposed solutions:
- constrain wage growth of healthcare professionals – doctors’ salaries alone represent 14% of healthcare spending (hospitals and drugs make up 29% and 16% respectively). “Unless physicians and nurses show more flexibility in how they work, and unless they accept that their remuneration cannot continue to outstrip governments’ revenue growth, it will be very hard to improve medicare’s challenges of quality, access, and cost.”
- “dehospitalize” medicare by emphasizing home care, long-term care sites, nursing homes, and family and specialist clinics
- institute regional health authorities where they don’t already exist and give them control over budgets
- make physicians and nurses accountable to these regional authorities instead of the provincial government
- encourage private delivery of publicly-paid services where costs are lower for equivalent services
- encourage delivery of services by lower-cost providers, such as nurse-practitioners
- allow hospitals to use operating rooms for privately-paid surgeries when not in use for other procedures
- allot hospital budgets according to some base amount plus an additional sum for each patient treated instead of lump sums – make patients sources of revenue and not costs
- lower drug costs through a national drug scheme
- institute user fees to discourage overuse and offset or waive them for lower-income people
- reduce social inequality – statistically, poor people have more health problems
Ironically, inequality is the most likely of these challenges to be addressed. Healthcare reform is politically unfeasible, hence Simpson’s ‘third rail’ moniker.
What makes healthcare the ‘third rail’ of Canadian politics? As Canadians, we have built our national identity around our healthcare system. Needed reforms threaten the interests of people working in healthcare – and these powerful groups know that by raising the scary spectre of private, Americanized healthcare, they can elicit a knee-jerk emotional reaction from the public that will prevent any changes.
Healthcare is part of a larger complex of social problems that really frustrates me. Regarding healthcare specifically, my generation is going to be on the hook for a host of cost increases and it’s going to be the quality of our healthcare that suffers as a result. Another example is the environment – the boomer and post-boomer generations are receiving all of the job and wage benefits but will not live to see the costs.
And we have to put up with all of this while the traditional media and the rest of the population tell us that we’re lazy, entitled, ungrateful, and socially dysfunctional. Right.
More “Old Economy Steve” memes here.
PS – Also, this:
One of my coworkers has taken to saying “Happy Ho-ho” instead of “Merry Christmas” – I guess that’s a cross between the two with a little secular Santa-ism thrown in? That aside, best wishes for the season and hopefully you all get a chance to get together with your families. My extended family on my dad’s side has called off the usual gathering as we’ve all been given the flu by the merry old St. Nick. Hopefully we’ll be able to reschedule before I head back to Montréal on the 4th! My mom’s side is mostly in Australia so that gathering will have to wait a few years.
Looked like we were almost going to have a white Christmas here in Vancouver – loads of snow late last week but it’s mostly melted now. My neighbour’s very enterprising kid built an igloo on his front lawn but it caved in after a few days. The one built by my downstairs neighbours in Montréal will be there until April, most likely. I’d almost forgotten what winter on the coast is like…
Sorry for the very sparse posting this year, by the by – posting more often is one of my New Year’s Resolutions. I’ll start it in 6 days, I swear!
First headline on my FT feed this morning: “Republicans defiant over shutdown” – Boehner says HoR Republicans will not stop shutdown or lift debt ceiling unless Obama negotiates on Obamacare (hint: he won’t).
Second headline: “Global economy ‘back on track,’ finds Tiger Index”
So, in short, here’s what we’re looking at: Tea Party takes GOP hostage through America’s broken primary system. GOP takes US federal government hostage through being the single most intransigent group in Congress since, well, forever. Their main bargaining chip - a default on America’s sovereign debt – would have an international impact on financial and real markets and crush whatever recovery has been achieved.
We’re finally getting our economies back together and the Tea Party is holding the world hostage. Political assassination rarely seems this justified.
Another TED video I found interesting.
Mrs. Robbins’ point is simple: you are never going to “feel like it.” This mirrors what I’ve been telling myself for the past few months: “The time will never be ‘right’ – just do it.”
We all have what she calls an “inner snooze button.” For most people, myself included, the first thing we do every morning is hit our alarm’s snooze button. Our bed is warm and comfortable, the room is cold. We do the exact same things with our ideas and desires for change: “I don’t feel like doing that right now, I’ll do it later.” Making changes is like getting up in the morning. The room is cold, the snooze button is seductive, “it’s only 5 minutes.”
But we don’t have 5 minutes, we have 5 seconds. If we don’t act on an impulse within 5 seconds, our brain hits the snooze button and we’ve missed our chance.
It can be small: write it down, send yourself a text. But we have to do it, or we’ll snooze the time away.
After a Facebook post drew my attention to the Journey of Nishiyuu, I wrote a letter to the CBC via their contact form. Basically, the Journey is a group of 6 Cree youth who have set out on a 1000-mile snowshoe trek to Parliament Hill. They have been joined along the way by members of the Mohawk and Algonquin Nations, amongst others, growing to over 70 walkers on the 4th. And somehow this has not been reported in the national meda. Go figure. Anyway, here’s the letter:
I’m sure you’ve received many emails about this, but here’s another.
The Journey of Nishiyuu started with 6 walkers and has since grown to over 70. This group of aboriginal youth is trekking over a thousand miles in the middle of winter to meet with the PMO. Following their traditional trade routes, the original 6 from the Cree nation are meeting with the Algonquin and Mohawk Nations, among others.
On 11 Feb 2013, you reported on a group of 50 aboriginal youth marching 250km to Winnipeg. (http://www.cbc.ca/news/canada/thunder-bay/story/2013/02/11/mb-jackhead-first-nation-walk-idlenomore.html)
The Journey of Nishiyuu involves more people, is six-and-a-half times as long, and is on snowshoes. They’re bound for Parliament Hill, not Winnipeg. Surely this is newsworthy?
Frankly, I’m shocked and disappointed that this hasn’t made national headlines yet.
You can find their website at http://nishiyuujourney.ca/
If you, like me, think this is dumb, write the CBC. Hopefully in the future this kind of thing will make news.