Thursday, April 14, 2016

Donald Trump can Make Canadian Healthcare Great Again

Sometimes it takes a fool to point out the obvious. Since I don't consider myself a fool, I decided to consult with an expert.

I was meandering in the bookstore yesterday when I stumbled upon the aisle full of grown-up (non-porn) coloring books. I don't know when coloring books became a form of adult entertainment. I remember them as the lamest of lame-ass birthday presents growing up, belonging in the loot bag more than the wrapping paper. Shaking my head at the number of these things on the shelves, I spotted this:

Yes, grown adults are apparently willing to shell out money to color in pictures of Donald Trump. Why, when you can get coloring books at a dollar store for loose change? Because Trump wins. He's a winner. He can make things great again.

Us elitist smartypants clearly can't. We've put out countless reports and recommendations. We've set up massive, expensive bureaucracies in the name of accountability. We pay consultants millions upon millions and don't heed their suggestions. That's why we're losing in healthcare. That's why we need to change our approach.

With that in mind, I wondered if Donald Trump could take time from his busy schedule of winning the GOP nomination to share his ideas on what could Make Canadian Healthcare Great Again.

Mr. Trump, what do you see as the problems in Canada's health care system?

You know, I was touring a hospital last year - and by the way, I build great hospitals - and there was an old woman lying on a gurney in the hallway. She's old, she's bleeding, she's got blood coming out of wherever. I thought, how could this happen in a developed country? You spend billions and billions and billions of dollars, and this wouldn't even be allowed to happen in China. And China's winning. They're killing us.

I asked the doctors and nurses why this was happening, and one of the doctors - a beautiful woman, a 10, not a fat pig like Rosie O'Donnell - tells me that it's been this way for twenty years. She's there because there's no nursing homes, no hospices. The government wanted to keep people out of hospital by spending on home care, but like 30, or maybe 40, or 59% of the money went to executives and bureaucrats. So the hospital wards are filled with old people that have nowhere to do, and sick people are left clogging up the ER.

I said, but if your ER is overstuffed, do you have enough people at least to treat all those patients safely? No. Well, where's the money go, I ask. She says, "See that guy there with the fancy tie and the stopwatch? He's being paid the salary of a full-time nurse to 'find efficiencies'. Like, how many seconds does it take a doctor to type in a medication order before it's faxed? Can we knock a few seconds off that and see more people?" I said that's stupid. She said, welcome to my world.

So how do you address that?

Look, I've got my names on nursing homes. Anything with the name Trump on it means quality. So I'd build nursing homes, I'd build hospices, I'd open up the beds.

Where does the money for that come from?

You have bureaucrats and administrators that are supposed to run things properly. They've proven to be a waste of money, so you fire them. Who rewards incompetence? That's not winning, that's losing.

There are only so many people that need to be in a nursing home or a hospice - even one built by Donald Trump - so you invest the money and see what happens. All of a sudden, no more bed crisis, no more fancy consultants. Look, can you imagine if one of my golf courses was so crowded, people couldn't enjoy the game or the clubhouse? You don't piss people off by shouting at them to play faster - people golf the way they golf - and you don't tell them to go home and play golf on a Nintendo Wii. You build a new course. The golfers are happier, and the staff are less stressed.

So that's the hospital overcrowding problem. What about Primary Care?

I just had a wonderful conversation with my good friend Dr. Ben Carson. He's a brilliant surgeon, a brilliant man. As he sees it, it's simply that you're trying to practice modern primary care in a medical system invented sixty years ago.

A lot has changed in the way doctors work, some for the better, some not. I certainly can't see how insulting hard working professionals is the way to make things better.

And don't bring up Ted Cruz. Nobody likes him, and he started it anyways with his lies.

Look, there are a few key issues. There's the problem of where the primary care doctors work. The Ontario government, for example, thinks adding a new level of red tape on top of the red tape that's already there is the way to get doctors to underserviced areas. Who thinks red tape is good? Maybe in China. Let them win in red tape, sure.

There are better answers. You could make a rule that new doctors have to spend 2-3 years in an underserviced area, period. It's not perfect, and maybe you have exemptions. But if you're getting paid a doctor's wage - and nobody begrudges the ones that aren't bilking the system - it's not unfair to say you need to pay some dues. Remember, I only started with a $1,000,000 loan from my father, and I had to work to earn my billions of dollars.

Then who knows? The doctor could fall in love with the small town and stay. In business, we call that a win-win. That's even better than we win, Mexico loses.

Plus you do something similar with nurse practitioners. Nurse practitioners are tremendous, beautiful people. I have some very close friends that are NPs, and they've been my friends without needing to have sex with me. It's a lot less expensive to train an NP than a doctor. Offer to pay an NP's tuition as a return-for-service to an underserviced community, and get more NPs out there.

That's fine for problem of distribution of Primary Care professionals. What about their compensation?

You negotiate. Didn't you read The Art of the Deal? It's the greatest book I've read after the Holy Bible. You get the players in the room and you negotiate. If the government won't deal because the doctors can't decide what they're worth relative to each other, lock the different doctor factions in a room together until they make up their minds, then bring the government in. Throwing a hissy-fit and leaving the table won't help anybody.

Think about it from the business standpoint. You can't plan a clinic if the doctors don't have a clue what they're going to make or how much you're going to claw back from their revenues. If I wanted to set up a branch of Trump University without knowing what the government will allow me to charge for tuition, how could I make a business plan? Or know how much space or how many staff I should hire?

The government says doctors drive up costs for the system as a whole, and some abuse the public insurance system.

How many thousands of doctors are there? You're going to scuttle a deal over a handful of greedy SOBs? You have a fraud investigation department, you have the College audit the charts, or you put in a hard cap to put the brakes on the worst offenders. There's no perfect answer, but how much do you want to spend on accountability?

There are always going to be people that take advantage of the system. I used to buy and sell these politicians. I'm a billionaire, and I used my money to buy a tremendous amount of influence. That's why I'm not beholden to special interests.

As for driving up costs, that's changing. The doctors themselves are pushing to control costs and stop unnecessary tests and things. Nobody wants to see money wasted, especially me. Do you think I would be able to have so many beautiful golf courses if I liked to waste money?

So you keep pushing the Choose Wisely business, you set limits - say, only one cholesterol test per person every three years, no payment for repeat Pap tests. Then, for the things that really bother the bean counters - like patients getting too many heart tests or colonoscopies - you decide what's reasonable and make the doctor apply to fund repeat tests when it doesn't make obvious sense.

Then you do the other stuff to save money. How many years have they talked about a national drug plan? Or at least pool your budgets across provincial lines to buy in bulk.

Do you think Canadians should be able to buy their own health insurance?

I was in favor of single payer, because it makes sense. It's cheaper. You wouldn't believe how much money is wasted on insurance company bureaucrats and profits with Obamacare. Plus it's poor people that use the most health care, and they couldn't afford private insurance anyways. I like poor people and people without an education.

There are two things to keep in mind. If you decide you want to repeal your Canada Health Act and open up to private insurance, that's a giant disruption to the health care economy. You're talking hundreds of thousands of workers, in health care and the public service facing job disruption. Plus, it doesn't fix the immediate problems. You have to put out the fire before putting the art back up on the wall.

The second thing is that when you signed NAFTA - which was a terrible deal, by the way, just tremendously awful - it opened the door to foreign insurers to cover essential services if you allow private insurance under the law. That's more money out of the Canadian economy, going to the American special interests, going to the Wall Street bankers, going to the Mexican cartels. You can't close that door once it's been opened. The same thing applies under the WTO for European countries. These European countries don't pull their weight with NATO, now we want to send them more of our money?

What about other countries that successfully blend private and public insurance? Or that allow private facilities for procedures that traditionally were done in hospital?

Two separate questions. Private health care delivery is all over the place in Canada. You have the Shouldice for hernias, and places for cataracts and colonoscopies and whatever. Your labs are mostly privately owned, and your doctors mostly work in private clinics. Whether that affects wait times or whatever, who knows? The data probably isn't there to make a solid determination.

Private financing of health care is another issue entirely. That's bringing in private insurance which we just talked about.

You brought up wait times. A lot of people suffer with chronic pain or disability waiting for joint replacement or cataract surgeries. How do we bring those waits down?

First of all, you put Trump magazine in the waiting room. It's a tremendous, tremendous publication, terrific stories for patients to read.

Look, you're doing okay with wait times. People still wait, but the wait's stayed the same while your volumes have gone up in the past five years.

You also need to have an honest discussion with the voters about what's possible and what isn't. In business they say there's good, cheap, or on time. You can have one or two of those, but not all three. I make sure the stores are always stocked with Trump vodka, but it's not cheap. It's a huge, huge operation, but the quality of the vodka is worth the cost. You let the voters decide between higher taxes, more comprehensive service, or quicker access. But the constant moving of the dials - we'll expand mammograms, but hike drug costs for seniors - the pretending that all of these things can be fixed with more and more's dishonest. And I prefer to be honest. Nobody is honest the way I am. I can't stand politicians and their small-minded dishonesty.

And you know what they say about people with small minds.

Hands. Small hands. And believe me, I got no problem there.

1 comment:

  1. Dr. Frank, Excellent description of the problems and sensible solutions. Well you should be the health minister, or at least a "Highly paid" consultant.