Tuesday, January 10, 2017

The Czar Of All Health Care, Part II

Talk can wait. The Czar has fires to put out.

Last time, I argued that the festering problems in health care needed strong, old-school leadership to solve...someone that works within concrete legal boundaries, has the authority to make meaningful and binding legislative decisions, but is not beholden to any politician or party. We're gonna need a Czar (or a Czarina), and that Czar needs to take action now. The acute crises? Overdose deaths, overcrowding, and the disgracefully chronic lack of clean water in Aboriginal communities.

The Czar is pleased that governments, particularly municipal governments, are finally taking the overdose crisis seriously. At the same time, however, the Czar is disgusted with petty political grandstanding and finger-pointing. What approach would the Czar take?

1. Declare the overdose death crisis a national emergency

Yes, it's unprecedented. Yes, the chattering classes will chatter, but the Czar cares not. It's what public health/addiction doctors have been arguing for months, and it's time their advice was heeded.

2. Suspend the "War on Drugs" and redirect police to public safety

Criminalizing possession and distribution of drugs has its roots in racism, and has been a woefully counterproductive public policy. On the other hand, the Czar needs police manpower to find vulnerable drug users and ensure they are treated safely and humanely.

3. Set up more safe injection sites, including a location in every hospital, and provide addicts with opioids on request and offers of treatment

The government as drug dealer? Yes. It might not "feel" right, but the Czar was not hired to coddle. Free injection drugs, with safety equipment on site, is the best way to reduce the risk of overdose, ensure users are taking a contaminant-free product, and reduce the spread of disease. As far as the cost, it will almost certainly be less that the cost of ER resuscitation attempts, ICU stays, and long-term costs of treating Hepatitis B, Hepatitis C, and HIV. If we can convince even a fraction of addicts to get treatment while we're at it, so much the better.

Overdose deaths won't stop with these measures, but the Czar foresees them coming under control until the long-term drivers of drug abuse can be dealt with.

Now, onto a problem that has been festering for at least 20 years, namely hospital overcrowding. The Czar will no longer tolerate spin or deflection or delays on this issue. Every time a bureaucrat wrings his or her hands over this problem and returns to the default position of spin and telling front-line workers to "find efficiencies", that bureaucrat is to be fired on the spot, with their salary directed towards the following uses:

1. Every hospital in Canada will submit a census on Alternate Level of Care (ALC) patients

In fact, they'll go farther. They'll submit statistics on ALC patients for the past three years, and will do so within one week of the Czar's issuance of the order. That will provide a clear picture of typical and maximal stresses faced by each hospital.

2. Every home care organization will submit a census on persons awaiting Long Term Care (LTC) placement for the previous three years.

See where the Czar is going with this?

3. Build the f**king LTC capacity

No more fretting over the costs. No more delays. No more spin. The Czar decrees that Canada shall get every person not in need of hospital services out of hospital, period. The Czar demands these facilities be built.

4. Bring Home Care under the schedule of insured services, and scrap the worthless bureaucracies

The Czar is fed up with bureaucrats making "cost-conscious" decisions that directly conflict with patient needs, and their incompetent executives and governors. Going forward, home care services can be directly prescribed by doctors, nurse practitioners, occupational and physiotherapists. Patients will choose their provider - or have a local default option such as the Victorian Order of Nurses (VON) - and services will be funded according to a defined fee-for-service schedule. The Czar will outlaw prescribers from having a financial stake in any service provider, as a precaution against gaming the system.

That's two of the immediate problems. Now comes a true national disgrace no developed nation should tolerate: Aboriginal communities without access to clean water. The Czar will not accept this any longer, nor the adverse health consequences follow.

1. Parliament shall declare access to clean water a fundamental right of all Canadians

2. The federal government will dispatch teams of engineers, hydrologists, and whatever other expertise is needed to visit every community under a long-term boiled water advisory, or with marginal access to clean water

3. There will be a firm deadline of one year to correct every water system deficiency

No strings attached, no insertion of water quality issues into land claim disputes. The Czar will see the problems fixed, and there will be severe consequences for foot-dragging and penny pinching.

The Czar acknowledges that putting out these fires might be expensive, but the costs are calculable and will have a ceiling. Once the water infrastructure on reserves is built it's built. Once the long-term care homes are built they're built. Both of these initiatives are also investments that should keep almost all of the money spent within the Canadian economy. Moreover, the result will be less preventable illness on reserves, and a radical decrease in the stress and strain on hospitals. As to the costs of safe injection sites, the amount is small, and if borne by the federal government negligible to taxpayers.

Next time: the Czar of all Health Care fixes the health care sector 


  1. Well said. How do you get the right people to listen and act?

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  3. Hey,
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