Saturday, September 30, 2017

Agony, Anguish, and Armageddon, Part I

Most of what's in the news about health care is a sideshow. But there's a disaster brewing under the surface.

I love reading the comments sections of medical-political features. There is probably no better way, outside of listening to overnight radio shows about aliens visiting Earth, to get a sense of just how far afield people can get with their thoughts on health care. This is no exaggeration. There are highly educated health care users (and providers!) that ascribe all sorts of nefarious intentions to Canada's politicians and health policy leaders. Whether it's painting Cabinet Ministers as "liberal fascists" (oxymoronic as the label may be), describing tax policies in draconian terms, or misinterpreting Peter Parker's life lesson, health policy debates never fail to bring out the crazy.

The truth is, almost none of it matters, and hardly worth the time to discuss beyond whatever effect the issue in question has on one's tax bill. Sure, a national drug plan would be nice, and probably save money. We truly need to take action to improve the living conditions of the poor. But past immediate crises like a lack of clean water on Aboriginal reserves, it takes an enormous amount of thought and planning to get economic stimulus right, if it's going to work at all. As far as whether putting money directly in the hands of the poor works, the good news is we'll get some answers soon enough.

When you get down to brass tacks, there are three issues in health care that require immediate attention. Since everything is better when you can narrow it down to three (rock, paper, scissors; snap, crackle, pop; blood, sweat, and tears; etc.), everyone loves alliteration, and nothing grabs the attention like doom-and-gloom language juxtaposed with over-the-top cartoon images, I humbly offer my Three Faces of the Canadian Health Care Apocalypse: Agony, Anguish, and Armageddon

Let's face it, Canadian health care is in Agony. Canadians get excellent care, but access remains a problem even in the cities, and is becoming an ever-greater problem everywhere else. Primary care is increasingly harder to access in rural Canada, whether in Eastern, Central, or Western parts of the country, and even the viability of basic amenities like ER service is now under threat

Wait times continue to be excessive for primary care, are stagnant for major surgeries, and are increasing for diagnostic imaging. Anyone who shrugs their shoulders at long waits, accepting them as the cost of equity of access, has probably not been through an extended period of disability that required a lengthy wait for treatment. Waiting is agony, physical and emotional, eating away at every aspect of one's sense of happiness and independence. Factoring in the growing problems nationwide with access, even the appeal to the system's much-championed equity becomes laughable on its face.

While people undoubtedly suffer as they languish on wait lists, their suffering is now overshadowed by a crisis arising from disjointed and grossly inadequate mental health care. The collective national failure to address mental health has resulted in collective national Anguish, for anyone either working in, or trying to access, the mental health care system. Canada is seeing a nationwide epidemic of death by suicide, particularly among the most vulnerable Aboriginal populations, and tens of thousands of deaths each year as a consequence of substance abuse. The crisis continues to grow, with families and entire communities having little to help recover from the pain of their loved ones' premature deaths

Of course, all the health care plans in the world won't be worth the paper they're printed on if we don't address the Armageddon Canada is staring down in its crisis of hospital overcrowding. There are few, if any, hospitals in the country operating under their target patient capacity. Many are well above where they should be, in fact, forced to crowd two patients into rooms built for one, to shove the sick and elderly into closets and hallways, and to inure the public to overcrowding befitting a refugee camp instead of the tenth wealthiest country in the world.

It's quite possible, especially with regards to hospital overcrowding, that Canada is past the point of no return, that we are headed for a systemic collapse of acute care because of 20 years of willful neglect on the part of policymakers. And I wouldn't blame anyone for rocketing right past cynicism into full-on nihilism about the health care system as a whole. When you consider that politicians can't seem to come up with ideas beyond more layers of toothless bureaucracy, or reshuffling public servants into a brand new Ministry(!), it's hard not to scream and hide under a rock.

But with political will and (unfortunately) a good amount of money, we might still be able to save ourselves from catastrophe. As bad as things seem right now, inaction would be a lot more painful.

Next time: Stepping back from the brink

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