Thirty-three years ago I began my career as a Canadian Government Hospital Inspector, in what was then a Provincial Government Hospital Insurance Service. My job was a fairly responsible one, visiting the government-owned hospitals and reporting on the fiscal performance of hospital boards and administrators. As a practical and somewhat pragmatic man, I quickly learned the economy of saying what needed to be said in my reports to government bureaucrats, and over the years made a few enemies.
Seven years into my illustrious career, I switched to the other side of the fence as a hospital administrator, and witnessed the conniving that went into the maximizing of government funding. I went along with the charade of pretending to have input into the organized medical staff of the hospital, and generally sought to keep my rear-end above the snapping crocodiles of egocentrism. For, as well as producing hypochondriacs, malingerers, and other little nasties among the patients, socialized medicine also breeds egoistic and larcenous health providers in the form of doctors, administrators, and indeed anyone who chooses to take nefarious advantage of the cornucopia of opportunity.
Doctors become elevated to god-like oracles within a monopolistic but essential medical service, and once accustomed to their revered position, they become convinced of the true worth of their own indispensable magic.
After a work life of dodging and ducking the slings of outrageous politics, I now spend part of my retirement in thankful reminiscence beneath the sunnier skies of Arizona, but unfortunately my reveries are often at discord with the views of some spurious experts, who misconstrue what little knowledge they have of the Canadian health care system and argue on behalf of a socialized service.
Medicine is a world-wide doctor dominated monopoly that is causing financial crisis in every developed nation. It is apparent that many Americans feel threatened by the possibility of disabling sickness; a possibility that could take away their savings and every shred of security ever accumulated through a lifetime of struggle. And their fear is legitimized and re-enforced by media coverage of stricken families, and the many thousands of sickness-caused bankruptcies every year.
The stressful accident and sickness traumata that supply the grist for the media create wholesale hypochondria and paranoia, and thirty-seven million uninsured Americans with no health care do little to spread the feeling of well-being. Americans feel isolated and vulnerable in their plight, sensing malignant, political and professional forces working against them, and they want answers to some very pertinent questions.
They want to know why health care is beyond the average person’s pocketbook. They want to know why health insurance coverage is never comprehensive, but has so many exclusion clauses, and why insurance policies are so easily canceled by the companies whenever chronic or terminal illness strikes. Many Americans want to know why their government is not turning to socialized medicine as practiced in Canada, England, Sweden, and some other countries, all of which are trying to smother horrendous financial problems that impose unfair rationing, two-tier systems based on ability to pay, and premature death for those who are either in the wrong location, penurious or unlucky in the health lottery.
Americans are also beginning to think of health care as a basic right. They are feeling resentful and deprived, and want to know what’s wrong with health care being paid for by the taxpayer, since all they hear about it from the beneficiaries of such a system sounds good. However, without realizing it, they are listening to propaganda from sources of monumental self-interest, and from survivors who have been fortunate in the health lottery. The vast majority of couriers have either experienced no serious illness, have vested interests, been very lucky, or have otherwise been influenced by such advocates. The rest are no longer in a position to voice an opinion.
Every American looking for a way out of the possible devastating financial consequences of health breakdown will understand what this book is all about. Every healthy, uninformed and complacent Canadian who thinks he has nothing to worry about in this regard, and every other Canadian who already realizes the fallacy in that belief, should read this book. It is a practical, experience-oriented approach that will allay misconceptions, expose the true causes of high cost health-care, and disillusion anyone who thinks that somewhere there’s presently a perfect system.
Caring technology will inevitably become a reality because it is now available and because every day, in every country, there is mounting evidence that we cannot give comprehensive care with universal access without it. In the context of hospital jargon, we think of caring as a human emotion, inspired by compassion and compensated by a remuneration, but caring is in great part a service that can be performed by the coming together of already existing and available technology. This is not to say that the warm human caring that can only come from an involved nursing staff or a trauma surgeon will ever be duplicated by a cold impersonal technology. These people are entrenched as indispensable parts of a health system. They earn and deserve every cent they make.
In the same context, we think of curing as a doctor function, but doctors can only cure through the knowledge of science and technology, and it is this same technology, when encompassed in the computer, that contains the promise of an attainable, affordable, comprehensive health care service with universal access. We already possess this technology, but it is splintered, misused and underused as useful diagnostic tools and treatments across the whole spectrum of health care. There are those already busy in the piecing together of the jig saw puzzle to form a complete caring unit that will take over an expanded comprehensive diagnostic and prescription function. If for no other reason than it being possible, caring technology will become a reality. How and why will be explained further in a following chapter. However, until the political will to introduce caring technology —- regardless of the inevitable outcry from vested interests and diehards —- we can only hope that the concept of equitable universal health care is merely postponed.
In the meantime we can talk about our shortcomings, suggest temporary solutions that will serve to redirect health care dollars, and indirectly improve patient care by bringing more programs and costly equipment within reach of private pockets and hospital budgets. But every complaint, every instance of hardship through neglect, every wrong diagnosis and wrong treatment contributes to a movement to hasten the evolution of technology as an integral controlling component of health care.
Fifty years ago, Canada was a country desperately seeking a national identity. Twenty years ago, it emerged on the international scene with the beginnings of a benign, non-aggressive, humanitarian image —- a country that championed human rights to the point of becoming maudlin. With the increasingly sensitive female influence in politics and the judicial system, Canada started giving massive sums and other forms of aid to the third world. Like England and other Western countries, it softened its immigration laws, brought in more lenient laws for the young offender, and experimented with easy parole and rehabilitation for the hardened criminal. Canada became a permissive society within a single lifetime.
It was at this stage of tolerant indulgence that Canada also started confusing emotional issues with the right to earn, buy, and own. It passed legislation that gave the have nots the right to put their hands in the pockets of the haves via taxation. Sickness became a political issue as well as an economic and emotional one. Health care became a basic right, and the politicians and physicians had enthusiastic support for what was misinterpreted as a free service. But as much as we might all like to endorse this concept, it is really nothing more than a socialist politician’s drawing card; the deuce that hides the ace; a freebie service that hides the reality of onerous taxes. However, the idea of making the rich give succor to the poor is not, and cannot be, a viable and permanent solution. No one has the right to take that which another has earned, notwithstanding the fact that there are many prodigious fortunes made by dishonest people.
And apart from the fact that those who pay taxes are not necessarily rich, no one likes to be the pigeon that’s left to pay someone else’s bill. Legislating health care as a basic right programs people into thinking that they don’t have to take care of themselves, that someone else will do it for them. But when carried to the ultimate conclusion, health is the only responsibility that any of us have to worry about.
Comparative Politics of Health
There are many well-intentioned Americans who think that they should have a socialized health care system in America. A health care system is the opening gambit of the socialist. It is easily the most justifiable of all social programs, but it is also the insidious thin edge of the wedge, politically irreversible, and probably the only system that grows tentacles of sub-industries, creating an economy and life of its own, too powerful to be controlled. It is a system (or program) unlike other social systems that are confined in scope to political minorities — the unemployed, the welfare recipients, or the aged, etc. A health care system covers everyone, the healthy and the sick! It is a system that caters to the ongoing vicissitudes of the human condition, and as such gains momentum and popular support until the people become both its addicted victims and its abusers. Socialized health care in Canada is now a headless monster that ravages the public purse and depletes the economy, until health becomes unaffordable because of the redundancy it would bring. In short, it becomes too hot a political potato to be taken off the stove by any elected government wishing to stay in power. And —- without strong leadership and accountability —health care becomes an open barrel for the picking.
Funding of socialized medicine originates and emanates from a centralized branch of government and —- without regional accountability —- the system duplicates costly facilities in every town and municipality competing for the tax dollar, proliferating grandiose hospital buildings with token lip service to multi-million-dollar state of the art technology. Socialized medicine creates a false confidence in the general public that a competent medical profession, equipped with all the required paraphernalia protects them. Socialized medicine spawns many non-productive industries within the nation’s economy. Medical supply conglomerates with inflated prices based on the availability of tax dollars. Drug manufacturing empires that retail at prices according to the affluence of their host country. Socialized medicine keeps prodigious labor forces employed to service its back-scratching system —- made more costly by militant unions —- and, for those who can afford the fare and are desperate enough, it provides easy access for exploitation by every individual within traveling distance by road, rail and air. It raises expectation, with reassurance founded on the extravagance of easy tax dollars. Many of these white elephant hospitals in Canada/England and other countries with social health care systems are now being closed down due to shortage of operating funds.
Anyone, who has experienced a socialized health care system, directly or indirectly, has a horror story to tell that is at odds with its projected image and over-use. Those in the system who are unaware of the health care system’s dubious worth are grateful to have a health net beneath them, something that will prevent worry and bankruptcy. But it is a well known anomaly that one is never at greater risk than when entering that net, for as someone remarked, ” while pretentious buildings are impressive, they do not a hospital make!” A few of the essential ingredients that are missing in most Canadian hospitals:
1. State of the art equipment and the expertise to use it.
2. A medical association that demands accountability and performance, rather than the union syndrome of blind loyalty to its less professional members.
3. Hospital staffs that are supportive of administrations seeking to beat the yearly budget, rather than prove that the current year’s funding is insufficient.
4. And last, but not least, custom prescribed drugs that are needed, not cheaper drugs that are available.
But we may ask ourselves what is the alternative to a socialistic health system that provides no alternative, and is touted by its operators and ignorant users as the best system in the world. And a government that is irrevocably and politically locked in, whose only option is to weasel out of its obligations; by using blindfolds against medical advances, postponement by imposing long waiting lists, and regarding death as the end of an obligation. It is precisely because of the lack of accountability within the socialized system that no one blows the whistle.
Books on health care systems never get to the core of the matter. They are scholarly tomes, written to elevate the writer. They are boring ego trips, paeaned for health care professionals, that fraternity of infallible doctors, with axes to grind and investments to make. Their writings on comparative statistics with other countries that are also looking for quickie answers, finds faults and blips in the system and suggests Band-Aid solutions in never ending delay tactics, but never specifically pointing the finger or accepting responsibility.
Being seduced by a politician’s unrealistic aspirations is no better than being hornswoggled by an idealist’s pipe dream. President Clinton had a concept of six basic requirements for a health care system: i.e., security, simplicity, savings, choice, quality, and responsibility—all sweet sounding words that any young and inexperienced aspiring politician could write. A socialized health care system can provide none of these things, because systems are controlled by imperfect, egoistic people. Systems are comprised of policies and procedures that provide guidelines for unanimous and conscientious effort. Systems leave loopholes of opportunity for the egoistic individual. Systems may frustrate with red tape, but systems never hound people into bankruptcy. Systems aren’t greedy cheats that promote insecurity, to perpetuate treatment, overcharge, and play on the gullibility and ignorance of the uninformed. Systems don’t run themselves into the ground through abuse, and overuse. It is the people who operate and use the systems who do all these things.
My own recollections as a Canadian government hospital inspector, and subsequent hospital administrator in a socialized service, are of strikes, disarray of service, inadequate facilities, sickness compounded through neglect and inadequate funding, and above all, misdirection of funds, extravagance and embezzlement. One can only marvel at the naiveté of a Canadian populace that believes that it’s all free, and the sheer gall of those with vested interests who still promote a psychological mirage of security, simplicity, savings, choice, quality and responsibility—obviously the best health care service in the world! It is all a ploy of the medical associations and government to justify exorbitant taxation and keep the people quiet.
Canadian hospitals in general are not examples of organized, efficient, and cost-effective health care. Why we’ve suddenly become greener pastures to some Americans is an understandable perspective from their position way out on a very long and tenuous limb.
Periodically, our Canadian provincial politicians attempt to curb the skyrocketing health care costs by introducing restraint programs. They preach frugality, oppose union demands through their bargaining agents, and try to wrestle the doctors’ remuneration down so that their own may be increased, while at the same time surreptitiously hanging tough and smothering new and costly health care options.
But before any government can control escalating health care costs, there must be a comprehensive analysis to identify causes. There must be drastic changes that preclude the opportunity to cheat. Militant unionism is only one of the many reasons for the universal rising cost of health care. The biggest culprits are the doctors, who have bedazzled society into a misconception of its health care requirements.
All Provinces of Canada are not in unanimous accord with their definition of what constitutes a health care level. But, for purposes of simplification, there are, by and large, ten levels of care that make up the total spectrum of the health care service. And because six of those levels are classified as sub-levels of long-term care, all with common denominators, it will serve to lighten my task by lumping these levels into two chapters under long-term care. I will then discuss ways of improving efficiencies in home care, acute care, and rehabilitative care, each as a separate and distinct system in a separate and distinct chapter. Later chapters will tell you how—with some very drastic changes—caring technology will provide good and acceptable health care within reach of the blue-collar worker, and even the pensioner. It will also ensure equal diagnostic opportunity with remedial prescription response to the outlying areas.
There are of course psychiatric hospitals, maternity hospitals, cancer hospitals, pediatric hospitals, and other types of specialized institutions, but because this is not a medical book, the aforementioned levels will suffice.
The socialized health service concept sounds good in principle. It is, however, idealistic in not taking into account human weaknesses, and as practiced in Canada, requires some initial discussion to throw light on unnecessary, fraudulent and wasteful practices. There is no quick fix or escape from the programmed egoist, the psychological snare, the societal hypochondria, or the pervasive insecurity that plagues all societies. But in recognizing our phobias and inherent greed we begin to see reasons, causes, and solutions.
Most Canadians think of their health care system as a fight between the forces of good and evil, with the harassed doctors in bloody white coats leading the good fight, right, left, and center. Though an anachronism, this bygone concept of the kindly horse-and-buggy doctor fighting the elements to visit his patient, has been unconsciously projected to the present day, giving an unrealistic image of dedication in an unrelenting pursuit of excellence with utter disregard for filthy lucre.
This naive viewpoint renders the bargain-seeking freebie-minded taxpayer vulnerable. Canadians, by and large, are unaware of the insidious battle that has ensued over the past three decades between doctors and governments; the one side ostensibly seeking unbridled excellence (with commensurate remuneration) and the other trying to control costs. It has been a fight by the doctors for a monopoly that controls, operates and bleeds the health care system. It has been a fight to have complete control over medical referrals to all other medical disciplines, control over the type and extent of all medical treatments, both within the government hospital, and their own private clinics and laboratories. Doctors are demanding unfettered charging rights, and expeditious burials, without embarrassing questions, interference, or censure. They want to be a private, free enterprise monopoly, without malpractice suits, from within a socialized government billing structure which—if it wasn’t for the health food stores and the unapproved health providers, the naturopaths and the homeopaths etc—is just about what they’ve got, for the time being.
No one person can act unilaterally to rectify defects and close loopholes. It will take time, legislation by the provincial governments, understanding and support from the populace, and the hands-on nursing staff. It will take a complete revision of societal attitudes, and it will require participation from those with knowledge, in positions to effect beneficial change, with less interference from those charlatans and ignoramuses who spend their time promoting and defending the status quo. And it will take administrative initiatives within both the government, and within the institutional setting, to push freeloaders off the gravy train. But ultimately it will take a coming together of all the presently available technology to supersede an inefficient system that is fraught with human failings.
An alternate or ancillary healthcare delivery system
Most elderly people today remember that eighty years ago there were little or no technological breakthroughs. The doctor stood alone as the champion of health, fighting injury and disease out of an eighteen-inch Gladstone bag. Because the doctor was educated, and wore a suit, collar and tie, he was considered far more civilized and therefore far more knowledgeable than the shaman, the witchdoctor, or the faith healer. However, in truth, the medical doctor’s bag of tricks was often smaller.
Since those far off days, we’ve seen doctors evolve into the undisputed hub of a nation’s health care system, with the Hippocratic oath becoming the rallying mission statement for those allowed into the club. A club which incidentally has evolved into a protective union, supporting and reinstating its members through the most outrageous transgressions, negligence, and monetary motivation that demonstrated blatant indifference to long term consequences.
Today, doctors, meaning general practitioners and specialists, gain
vicarious prestige and power through the use of fragmented medical technology possessed by the hospitals. Advances in medical technology have been interpreted as doctor successes, enabling doctors to enhance their reputation and become an indispensable power-structured monopoly in what is essentially an international humanitarian service. However, their serendipitous rise in these most privileged positions have been accompanied by an onerous price tag that cripples economies and feathers personal nests in various forms of medical larceny.
Doctors have been afforded exclusive control of all health care facilities, including all advances in medical technology (X ray, ultra sound, MRIs, computers, ECGs, and EEGs, etc etc). Because of the past absence of any alternative in the medical market place, the doctors’ greed and unionized concert has enabled them to elbow out other less privileged disciplines (such as midwives, nursing practitioners, and physiotherapists) as being either incompetent, inappropriate, or bordering on charlatanry.
Piecemeal diagnostic technology was conceived as long ago as the 1950s, but in those early days the systems were not comprehensive or conclusive. As we approach the year two thousand however, diagnostic technology has not only come of age, but can now be integrated into comprehensive diagnostic systems that are being circumspectly ignored by doctors who realize its true potential.
Doctors are intelligent beings. They are well aware of the potential of integrated medical technology, but they have selfishly relegated each new technological breakthrough to being additional useful tools for their profession. They are refusing to recognize a caring technology that for the first time could provide a viable and competitive alternative capable of breaking the doctor monopoly in the delivery of health care, and bring health care costs down to within everyone’s reach.
Socialized or Privatized Medicine is a limiting concept.
There is now another middle of the road hybrid alternative. Having spent the better part of my life in the Canadian healthcare field, I feel frustration when I hear only two alternatives trumpeted. Canadians in general are prone to look at their socialized health care system, and smugly compare it to the private system in the U.S.. They have all developed a mind-set that tells them that their choice is limited to either one or the other. We should know by now that neither concept provides universal or comprehensive access, nor do they provide adequate response. Some Canadians are even beginning to realize that their system has a limited life span depending on the continued available tax dollar, which is certainly not keeping pace with increasing technology. Not realizing that it has already happened, they fear that their system might deteriorate into a bread and butter service as now experienced in Britain. Canadian health care is now in truth a rationed, selective and inconsistent service. Both doctors and patients are malcontents.
Canadians have certainly learned that socialized medicine isn’t the final answer, but comfort themselves by persistently comparing their system to the undesirable alternative in the U.S, where through lack of funds, some thirty-five million are without any form of healthcare. Canadians are as insecure in their health care as their American cousins. They don’t want to regress, and so keep up the political pressure on governments to maintain the status quo in Canada.
When the Canadian doctors’ “medical association” present the people with the possibility of an extra private-billing structure, thus emulating the British two-tier system, the people see it as an answer—a third route. Many deplore government opposition to private billing as an impediment to what they consider their basic right to do what they will with their own money. However, in Canada, this bloody-mindedness that espouses sanction of their basic democratic right to allow those who can afford to pay for a two-tier system, is really a short-sighted sense of righteous indignation that helps Canadian doctors in their predisposition to further strengthen their very unhealthy monopolistic health care system. Canadians with the money are indeed already flocking across the US border to exercise this democratic right born of killing delays, and a deprivation of comprehensive and universal health care at home.
When our present diversified health care technology is pulled together into a computerized and integrated system, and with the recent advent of nursing practitioners on the scene, there is born a viable alternate delivery system to the costly general practitioner. This integrated medical technology is presently being amply demonstrated by at least four computerized systems in US hospitals and on naval vessels. They are capable of independent diagnosis, prescription, and/or effective referral services to a more appropriate specialized medical expertise. Today, our technology will even permit sophisticated remote surgery. These diagnostic systems have consistently been proven to be more accurate in diagnosing than the efforts of individual general practitioner. GPs are, for reasons of cost or vanity, often loath to refer their patients to specialists. These systems are, or can be, computer-programmed with a consensus of thirty or more specialists within every particular field. They are called the DXplain system, (developed by G.Octo Barnett, MD, of Harvard Medical School’s Laboratory, and currently in use at the Massachusetts General Hospital.) The Meditel system, the Iliad system, and the QMR system are systems currently being used as confirmatory adjuncts to the medical practitioner in many parts of the US. There used to be quite an enlightening article on these systems on the World Wide Web, but for some reason it has recently been withdrawn. However, the American Navy is currently using this form of diagnosis on some large ships and submarines instead of having medical doctors aboard. But, throughout the world, doctor associations are relegating these systems to being just useful tools under superficial doctor supervision.
These systems represent the nucleus of what might be called Caring Technology, an affordable, automated diagnostic/prescription system that could be set up in clinics throughout the world. But in truth, their potential is being stifled to protect and preserve the general practitioner as the gatekeeper to the health care system. Doctors go to great lengths to explain that these systems are merely support systems and nothing more. But these systems can be fare more than mere tools for the doctors. They are effective robots that will serve in lay-staffed clinics, without complaint, and in any God-forsaken and joyless no culture, boon-dock territory, without bonus, and at an overall affordable cost. They can be programmed to have instant communication and interaction with the currently accepted medical expertise in the large cities, and bring to society the much yearned for equitable and comprehensive health care, with universal access. But most importantly, these systems do not prejudiciously enhance their own stake in the medical marketplace.
The adoption and development of this new medical technology is a must. It must be developed under private enterprise to avoid contributing further to the doctors’ monetary stranglehold on health care. It is the natural evolution of health care, and the ultimate answer to failing medical systems throughout the world.
The time has arrived for medical associations around the world to acknowledge the technological birth of an alternate and viable healthcare delivery system. The time has arrived for the professionals to fulfill their true destiny and help humanity as never before. It is also time for the medical profession to acknowledge that as a body they know less about herbal products (and their injurious effects) than they do about the side effects of conflicting prescription drugs. The monopoly of health care by medical doctors must come to an end.