The Politics of Health Care - Part 1

This blog is going to take a few to write I think which is why I've labeled it Part 1. Health Care is a complex subject and one that hits home for everyone at some point in their life. In fact, for most people it involves a number of interactions and health plays an intricate role in our happiness, even if some of us do take it for granted.

I am going to try to write about this topic from a variety of angles, disecting health care into its different segments and facets. I want to look at the topic of public versus private health care provision, private versus public insurance, user interaction and mis-use. I will review and discuss our perceptions and expectations of care and try to deal with the issues of right to care and whether or not Health Care ought to be a basic human right or if it is a privilege or an obligation of the state.

No discussion of Health Care can be conducted outside the context of existing systems. I will attempt to educate myself and make reference to documented proof and world-wide standards of outcomes. I, like any Canadian, have strong opinions about health care and I will try to adopt other sets of lenses than my own in order to conduct a balanced and empirical review. In other words, this blog will take some time and some re-edits and my opinions may change over time. For now, let me state my basic beliefs.

Health Care is a right, particularly the right to critical care or emergency services. Particularly within a developed nation is Health Care a right. I would like to state that in a perfect world all nations would have access to top quality health care and that no person should die due to lack of access to care. I also believe that individuals need to play a stronger and more conscious (yes, there is one finger pointing back at me) in their own preventative, holistic care. This is an area where tax incentives for physical fitness would be ideal.

I believe that we also have unrealistic expectations of care but that these are very natural. One is expected to be anxious and wanting nothing but first class, gold-plated Health Care when their or someone they love is in a health crisis. We ought not to base public policy on the hearts and minds of those under the most stress. That leads to irrational public policy that anyone not confronted with such a crisis fails to agree with. I also think that (and have heard directly from someone in the know about Ontario's Health Care System) surveys of those in the system are under-reported and are actually more positive than many other people would perceive.

I also believe that while patents need to be long enough for drug companies to recoup their research and development investments, there is also a lot of bluster when one looks at the amount that pharmaceutical makers spend on lobbyists and advertising. Generic manufacturers offer affordable opportunities, particularly to developing nations.

I believe that the Canadian system, while not ideal, is one of the best in the world particularly when one considers the presence of the for-profit American system and the lure it presents to Canadian Doctors. I support residency requirements for Canadian Doctors until health education subsidies are worked off by doctors receiving Canadian educations. I also support incentives for those who go to under-served communities.

I believe in the public provision of emergent, critical, non-elective and palliative care for all citizens but also support optional higher tier services that can be supplemented by private insurance in addition to public taxes and offered by private care providers. No one should go broke because they get sick but those who can afford better care ought not to be prevented from seeking it. The tricky part is ensuring that public sector health care is not undermined.

I believe that the US system adds at least two and even three layers of unnecessary profit and cost to the system. Private Insurance creates a profit-driven decision making system when it comes to care. Claims are often disputed, payments delayed and are often only partial (health care coupons.) Private companies are responsible to shareholders, not to doctors, hospitals or clients. Secondly, private hospitals have an incentive to charge higher costs, seek care that may be unnecessary and have their own issues that I'm not altogether familiar with. But it only makes sense that private hospitals would seek to maximize revenues and reduce costs. Doctors are exposed to significant malpractice suits and those companies that ensure them are forced to charge higher premiums. Trial lawyers also get rich from lawsuits. Tinkering will not fix their broken system.

I believe that the Canadian system conversely is in need of some tinkering to make it run smoother. We need more doctors and more community care. We need investments in community centers and fitness programs both in and out of our school systems. We need a greater emphasis on preventative care, healthy diets and active transportation. And unless we change things, we need to check unrealistic expectations at the door or prepare to pay more for high quality care for all.

I will write more but I think this is a good basis. I will expand on the thoughts above in coming blogs. I welcome comments.