machado: it's struggling, but there's a lot about universal healthcare that works
despite the state of our healthcare system, there are still many excellent healthcare professionals meeting the complex needs of patients and their families across canada. we don't do a good job of telling those stories.
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despite er deaths, excruciating wait-times, and ambulances with nowhere to leave sick people, depending on where they are, canadians get looked after. getty
there was a long pause, and it wasn’t clear if her attention had strayed for a moment to the set of keys she had just dropped on the floor beside her black patent leather sneakers, or if she was taking a moment to deeply ponder. as she stood up, her face red from the bend-over, she shrugged her shoulders. “i guess it all depends on how many people have the furthest to fall.”
she taught piano in her home during the week and yoga on the weekends, always complained about how hard it was for an artist to make a half-decent living and as a sixty-something mom of a kid with complex needs, she often said that healthcare was her “jam.” she was sweeping snow off of her step as we talked about whether better healthcare can be had if we paid for it. i was most interested in how she thought a decision on whether private healthcare was better than public was made — she said she hoped that it would be based on whether or not people could actually pay.
she told me about one of her adult yoga students who had signed up at one of these full-service medical clinics, the kind with membership fees, doctors in pricey italian suits with handmade buttonholes and a smooth lapel roll, and a platter of fresh, healthy food in the waiting area. he had paid a few thousand dollars to spend a day there, she said, banging her broom on the metal railing to shake the snow off, getting a swath of tests — and some juicy strawberries — consulting with a seemingly limitless supply of shiny-faced experts who cajoled, comforted and calmed his fears about an early demise. his father had just died of colon cancer and he wanted to ensure that his destiny wasn’t the same. at the end of the day, he had a referral to a gi specialist — the appointment was within days.
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“hallelujah for him,” she smirked. “by the end of the week, he’d know whether he should bother getting his affairs in order.”
some would say a few thousands dollars is all in a days work if it means saving your life, but for most, it’s nice work if you can get it, which is increasingly unlikely in a world where blueberries cost $8 and interest rates have made the homes we live in unaffordable. and anyhow, it’s not like health care that you pay for out of your own pocket is better for you, or for any of us — just ask cathy macneil, author of dying to be seen: the race to save medicare in canada.
but it’s not just about paying for health care. this strawberry-filled nirvana of care is just one snapshot in time. we know that this guy’s bad colon connections won’t be the last of his health care woes. add in a few surgeries, blood tests, x-rays for the tennis elbow or worse, cancer medication, oh and don’t forget about family members and mental health. paying for care quickly becomes, for most of us, well, impossible.
it’s easy to forget about that though, what with the constant drizzle of reports about emergency room deaths as patients die as they wait, bed-less hospitals and burned out healthcare workers. there’s desperation: someone just needs to fix it. as a friend of mine said recently, “we have been put in the position of begging for healthcare.” and since healthcare equals life, yup, damn right, most of us can’t afford to be too proud to beg.
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so then what?
put aside the ongoing train wreck stories that dominate health care news in canada these days for a moment and consider the part of the story that we aren’t hearing or telling and maybe forgetting: despite the er deaths, excruciating wait-times, ambulances with nowhere to leave sick people, our system has what it takes to work. in fact, it works somewhat every day — depending on where they are, canadians get looked after (even in emergency rooms!). there are many very excellent healthcare professionals meeting the complex needs of patients and their families, and today, right at this moment, in hospitals all over this country, screening is happening, diagnoses are being made and someone is getting tucked into the bed where they will be cared for and recover. we don’t do a good job of telling those stories.
still, as ontario expands the number of private clinics offering medical services like imaging and cataract surgery (which cost the government more than they would if done in hospital) — soon to include knee and hip replacements — it’s hard not to feel like the sun is setting on those brighter stories. depending on who you ask, more private clinics mean reduced wait times, while others consider them a tight shot to the gut of the public system, shoving us closer to the full privatization of health care, where essentially care will depend on the depth of your wallet. the bottom line though, is that despite the one or the other vibe that hangs over the debate around public healthcare versus private — that is, the public system is in flat-out crisis and we need a solution right now and if paying for it makes it better, then let’s — there are actually many shades in between, and it’s critical that we don’t ignore that.
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the canadian medical association is in halifax this week, part of a series of cross-country events where hopefully these insights have an opportunity to be shared. but the main goal of the road show — which is sponsored by the globe and mail — is getting feedback from canadians on “expanding private delivery of health care in ontario” (their words). i attended one that was held in toronto last year, and it was quickly clear that, like the piano teacher with the snow on her broom, canadians feel desperate and scared and want a solution to health care that means they and their kids can get their surgeries and appointments and mris in a timely fashion. they also want to be able to wait in an emergency room and know they’ll get out of there alive. it’s a desperation that has made even the most diehard universal healthcare supporters start leaning toward a pay-for-care model or some version of it, not taking the time to understand the consequences of doing so.
but let’s take time to consider all that works in our healthcare system — and there’s a lot — and remember that universal healthcare came about out of the belief that every person had a right to health care, and that no one should be refused care because they weren’t able to pay for it. the next step though is to evolve this system so that it not only reflects the changing needs of our population, but also adapts new models of healthcare delivery that meet these needs.
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it’s certainly possible. but just like the many patients who are bravely navigating through the rubble of today’s healthcare system, governments also need to be brave and have the tough conversations along with a vision for change that helps — not hurts — canadians. now is the time.
lisa machado is the executive producer of advocacy & better health. she can be reached at lmachado@postmedia.com.
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