August 2006First get rid of the beancounters!
Fixing the Canadian Health Care System - try the Green Island Model
(some musings sparked by CNEWS Aug 21/06:
CMA concerned about wait-time guarantee
We here on the Green Island have been shaking our heads about the latest stuff coming out about the Canadian health care system after the annual conference of the Canadian Medical Association on PEI last week, where a guy who thinks privatisation for some things is fine and actually already has a lot of business for his private clinic from the BC gov (which appears to contravene various rules of the Canada Health Act) was elected head of the CMA, and the Canadian Health Minister gave a little talk about 'wait list guarantees', among other things. Wait list guarantees. Imagine now. It boggles the mind, it really does. The government basically saying that they are NOT going to do what is necessary to get the health care system back on its feet again (more doctors, more medical school seats, more resident spaces in hospitals, more beds, controlling Big Pharma, more nurses, more technicians, in general, more money to replace what was taken out of the system through years of cutbacks, plus a few steps into the modern world), they're just going to spend a lot of extra money to attempt to provide some sort of alternative options to sort of make up for the worst of the problems (but but but, if everybody has a waiting list, who are you going to send them to? it just doesn't work, in the long run, for starters). When a patient is hemorrhaging, you don't put her on a waiting list, you call the blood bank.
But the Canadian gov, of course, is trying to pacify Canadians who still have this tired old outdated idea of a comprehensive publicly funded health care system instead of moving to the laissez-faire 'look after yourself' system promoted by that great bastion of 'I'm ok fuck you' to the south of us that is the role model for the world, or at least our top politicians in Canada want to move this way (whilst pretending otherwise to get elected, of course, Lies 'R' Us in action again in the Canadian political circle), while paving the way for privatising the health care system to get more in line with their corporate buds to the south, so they have to do this stuff (actually, of course, there are a whole lot of Americans who are not as braindead as their 'leader' who want to have a Canadian style health care system in the US!! - but of course, if your reading is confined to the Canadian mainstream media you'd never hear about this sort of thing - Health Care for All (this is issue 39 of Yes Magazine, if the link changes with a new issue) - like you don't hear about all kinds of stuff). And they'll keep doing it as long as Canadians keep electing political parties that are dominated by Corporate Canada. Just like Lucy and Charlie - Lucy's having a great time, the world is moving the way she wants it to, and as long as Charlie keeps believing her, she'll keep putting that old ball up for one more kick, and Charlie'll keep falling on his ass. One of these days he'll find he can't get back up.
You do see the waiting list scam, don't you? If the public service, or what is left of it, cannot deal with the patients, and they have a 'guarantee' - why, we're real disappointed that things have come to this, folks (but remember, you did ask for it, demand it really!, yourselves! - there's never a better con than the one where the scamman says 'but you asked for this one yourself!!', and you have to walk off shaking your head, lighter in pocket but not, it appears, necessarily with a corresponding increase in brain power), but I guess we'll just have to allow private clinics to be paid for with health care dollars, oh my oh my - so expensive, too - but you did say this is what you want!! And there she blows - NAFTA will open the door for the HMOs, and we'll wind up with Medicare-US for the poorest, and a bit of Medicaid-US for the elderly, and the shrinking in size and money middle class going bankrupt over medical bills and premiums and deductibles, and 5 million Canadians with nothing at all - just like in the good ol USofA like the corps want. And at the first, the docs, at least a lot of em who are interested much more in their bank accounts than the public weal (a good bedside manner is NOT a positive attribute for medical school admission - puts you at the back of the line, really), will head for where the hours are shorter and the money higher and the work easier, and - and - and holy surprise, Batman!!!! - the waiting lists at the gov-supported hospitals and clinics and test centers aren't shorter, they're longer!!!!!!!!!! Golly oh gee, who would have thought, who could POSSIBLY have foreseen this terrible thing?!?!?! (And surprise surprise, by the time the shit really hits the fan, the gov that really got the show on the road will be long gone, and we look around in total vain for someone to actually blame for this latest debacle - as always. And the sharks'll keep doing this to the marks until the marks just get serious about stopping the whole game.
Wait time guarantees - jeez how gullible can people be. Why not just demand a decent system, like the one you had before they took it away?
Well - just in case anyone wants to know how things are done on Green Island, where we got rid of the sharks and the liars and the rest of the scum - read on.
Fixing Canada's health care system - try the Green Island Model
The single key to understanding anything that we have done here, or that you are doing or not doing in Canada (or anywhere else you might be reading from), is simply this: Political Will.
What gets done in a community or country, gets done because someone has the political will to do it (it is important to note that 'political will' in this context has nothing whatsoever to do with numbers (as of people) but power and influence - i.e. slashing both health care budgets and corporate taxes in Canada over the last 25+ years has been opposed by a pretty solid majority of Canadians all along, but favored by those with the 'real' power in the country - a quite small minority - exercising their political will). What does not get done, does not get done for one of two reasons: either basically nobody wants it so it just isn't an issue (declaring Mars to be the 11th Canadian province) or because the political will opposing whatever 'it' is, is stronger than the political will desiring it (which again of course has nothing whatsoever to do with numbers (once again proving the lie of 'democracy' in Canada) - i.e. legalizing marijuana in Canada has been favored by 70-80% of Canadians for decades, but no government will touch it - even though illegal drugs are a huge source of money for organized crime', and these crims would take a very real and serious, probably fatal for most, hit if drugs were legalized - so - the logical Holmesian mind sort of concludes....?????? c'mon, say it for yourself, thinking isn't that hard once you get used to it and practice a bit....).
But I'm tangenting again, the writer's curse when there is so very much to talk about and so little time. This is supposed to be about health care. But really, EVERYTHING is tied together here, like any complex system you cannot properly analyze one component as if it existed in a vacuum, it's all a great calculus, and what affects one thing will have at least some effect, maybe great maybe small but SOME effect, on everything else...
So anyway, from recognizing that political will is the true driver of anything, it is only a short step to understanding that once Prince Edward Island became Green Island, with a government truly of, by and for the people, rather than of by and for the oligarchy administered through the legislative assembly that PRETENDED to be the people's government but was really controlled by the oligarchy, the dynamics of the 'political will' changed dramatically, and that is why everything that happened, happened.
So, on Green Island, formerly one of the poorest provinces in Canada, we rather quickly became one of the most prosperous small states in the world, let alone Canada, because we had the political will to do so, and we got rid of the cancerous beast called capitalism sucking the wealth from us faster than we could produce it. One of the things we did was getting our health care system back on track through the following measures:
(Yes, this stuff costs money - and generally, the Green Island government has much more money than the PEI government had for three reasons: We quickly eradicated the provincial debt (1) owed to banks and 'investors' (they are actually fraud artists, and we are in the process of regaining most of that money, but we paid up front to clear the slate quickly, as it were, replacing the Canadian $$ that had been the means of exchange that were sent to pay off the 'debt' with Green Island $$, issued by the government debt-free, belonging to the people not rented from the banks - you guys in Canada are looking at well over a trillion dollars you could regain if you followed this path (and get a lot of people behind bars you really shouldn't have running around free there, given their overall contempt for you all and their thieving ways), our sum was much more modest, but we're a more modest sort of place) through printing our own money supply (2) rather than letting private banks create it and the government borrow it at prime rates of interest, which is sort of a stupid thing for a 'sovereign' people to be doing but most of you do; and finally we rearranged various economic policies so the wealth of the Island that was produced by Islanders stayed mostly on the Island, rather than getting sucked up by the Great Capitalist Vacuum Cleaner (3) (the 'debt' was part of this, but there were many other avenues through which Island wealth was being lost, through 'foreign' investment (otherwise known as 'keep em down on the farm'), foreign-owned franchises, stopping subsidized (by foreign governments) items from undercutting Island products through 'fair trade' policies, and so on - y'all can do the same if you want, but you gotta get control of your gummint first, of course)
But specifically on the health care front, we did the following - no real big secrets here, just intelligent people doing what needs to be done for themselves - you'd be surprised how quickly everything falls into place once you get that great bloodsucking capitalist parasite beast off your back:
1. First we got rid of the bean counters that the capitalists had imposed here (and everywhere else of course) to ratchet down services to the lowest possible level with constant pressure to reduce them even further, regardless of the health impacts on everyone, which of course were considerable and are in your Canada after 20+ years of cutbacks, the long waiting lines for instance just being one of the more visible aspects. 'Efficiency' is fine, normal intelligent people involved in any sort of enterprise do that, and we all keep an eye on that sort of thing too, but you shouldn't get efficiency confused with cutting everything to the bone as the beancounters insist on doing - that is a different sort of story with all kinds of not-so-good ramifications. Starving people or systems, placing them perilously close to total collapse when something unexpected occurs, is NOT fine, it is not 'efficiency', it is starvation, and that is not good for anyone, it is actually stupid when done 'by choice' for no other reason than to allow certain people to keep more of 'their' money (which is actually YOUR money THEY are stealing, along with many other things such as your wellbeing and safety). The high stress levels in overworked and underpaid nurses and doctors were another result of bean counters running the system for their corporate masters, who wanted every possible penny in profits squeezed out of the Canadian economy, of which the old PEI was just a minor sort of subset at the time, and the absolute minimum level achievable in corporate taxes, and such bean counting was one way this was achieved. On Green Island we have booted the lot of them, recognizing them for the parasitic scum they were. The point of a country or government (at least so we believe here on 'we the people' Green Island, I guess it may be different in 'we the oligarchy' Canada these days) is not to arrange things to maximize corporate profits for those who own the corps and their investors - the point of a country and government (again, so we believe here on Green Island, but apparently not so in Canada) is to arrange things so that MOST citizens have as good a life as they can, not so the few thrive while the many suffer - that was the old way of things on PEI, and it was good for the few and less so for the many.
That means, for instance, that when deciding on a health care budget, the process is not "Ok, there are an average of 50.872 patients here per shift, so we'll just round that down to 40 and cut that by another 20% to be sure there's not EVER anyone sitting around for a few minutes 'getting paid for doing nothing', figuring we can get at least 20% more work out of everyone if something unexpected comes up, and then we can cut it by another 20% as well for patients who caused their own illnesses and therefore they should not expect hard-working taxpayers to cover self-inflicted illnesses and then another 20% because Canadians just expect too damn much from the health system and it's already overloaded and costing too much - etc and etc." - no, that is not the right way. Actually, it is the 'rightwing neocon corporatist government' way - but not the Green Island way. We do something more like, "Ok - 50 average, let's allow staffing for 60 to be safe, and be damn sure we have someone on call if something unexpected happens, and do some more number crunching to be sure we have adequate people plus cushion at peak times and some smaller number at times known to be almost always slow. Staff sitting around for a few minutes relaxing in a place they believe in and enjoy working in will be talking about ways to improve things when they don't actually have something to do, and will be fresh and ready when they do have something to do and thus give the best service for their patients (who are after all we the people), and will be happy to be working there so the work will be good - and we want happy citizens and workers everywhere, with good services, so we all win because of that." I can see the bean counters and their controlled press 'journalists' either laughing at the "naive idealism" of such statements, or falling off their chairs with shocked looks on their faces at the terrible damage we are threatening to corporate profits by such actions - but that's ok. They don't run Green Island and we don't really much care what they think in their puckered shriveled little brains, as long as they keep their beancounting little asses the hell away from us in the future. (we do feel sorry for them, however, and they are welcome to come join us if they want a real life - we have a special wing in the psychiatric ward for recovering bean counters - our staff like working there, actually, it's sort of like a regular real live Dickens' Christmas Carol event, with recovered Scrooges finding their epiphany into the real world of humanity and laughing and feeling joy at something positive for the first time in their lives)
2. We gave the system enough money to do what it needed to do, what we wanted it to do. We began from the assumption that we had responsible, intelligent physicians who only recommend procedures or treatments or tests that were necessary for their patients, and then figured nobody should have to wait more than a few days for such things, and they should not have to wait at all for important things. Long wait lines, such as were common on PEI and still are in Canada, are a sign that a system is drastically underfunded (corporate complaints of 'mismanagement' are just lying - oh they can probably justify such statements with their fingers crossed behind their backs or something, because the system isn't being 'managed' to max out corporate profits, which is the only kind of 'management' that concerns them, and from that perspective they can say they were telling 'the truth as they understood it to be' - but for a lot of years, before the bean counters moved in, the Canadian health care system was excellently managed, by very intelligent and caring Canadians, who can do a damn good job of most anything when they are allowed to do so, and when that is their mandate rather than paring everything to the bone so corp profits can go to investors rather than taxes for 'extravagancies' like health care for the people who made the corp profits possible). On Green Island we realized we needed more doctors, more nurses, more hospital beds, more university medical spaces, more lab techs, more everything, pretty much, except bean-counters running things, and got the Green Island Health Office working on it. (When Green Island people get to work on something, results happen - like they used to in the golden years of Canada before the corporate bean counters took over, and changed the whole system over to maxing out corporate profits, to hell with everyone else, and having to lie about that on top of it all because it is just too early to let the people know their country has been stolen - they might get upset).
3. With the corporate bean counters gone from Green Island, common sense began to prevail in all areas (there's a real synergism that happens when good people get together trying to do good things without a hidden 1,000-pound bloodsucking parasite weighing them down, just as there is a sort of negative synergism that happens when bad people like corporate bean counters (who are operating under a certain agenda that they are lying about - that is to say, they yap about improving 'public efficiency', but in reality they are only concerned with maxing out - yea, you guessed it - corporate profits, whilst having to conceal the true nature of their work from average Canadians (not all that difficult to do with a media controlled by the same people who control the beancounters, oh shame on you all) are allowed to paw through a public system doing bad stuff, and all sorts of unintended bad consequences happen from stupid bean counter suggestions meant to squeeze a few more pennies out of the system somewhere).
(Don't misunderstand the 'more of this more of that' comments - we were not looking for endless expansion, that's another stupid, shortsighted, greedy capitalist idea (they're full of them), we just wanted to restore the system to its former decent functionality, plus add a bit for comfort and normal growth and improvements and to allow for unexpected things that happen sometimes. Actually, since everyone's health has improved a lot in the few years of government of, by and for we the people, we find the health care system is being used less and less - we've reduced by probably 90% most of the modern complaints that are related to stress and other system-induced psychosomatic illnesses which are largely brought on by combinations of passive resistance to the Box and internalized inability to deal with the many discontinuities imposed on the human brain by capitalist imperatives of working one's whole life in some meaningless job to produce wealth for someone else whilst having no life to speak of that means anything one wants it to mean - but that's a chapter for the text book, not part of a short analysis of what you need to do in Canada to get your health care system healthy again.)
4. We have also been at some pains to considerably reduce the 'doctor-as-god' stuff, which is really nothing more than another part of the hierarchical 'do as you are told by people who know better, don't ever think for yourself beyond deciding which tweedledee-dum candidate to vote for when we tell you to mark an X somewhere or which fast food junk you will buy for your kids at the mall on Saturday' society Canadians have been trained to accept, but which has no place in a society truly run by We the People and not some oligarchy hierarchy. Trained doctors are good to have around for certain things, as are any professionals with special training in somewhat advanced fields requiring some years of dedicated education not commonly known by everyone, but intelligent adults prefer to think for themselves as much as possible, and not rely on doctors or any other 'experts' to tell them what to do every time they run into some little problem in their lives. We upped quite a bit the number of nurse practitioners, for instance, in the Green Island system, to take care of smaller things that don't really require a doctor to do but might require a bit of skill the average person might not possess, such as putting a stitch or three in a cut foot, or giving a vaccination or something. The doctors are freed for the stuff they are trained to do - diagnosing heart problems, operating on stuff inside the body, diagnosing tricky diseases, stuff like that that you can't really manage on the kitchen table with some advice from a friendly DIY website. Our highly skilled medical professionals don't waste half their days telling people with a cold to go home and take two aspirins and call me in the morning, they spend most of their time on serious stuff and research (and seem much happier for it all as well - and they do and can keep in touch with 'the people' through various things like occasional day clinics or school visits or filling in for NPs from time to time - nothing is writ in stone here, and people are pretty free to move around and do what they feel most comfortable doing, and some doctors do like day-to-day routine stuff sometimes). Now our nurses do at least half of the stuff a doctor formerly did, for somewhat less money (everybody makes a bit less money now on Green Island, but they have much more to actually spend themselves when they don't 'donate' half of everything they make to the great capitalist vacuum, and much better life styles with less work stress etc because the bean counters aren't hassling them every second of the day, including the doctors). The conscientious NP will send the patient off to a doctor if and when she or he deems it necessary.
5. We got the drug companies out of the provincial finance department, the drug companies that seemed to feel that because they had enough money for important lobbyists and had, as part of the hierarchy, managed to have a pretty controlled but pretty necessary product, that they had some sort of right to a blank cheque from we the people for necessary medications. We disabused them of that notion. Everybody deserves a profit for their work or creations, but these guys were way overboard. There are limits to rights - we don't let killers say they have a 'right' to make a living if someone wants to pay them for killing people, and we shouldn't let drug companies blackmail us by saying they have a 'right' to windfall profits or the people can just die if they can't afford the drug. Farmers have a right to make a profit on what they sell, but they don't have a right to get together and say 'OK, peasants, a hundred bucks a pound for spuds or die!' (farmers was not a great example, I concede, as they were one of the most abused groups by the capitalist system - they are much happier on Green Island). On Green island, we don't set the price of a drug by what the market will bear, we set it by a process that allows a fair profit for the drug supplier and no more. If they want to take their candy and go home and not offer it here, that's fine too, nobody is making them do business here, we have companies here with good research labs who can make a generic equivalent for a fair price (we do not recognize 'world wide' patents here for things like important new scientific advances, nor do our scientists try to acquire such things for themselves (more outraged bodies tumbling to the floor, I can just hear it - that's cool, the more capitalists on the ground the better)). And we are developing many new drugs as well, and that's something you are really screwed up with there in Canada - when most of the research for a drug is done by publicly funded university research, as most of it has been, then why on earth do you allow the private drug companies to essentially steal that research and file some patent that allows them huge private profits that the people and government will have to pay outrageous prices for, for the next 15-20 years? You guys are really crazy, or else your leaders are really corrupt, doing this (sort of the same as with the money supply stuff). Here on Green Island, as we do with health care or electricity or other 'essential services', the manufacturer of important drugs is under government (that is to say, We the People, remember, not some 'they') supervision, and they provide the drugs at a reasonable price for a reasonable profit. Of course, here on Green Island we have real people doing stuff like this who care about the common weal and not investor profits, and not 'corporations'. Don't get me started.
- well, I could go on with other things, but that's enough to tell you about the general pattern - there's lots of details about everything, but if you get the right ideas going in, the details aren't much of a problem - intelligent, caring people, not driven by the hidden motive of trying to max corporate profits in your country while pretending to care about 'the consumers of health care', will see everything work out fine - like I said, the only real problem is the political will - you solve that, and the rest works fine. Don't lose that message - don't even bother talking about the health care system changes until you have the political will to implement them - that is, of course, exactly what the rulers want you to do, since all the talking you do about ANYTHING except changing the political will is just a waste of time, like kids in high school fantasizing about what they would do if they were principal or something - at the end of the day, the principle pats you on the head and chuckles patronizingly about your little meetings as he goes ahead and does as he pleases. First - ya gotta get rid of the bean counters you've allowed to be put in charge and that huge corporate capitalist parasite sucking the wealth out of everything you do. If that is not the first step, anything else is just bandaids on a gaping wound, like that wait list guarantee crap, which is some real bad medicine from a real quack doctor whose only purpose is to keep milking you for a bit more time and money before they declare the whole patient dead and gone, and they are gone with what's left of the wealth of the country, and everything that was good about Canada that took 100 years and more to build is gone with them.