Posted on 12/20/2003 9:51:45 AM PST by Pikamax
Backed against a wall
By MARGARET WENTE Saturday, December 20, 2003 - Page A29
Kate Hansen can't remember exactly how long it's been since she was able to stand up straight. She thinks the last time was around 15 years ago.
At 44, Ms. Hansen is almost doubled over from a rare form of degenerative rheumatoid arthritis that causes her spine to curve. "I look like a question mark," she says. She has been avoiding corrective surgery for years, but now she knows she has no choice. "If I don't do it, I'll be looking through my knees to walk," she says with a rueful laugh.
But now, Ms. Hansen has discovered what hundreds of thousands of Canadians already know. Deciding to have surgery and getting it are two different things.
Marcel Dvorak, also 44, is Ms. Hansen's surgeon. He's the medical director of the spine program at Vancouver General Hospital, and one of Canada's top spine surgeons. Ms. Hansen finally got in to see him last July after several false starts to get the right referral. They agreed she was a good candidate for surgery, and his office told her she'd be contacted in the late fall or early winter. And that's pretty much the last she heard.
At this point, Dr. Dvorak isn't certain when he'll be able to perform the procedure that will allow Ms. Hansen to stand up straight again. That's because her surgery is "elective," as opposed to urgent, and these days his elective cases are constantly being bumped, with patients usually a year or so for surgery. "Yesterday, we were going to do three surgeries," he told me when I spoke with him last week. "We had to cancel all three because there were no beds."
There are many ways to ration health care, and one way is to close hospital beds. With far fewer beds than they had a few years ago, hospitals often have no room left over for anyone who's not acutely ill. Another way is to close operating rooms. "We're taking three weeks off -- that's the Christmas closure -- in order to save money," says Dr. Dvorak. "And then there's another closure over March break, and the summer closure right after that, and the reduced activity days. Those are days we're not allowed to work. There are 11 of those." Eleven years ago, when he began his practice, he got three days a week to perform elective surgeries. Now, it's down to about one day a week.
Ms. Hansen started thinking about corrective surgery around three years ago. She wasn't too concerned about the wait, because back then the wait for orthopedic surgery at Vancouver General -- after you had seen the specialist -- was just two weeks. The following year it was two months. Waiting times reflect the gap between supply and demand, and Ms. Hansen's wait is a measure of the growing dysfunction in our health care system. One year after the Romanow and Kirby reports, the gap is bigger than ever. And even though we're spending a record amount of money on health care -- $120-billion, or 10 per cent of GDP -- not a cent of it is moving her any faster toward a normal life.
Dr. Dvorak has about 60 patients on his critical list. Most, like Ms. Hansen, need major surgery, and it's not trivial to bump them. Yet nearly half his patients over the past year have had their surgeries postponed at least once. The day he spoke with me he was nearly exploding with frustration. "My secretary just got off the phone with two patients for tomorrow," he said. "We had to cancel them, too."
"I'm deteriorating slowly," explains Ms. Hansen. "My chest cavity is already compressed. I have 70 per cent lung capacity. My rib cage is tucked underneath my hipbone and my organs are squashed." She can no longer drive a car, and when she wants to cross the street she has to turn her entire body to check for traffic. She gets by with help from her husband and her 11-year-old daughter. "I don't complain about the pain because complaining doesn't get you anywhere," she says. But she wonders if she should have made a bigger deal about the pain. "Right now there are moments when it is just not bearable."
"I don't think people know how bad it is," says Dr. Dvorak. "It's got to the point where we are really hurting patients." If a patient deteriorates too much, the surgery could become more complex and riskier.
Dr. Dvorak sees conditions every day that he can't do anything about. Recently he saw a young woman with a massive disc protrusion in her back. She was so disabled she couldn't get up off the examining table. "It's something I could fix like that," he says. "She could probably have gone home the next day. But we couldn't get her into the hospital." He wonders if it's even ethical to see new patients at all when there's no chance he can help them.
Canada now performs fewer lumbar discectomies (a common form of back surgery) than any other developed nation in the world. And our specialists are leaving in droves. "Twelve of the 14 Canadian specialists we've trained have gone to the United States," Dr. Dvorak says. "How much did it cost to put them through medical school? A couple of million each?"
Dr. Dvorak loves public medicine, and would never move to the United States. But he also points out that Canada is the only leading nation in the world without a parallel private system. "We're going to have to start sending people elsewhere because we can't care for them all," he predicts. Meantime, if you think everyone is treated equally, he's got news for you. Everyone who can pulls strings. He often starts a visit by asking, "How did you get in to see me?"
"I know there are people who are worse off than I am," says Ms. Hansen. "But I also know that there are probably some people with louder voices who are in front of me."
But we Canadians are stoic. We think waiting lists are just the price we've got to pay for our fair and equitable health system. "People are deteriorating on our waiting lists until they come into emergency needing operations that can't wait any longer," says Dr. Dvorak. "We're more or less running a MASH unit. That's the feeling a majority of my colleagues would express to you."
It's already here. Just walk into any emergency room and demand it.
Perhaps the solution is to somehow compel a number of years of service in Canada, perhaps through contracts or charging high tuition fees which are forgiven after minimum service time is fulfilled. One very innovative solution I've heard proposed is to simply tax Canadian doctors who leave Canada, say an extra 10 or even 20% of their income, should they choose to practise abroad. This way, they can practise where they want and the costs sunk into their training are recovered through steep taxes on their large incomes. It is also an excellent incentive to stay at home.
But don't you think the lower Canadian wages are related to socialized medicine?
In Canada, you don't pay for health care because you don't get health care.
Not really, Canadian wages are much lower across the board, in every conceivable occupation, especially in the professions. You can't really compare Canada, or any country to America, which is the richest nation in the world. Naturally, our standard of living and wages are much lower.
That argument could easily be used by, say, Norway.
However, Norway has a higher per capita income than the U.S.
If nations from Finland to Iceland are doing better economically than Canada, then Canada should examine their societal culture to see what is holding them back.
Gross National Income (per capita)
1. Luxembourg $39,171.23 per person
2. Switzerland $37,934.86 per person
3. Japan $35,597.56 per person
4. Norway $35,579.17 per person
5. United States $34,858.61 per person
6. Denmark $30,546.58 per person
7. Iceland $29,180.2 per person
8. Sweden $25,459.8 per person
9. United Kingdom $24,758.27 per person
10. Netherlands $24,272.15 per person
11. Austria $23,868.01 per person
12. Belgium $23,845.21 per person
13. Finland $23,728.91 per person
14. Germany $23,302.8 per person
15. Hong Kong $23,277.05 per person
16. France $23,090.05 per person
17. Ireland $22,593.87 per person
18. Brunei $22,096.79 per person
19. Canada $21,377.77 per person
Perhaps the solution is to somehow compel a number of years of service in Canada,
Or, better yet, build an iron curtain around your country to keep all the patients and doctors inside. It worked in the Soviet Union for years.
You can't really compare Canada, or any country to America, which is the richest nation in the world. Naturally, our standard of living and wages are much lower.
And how do Canadians account for that situation?
And how do Canadians account for that situation?
Well, I would have thought that would be clear. High taxes, a socialist economic system, massive economic regulations, out - of - control "social programs" etc.
So9
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