Comparing and contrasting the challenges and benefits of paying for healthcare and waiting for healthcare.
In the interest of full disclosure… Journalists use this phrase when they want to declare a personal connection to their subject. I think the bloggers’ equivalent of full disclosure is admitting not to a special connection or knowledge but, rather, to none at all. I wouldn’t have done well with Sgt Friday. Just the facts, ma’am. Nope, sorry, no facts here Sergeant, just opinions. Or, in this case, maybe ‘questions’ comes closer to the truth.
So — in the interest of full disclosure in the blogging sense — let me say that I know nothing useful about the structure of our health care system. Two recent encounters with physicians, however, have left me puzzled. Can we talk?
First up: Extra billing. My ‘melanomic mole downgraded to irritated age spot’ saga took me to my family doctor in December. The darned thing hurt and I wanted it off. Given the pre-Christmas rush and my schedule of trips in the New Year, a referral to a dermatologist for later removal-by-laser was not feasible. That left immediate removal-by-freezing. My doctor apologized in advance for the $10 he would have to charge me to replenish their liquid nitrogen. Removal of age spots — even ridiculously irritated ones on justifiably irritated patients — is deemed an elective procedure. I could, after all, just cover it with a Band-Aid® (or generic substitute) and wait for it to settle down. When I allowed as how I supported user fees for elective procedures, my doctor allowed as how he did not.
Second: Drug pricing. The specifics of the encounter aren’t mine to share, but here’s the gist. A specialist referred to the price being charged for a new drug as “immoral”. Still under patent protection, the drug offers important (but not life-saving) benefits not available through any other medication. Its price, however, means that the only patients who have access to it are those with private insurance plans and private means.
Now, the family doctor who fusses about ‘having to’ charge a nominal fee for an elective procedure is so busy that the interval between my nominally annual physicals is never less than14 months and has run as high as 16 months. The specialist who objects to the price of a new drug — developed at who knows what cost and business risk — is so backlogged that it takes several months to book initial referrals and even repeat visits. From where I stand in the queue, it looks as if these waiting periods result from the intersection of two sets of interests: health care costs (the interest of Government payers) and physician compensation (the interest of medical regulating bodies). The result is a limited supply of physicians, especially specialists, in the face of more or less unlimited demand.
So for me this raises a question: If it’s not OK to use money as a barrier to health care services — to ration access based on ability to pay — why is it apparently OK to use time as a barrier — to ration access based on ability to wait? Why is the one restriction “immoral”, and the other not worthy of remark?
Other than in triage situations where lives are clearly at stake, I don’t see that rationing by ability to wait is inherently any better than rationing by ability to pay. The longer I live, the more people I know who wait in pain/anxiety/disability for diagnosis and treatment. If your own health and that of your loved ones hasn’t subjected you to this yet, congratulations. Now go hang out with someone who has unexplained neurological symptoms or someone who needs a hip replacement and you’ll see what I mean: waiting can be downright nasty.
In the interest of full disclosure — this time in the journalists’ sense — let me state that I can afford to pay extra fees for medical treatment. Sgt Friday would be proud: this isn’t an opinion, it’s a fact. I coughed up the $10 for my late, unlamented age spot and would do it again without a second thought. Of course I’d rather have that money to put toward vacations or good wine, but I don’t seriously count the cost. Nor was that $10 an aberration. Every three months I buy batteries and cleaning solution for my hearing aids. Every four months I have my teeth scraped by my ever-patient dental hygienist. Every two years I pay for eye exams and the two pairs of prescription glasses (regular and sunny day glasses) that ensue. Periodically, in lieu of maintaining a sensible exercise program, I pay for physio appointments. And when even I can’t deny that the old hand-crank technology is obsolete, I will buy new hearing aids. Some of these services are covered in part by private insurance (for which I pay), some are not covered at all, and none are covered completely. For all such differences between cost and coverage, I pay. I do not wait.
For me, timely access to health care is important. I hear that Canadians think universal access to health care is more than ‘important’ – that it’s a sacred trust. Maybe that’s true, although it doesn’t seem to apply to care of the eyes, ears, teeth, or muscles and joints. For sure, all such pronouncements must be filtered through the self interest — disclosed or not — of the pronouncers. Maybe it’s too much to expect that anyone with a stake in the system will subscribe to any version of ‘full disclosure’ anytime soon. And so I pay. I wait. And I hope.
We find ourselves constantly in the midst of this waiting game as we try and book appointments for “yearly maintenance”. After working 30+ years in Health Care, I have seen the system from that side as well. My advice to you all is, start eating healthy, and doing those exercises on your own – because the best defence is an offence – do what you can to stay healthy! Otherwise, you’ll wait.
Alison – Eat right? Exercise? I was hoping for that magic pill… It will be interesting to see how this plays out as Boomers age. Without lapsing into ‘The sky is falling!’ rhetoric/hysteria, it sure looks as if the current approach is not sustainable, but too few folks are talking sensibly about the problem yet. For sure we can’t guarantee a good outcome by taking care of ourselves, but it looks as if it’s the best shot we have.
I’m really taken with your comment equating time and money. Both are currencies, in a sense, but we tend to value the one, and ignore the other. I need to think about this one a little more…………………………………
Jim – Yes, and the older I get, the more I value the time, as opposed to the money. I appreciate that’s a perspective from a certain situation, but hey! It’s mine. The challenge, I guess, is to try to balance all the perspectives, once we decide what the heck we’re trying to accomplish.
Reminds me of church Isabel! You know the annual stewardship appeal. Give us your money or your time. So in healthcare you are saying let’s have a pay or wait system.
Now let’s see how can we solve this. I am guessing that those who are capable of paying more for healthcare and for private insurance could pay higher taxes. The public system needs more $$$ so, connecting the dots here, do we need to have higher marginal tax rates at the upper end? Can we improve the system by reducing wait times with more $$$ from taxes? But would the extra $$$ raised necessarily be used for better healthcare? Well, we could bring back the healthcare premium for all, but of course with premium level based on income.
But some say we should not bloat the government bureaucracy any further but instead we should create a huge private enterprise insurance bureaucracy like our neighbours to the south.This discussion could go on for ever as it seems to be doing just south of the 49th.
The Scandinavians have figured this out which explains why they are the happiest people on the planet by most measures of happiness.
Dave – It seems to me that a mixed-provider approach works better than either the pure government or private approach – indeed, we really have a mixed approach already. And I think we’re going to have to accept tiered care – indeed, we have it already, based on the province you live in and who you know in the system.
Isabel, this is a very complex issue, but it all boils down to how much pain and suffering will we as a society allow to befall the sick, the elderly and the infirm before we accept that we have a responsibility to take care of them. In Alberta the Tory government is pushing as much as it can into the private market. They’ve already privatized about 30% of health services (teeth, eyes, joints, etc. as you’ve pointed out) and they’re hoping to privatize more. The concern I have with privatization is that it replaces the social safety net model with the corporate profit model. Rising costs eat into profits so service levels are reduced. The result is poorer quality health care.
I like Dave’s train of thought. We should look to European examples and apply what we can to the Canadian situation.
Susan – Glad you’ve weighed in. It is complex – that much I do understand! I’m all for looking after those who can’t look after themselves. I just want to be able to look after myself too. I hope these two goals are not incompatible.
Isabel, you ask for “the magic pill”. I heard Dr. Mark Moyad speak (google him, he’s interesting) and he said when he told people he had the “magic pill” to good health they were all VERY excited, UNTIL he explained that it was “20 minutes of exercise every day” .. .and then, suddenly, we think it’s too hard to do.
Alison – Yup, that’s similar to the Dr. Evans youtube video on getting 30 minutes of exercise a day. Even just a bit of regular exercise is good, it seems. Maybe we need to power our TVs from our treadmills or exercise bikes – I wonder how many programs would be worth watching if we had to walk/cycle to get them?