thanks Rick....as always much appreciate your expertise and generally agree with you. You should be Health Minister! Getting rid of the Act and embracing private practice, slashing managerialism, rationalizing services as health not employment providing and of course removing DEI and the host of fashionable parasitic services, and Robert is your father's brother! No chance of happening till total collapse.
Thanks for the vote of confidence! No danger of becoming Health Minister. I found out the hard way that talking sense gets you fired. I agree that change won’t happen till things collapse, although I would tend to say that the collapse has already happened and here we are, fiddling while Rome burns (menopause centre of excellence, anyone?).
Thanks for this Rick - I always appreciate your view.
I am perhaps more pessimistic, but in a day and age where we feel medical care is not just for fixing problems - broken bones, infected appendices, cancers - but also for keeping us "well" - ie: I want counselling if I'm sad, I want my vitamin D checked, my potassium levels, my magnesium and selenium levels, I want my bone density checked, my cholesterol, my blood pressure. I want my bowel scoped, my prostate checked, my breast screening done. It is impossible to pay for everything that everyone WANTS, because the benefit-to-cost ratio is questionable, and a matter of personal opinion as to whether it is "worth" it. But when it is "free", why not get everything checked!?
I agree with you. You’ve anticipated my next post.
The slippery slope that we went down was that anything other than perfect health was ill health, ill health required health care, health care meant individual services, and nobody should have to pay for their health care services. The patients came to expect that they could ask for anything and everything, at no charge. The doctors stopped charging for the uninsured stuff. The advocates, backed by Big Pharma, etc., started pushing to add things to the list, which is why the PC’s are talking about a menopause centre of excellence and shingles shots for seniors as part of their election platform. We’ve gone way past what’s needed. We’ll never have enough buildings, machines, people and dollars to pay for all the things people want, and the marginal gain is minimal (how much more heart attack risk reduction do you actually get by adding another drug, after you’ve been scented, stopped smoking, added ASA, started a beta-blocker, lowered your cholesterol, etc. Huge waste in the system.
Increased personal financial and other responsibility would help people have more respect for what they need and can get.
I really think we need to dial back to some sort of public insurance for the big expenses, and let people buy their own insurance or pay their own way for the other stuff. Married up with that, we need to open up the system to private facilities and providers that can bill the government for the insured stuff and the patients/insurers for the rest. A bit of competition would help enormously.
Yeah, I’m very tired of the news of the day about government saying how big the med schools will be, which people will be admitted to med school, where docs can work when they finish med school, where clinics will be built, which hospitals are to be expanded, which drugs will be added to the list, which niche treatments are now publicly funded, and what things doctors must refer to or cannot talk about. As if they can afford it, which they cannot, and as if they are simply fine-tuning a well-oiled machine, which it most certainly is not!
3 things I can think of that “might” change health care in Canada could be 1. Decouple from the WHO. At the moment it is a highly compromised authority blob that has too much influence from the rich and powerful (ie: Bill Gates). These people may operate under the impression that they know what is best for everyone, but do they?
2. Many Canadians will use health services far too easily due to the perception that it is “free”, when in reality, nothing is free. Medicine and medical services cost money. Under the current structure, tax dollars pay for this. Perhaps adopting a system similar to the Japanese system (ie: you pay for 30% of your care yourself, and the remaining 70% is paid for by government insurance, which is taxpayer funded. And the government here always ensures that generic medicines (pharmaceuticals) are available first if possible) this helps to ease the pressure on the system and prevents too many unnecessary visits.
3. Perhaps tie physician compensation to patient outcomes. This would mean when something isn’t working, the physician, practitioner could use more of their judgement to explore alternatives to only college/ government sanctioned protocols and “standards of care” that aren’t working for patients. ie: off label prescription (ivermectin, HCQ), referrals with follow up to other professionals (acupuncturists, chiropractors, massage therapists or naturopaths). This would change medicine for the better as there would be more cross disciplinary consultations instead of the siloing that functions as barriers to learning and care.
I will agree wholeheartedly with 1 and 2. That’s where I’m headed in future posts.
3 is a bit tricky. You don’t want docs to specialize in “sure things” (by which I mean the patients who will do well with or without an intervention), nor do you want them to be tied to things beyond their control. By pure random chance, in a small sample of patients, you could have a bunch of bad outcomes, despite doing everything “right”. I could prescribe the right drugs and do the right tests, but what if the patient does stuff that makes the treatment fail? I’m told, for example, that continued smoking cancels out the effects of one chemotherapy drug. So a smoking patient on three chemo agents might have the outcome you would expect for a patient on two drugs. Besides that, some outcomes are statistical - more likely to do good than harm, but it’s still a crap shoot.
I suppose you are right on 3. However, it was a reality for my whole career as when a patient didn’t get the outcome that they were satisfied with, they went to another practitioner (who may or may not have helped them). If however there had been a system in place where another practitioner that I had referred the patient to solved their problem, I would also have been included in the outcome, and subsequently benefitted. (although that would probably be wishful thinking on my part).
thanks Rick....as always much appreciate your expertise and generally agree with you. You should be Health Minister! Getting rid of the Act and embracing private practice, slashing managerialism, rationalizing services as health not employment providing and of course removing DEI and the host of fashionable parasitic services, and Robert is your father's brother! No chance of happening till total collapse.
Thanks for the vote of confidence! No danger of becoming Health Minister. I found out the hard way that talking sense gets you fired. I agree that change won’t happen till things collapse, although I would tend to say that the collapse has already happened and here we are, fiddling while Rome burns (menopause centre of excellence, anyone?).
Thanks for this Rick - I always appreciate your view.
I am perhaps more pessimistic, but in a day and age where we feel medical care is not just for fixing problems - broken bones, infected appendices, cancers - but also for keeping us "well" - ie: I want counselling if I'm sad, I want my vitamin D checked, my potassium levels, my magnesium and selenium levels, I want my bone density checked, my cholesterol, my blood pressure. I want my bowel scoped, my prostate checked, my breast screening done. It is impossible to pay for everything that everyone WANTS, because the benefit-to-cost ratio is questionable, and a matter of personal opinion as to whether it is "worth" it. But when it is "free", why not get everything checked!?
https://pairodocs.substack.com/p/when-its-everyones-money-its-no-ones
I agree with you. You’ve anticipated my next post.
The slippery slope that we went down was that anything other than perfect health was ill health, ill health required health care, health care meant individual services, and nobody should have to pay for their health care services. The patients came to expect that they could ask for anything and everything, at no charge. The doctors stopped charging for the uninsured stuff. The advocates, backed by Big Pharma, etc., started pushing to add things to the list, which is why the PC’s are talking about a menopause centre of excellence and shingles shots for seniors as part of their election platform. We’ve gone way past what’s needed. We’ll never have enough buildings, machines, people and dollars to pay for all the things people want, and the marginal gain is minimal (how much more heart attack risk reduction do you actually get by adding another drug, after you’ve been scented, stopped smoking, added ASA, started a beta-blocker, lowered your cholesterol, etc. Huge waste in the system.
Increased personal financial and other responsibility would help people have more respect for what they need and can get.
I really think we need to dial back to some sort of public insurance for the big expenses, and let people buy their own insurance or pay their own way for the other stuff. Married up with that, we need to open up the system to private facilities and providers that can bill the government for the insured stuff and the patients/insurers for the rest. A bit of competition would help enormously.
Well said!!
Yeah, I’m very tired of the news of the day about government saying how big the med schools will be, which people will be admitted to med school, where docs can work when they finish med school, where clinics will be built, which hospitals are to be expanded, which drugs will be added to the list, which niche treatments are now publicly funded, and what things doctors must refer to or cannot talk about. As if they can afford it, which they cannot, and as if they are simply fine-tuning a well-oiled machine, which it most certainly is not!
3 things I can think of that “might” change health care in Canada could be 1. Decouple from the WHO. At the moment it is a highly compromised authority blob that has too much influence from the rich and powerful (ie: Bill Gates). These people may operate under the impression that they know what is best for everyone, but do they?
2. Many Canadians will use health services far too easily due to the perception that it is “free”, when in reality, nothing is free. Medicine and medical services cost money. Under the current structure, tax dollars pay for this. Perhaps adopting a system similar to the Japanese system (ie: you pay for 30% of your care yourself, and the remaining 70% is paid for by government insurance, which is taxpayer funded. And the government here always ensures that generic medicines (pharmaceuticals) are available first if possible) this helps to ease the pressure on the system and prevents too many unnecessary visits.
3. Perhaps tie physician compensation to patient outcomes. This would mean when something isn’t working, the physician, practitioner could use more of their judgement to explore alternatives to only college/ government sanctioned protocols and “standards of care” that aren’t working for patients. ie: off label prescription (ivermectin, HCQ), referrals with follow up to other professionals (acupuncturists, chiropractors, massage therapists or naturopaths). This would change medicine for the better as there would be more cross disciplinary consultations instead of the siloing that functions as barriers to learning and care.
I will agree wholeheartedly with 1 and 2. That’s where I’m headed in future posts.
3 is a bit tricky. You don’t want docs to specialize in “sure things” (by which I mean the patients who will do well with or without an intervention), nor do you want them to be tied to things beyond their control. By pure random chance, in a small sample of patients, you could have a bunch of bad outcomes, despite doing everything “right”. I could prescribe the right drugs and do the right tests, but what if the patient does stuff that makes the treatment fail? I’m told, for example, that continued smoking cancels out the effects of one chemotherapy drug. So a smoking patient on three chemo agents might have the outcome you would expect for a patient on two drugs. Besides that, some outcomes are statistical - more likely to do good than harm, but it’s still a crap shoot.
I suppose you are right on 3. However, it was a reality for my whole career as when a patient didn’t get the outcome that they were satisfied with, they went to another practitioner (who may or may not have helped them). If however there had been a system in place where another practitioner that I had referred the patient to solved their problem, I would also have been included in the outcome, and subsequently benefitted. (although that would probably be wishful thinking on my part).