MUCH has been said and written over the years about health care, and politicians have been hiding behind clichés — often misleading — such as "no private health care" and "no two-tier system," without offering any innovative ideas on how to fix our system.
Our health-care system is complex and misunderstood; because we as individuals don’t pay for services, we don’t realize that our system uses private companies on a regular basis, for services such as X-rays, lab testing (Dynacare) and most physicians’ services.
Politicians tend to ignore these facts, and some are eager to trigger fear by comparing our system with the imperfect U.S. model, while overlooking the fact the majority of European countries are using both private and public systems successfully.
Most people don’t realize that a two-tier system is also in existence in Manitoba.
The Workers Compensation Board has long-standing arrangements with Manitoba Health to bypass waiting lists for tests such as CT scans and MRIs, orthopedic consultations and surgery scheduling. Professional athletes are also able to have quick access to tests and treatment.
We must wonder which is right: a professional hockey player having surgery in 24 hours, or an 80-year-old person, bedridden by disabling pain, on a three-year waiting list? If it is unacceptable, for economic reasons, for WCB patients or athletes to wait, it is also unacceptable, for health and humanitarian reasons, for other patients to wait.
Unfortunately, suffering patients have now been reduced to annoying numbers on a list, an excessive expense to ignore or postpone as long as possible. Of course, politicians will object to this view, but how else would they explain their lack of action on a situation that has existed years before the pandemic?
I wonder if they would be willing to subject themselves or their family members to a long wait.
A task force has been created in Manitoba to resolve the problem of waiting lists, and I hope discussions will be practical and transparent, and will focus on offering quick but also long-term solutions unencumbered by ideology or bureaucratic and financial restraints.
There is much to do, but hopefully the task force will consider the following points:
1. Patients having surgery outside of Manitoba must be reimbursed for their costs (up to the Manitoba cost for the same procedure). This decision must be immediate. The government is not providing a needed service in a timely fashion, and is failing daily to come to the rescue of suffering patients facing potential injury or death while waiting for surgery.
2. In order to do more surgery, the arbitrary cap on the number of surgeries done per year must be removed immediately.
3. Operating rooms must run efficiently. A small group of independent and qualified professionals (including physicians) must be formed to come up with rapid solutions.
4. As long as the wait time is six months or longer, ORs must be functioning 24 hours a day, seven days a week, and all obstacles (such as staffing) to that goal must be addressed.
5. Discussions must start immediately to offer surgery privately at no cost to the patients, as is being done with laboratory tests and X-rays.
Cost to the patient has always be used as an argument against private medicine. If Manitoba Health is unable or unwilling to pay for timely services, we know many patients are willing to pay to end their suffering, but at present they have to leave Manitoba to do so.
In a recent letter to the editor, Don Porter says, "He (medical ethicist Arthur Schafer) should discuss the ‘ethics’ of a health-care system that makes people wait more than three years for a knee replacement, a system that doesn’t let people use their savings to get their life back and, at the same time, shorten the wait of others."
Another argument against private medicine is the fear that surgeons would limit their practice to the private sector and wouldn’t be available in the public sector. This, however, is not happening in other countries using private and public health care. Manitoba surgeons have also demonstrated their willingness and ability to do more surgeries, but are currently constrained by the limits imposed by our current system.
6. Waiting lists for MRIs and CT scans must be managed differently. More tests may not be the solution, but rather elimination of unnecessary tests.
7. All the discussion and planning must be fully transparent with ongoing public reporting.
8. In view of the urgency of the situation, the task force must make public and ongoing ecommendations, without waiting for a comprehensive report in some distant future.
We are all patients or potential patients, and we must all be concerned by this situation. The current system is not only unacceptable; it is also costly, as patients on waiting lists continue to use other services, such as emergency services, doctors’ offices and home care.
We may feel helpless in the current situation; perhaps it’s time to form a patient association to add power to our voices.
Philippe Erhard is a retired Winnipeg family physician and sports-medicine physician.