(Image Credit: Rachael Gorjistani via Wikimedia Commons; the image is at this link. Used without modification under Creative Commons Licence)
Obeisance to our ‘healthcare ideology’ requires that even the most glaringly obvious facts must be ignored if they go counter to the foundational tenets of the ideology. The blame for any problem must be deflected elsewhere.
(Note: This article is Part-2 of the previous article ‘Bottomless Pit’)
THE OTHER HALF
In the previous article, we saw how the report by Ontario’s Financial Accountability Officer (FAO) on the province’s healthcare system evoked a slanted reaction from mainstream media in their coverage of the report; everyone picked up on the word ‘underspending’, and ran with it. This was because ‘universal healthcare is underfunded’ is one of the foundational tenets of our ‘healthcare ideology’; the underlying assumption is that any problems encountered in its functioning came into existence solely owing to a paucity of funds, or at the very least, can be resolved by increasing funding for the system.
There was another headline point from the FAO report that the media ran with, viz., understaffing. In this article, we will see how the media yet again failed do a proper analysis of an issue based on information that is readily available in the public domain (and even if it wasn’t so, it is the very function of the media to dig it up, using all the resources at its disposal).
GOOD AS GOLD
Before we go into the details, however, there is an important aspect of this debate – as it is happening currently – that needs to be highlighted. All the sides involved in this, viz., the government, the opposition parties, the media and even the FAO, keep talking about bringing the situation in healthcare (on a whole host of metrics) to ‘pre-pandemic levels’ – as if the healthcare situation in 2019 represents some kind of a Gold Standard that amounts to achieving healthcare Nirvana. The fact of the matter is that it was anything but. To put it bluntly, the state of the universal healthcare system was abysmal in 2019 (see my article ‘Canada’s Healthcare Crisis’ for a detailed look at the mess that we were in at the time). While the massive further deterioration that happened starting in early 2020 may make the situation in 2019 seem vastly better, it is not something that we should aspire to.
For example, there is a persistent issue of senior patients in hospital who have recovered from their ailment but cannot be discharged because there is no space available in Long Term Care Homes. The average duration for which they were stuck in the hospital awaiting discharge was around 90 days in 2019. In all the hue and cry about inadequate hospital beds, you won’t hear anyone even mention the possibility that these hospital beds can be freed up for new patients if we can find a way to relocate the recovered senior patients to LTCs. And the numbers are significant – as of January 12, 2022, nearly 41% of the hospital beds in ICU’s across the province were occupied by recovered seniors awaiting transfer to LTC’s. The charts below are based on data from Ontario Hospitals Association, via the National Post / True North Centre journalist Rupa Subramanya’s Twitter posts.
Given this scenario, ‘returning to pre-pandemic levels’ would mean that hospitalized seniors who have recovered from their ailment would have to wait for 3 months before they can be discharged from the hospital. I don’t think anyone could possibly call that a desirable state of the healthcare system. Regardless of this obvious truth, talk about ‘returning to pre-pandemic levels’ has become a mantra everywhere it matters, including in the media.
ABOVE & BEYOND
Let us now turn to my pique that people offering commentary on policy – and especially healthcare policy – routinely stay away from analyzing facts / information, or putting various known facts in juxtaposition to each other so the audience can gain a better grasp of the situation. In common parlance, this is called ‘connecting the dots’. Consider, for example, this part of the report by Global News and the corresponding part of the FAO report (page 38 at this link):
At this point, inquiring minds would want to know if this huge jump in the number of vacancies in health sector jobs may have at least something to do with the fact that thousands of HCW’s are no longer employed in the health sector because they decided against taking the Covid vaccine. For the reasons that I have detailed in my article ‘Structural Dysfunction’, there is still an unsettled debate going on as to whether they ‘were fired’ or ‘made a choice’. Just like the other debates in Canada, this one will never get settled, in my opinion. But regardless of where one stands in this debate, the undeniable fact is that a sizable portion of the new 20,000 vacancies arose because people who were holding these jobs until recently no longer do so. The minimum that the Global report could have done was to allude to that fact. But in the hyper-partisan times of the Covid era, even making this allusion exposes one to the risk of being called ‘anti-science’, so mum’s the word.
Another aspect here is that even if one agrees with the position that HCW’s who did not take the Covid vaccine had lost the right to continue in their jobs (a position that I DON’T hold, by the way), for anyone involved in making and implementing this policy, it was incumbent on them to think of the consequences of losing so many workers and how to deal with that situation. Unfortunately, ‘believing in science’ obviates the need to prepare for dealing with the aftermath of a policy measure. None of the media have hammered on this the way they hammered on, say, the Mike Duffy affair, even though the former matter pertains to an area as crucial as healthcare (which could literally be a life-and-death issue in many cases), while the latter most glaringly does not. It is bad enough when important questions go un-answered, but it is worse when these questions are not even asked – and worse still when the people whose very job it is to ask these questions don’t ask them.
Given the fact that our healthcare system has been deteriorating over the past 50 years, a natural line of inquiry should be tracing the origins of any given problem or shortcoming in the system. As it relates to nursing shortages, as I showed in my August 2022 article ‘Nursing Old Wounds’, the problem can be traced to at least 13 years back by then. As far as I know, not a single media unit or commentator has pointed this out. I believe that this is due to the culture of recency bias, where the opinionator remains limited to the most recent information so that the current situation can be shoe-horned into a narrative. The disadvantage of this approach (to the society) is that it prevents a fuller understanding of the issue, and thereby prevents effective solutions. Accordingly, our media treats the HCW shortages as something that pins the blame for it exclusively on the current provincial government.
If we can escape from this mental trap and look at how and why these shortages have arisen over a long time (regardless of which political party has been in government), we may be able to devise policy that serves to undo the negative impact of whatever caused the problems. We often talk of ‘political will’, but I guess we need to start talking about ‘media will’ as well – if our media wants to be seen as not being a political entity. They can do that (as I said in the previous section) by asking questions that are based on a fuller view of the facts over the past decades – but so far they haven’t.
It is therefore left to us average Joe / Jane Canadians to ask the pertinent questions – however infructuous the exercise may turn out to be. I am sure you have your questions. Let me add mine – but it will take a bit of background to get to the question.
I have a mole at the back of my left temple. During my annual physical in the first week of November last year, my family doctor said that we should get it checked to rule out melanoma, and so sent a referral to a dermatologist in my city (Brampton). The dermatologist’s office gave me an appointment of mid-January. Excluding the week of Christmas, this meant that it was going to take me 9 weeks to see a specialist doctor. My immediate thought was that in India and Kenya (both Third World countries where I have lived), such an appointment could not have been more than one week out at the most. Thankfully, having taken a deep dive into the (mal)functioning of our marvellous ‘universal’ healthcare system throughout the course of 2022, I was able to accept this 9-week wait with relative equanimity. However, being reconciled to a situation cannot be equated with the situation being good. This was definitely a bad situation – and then it got worse.
A couple of days before my appointment in mid-January, the dermatologist’s office called and said that it was being postponed to the last week of March. This brings us to 19 weeks of wait time for me to see a specialist doctor (excluding the week of Christmas). A waiting period of 19 weeks to see a doctor is worse than waiting for 9 weeks – but it got even worse. In mid-March, the dermatologist’s office called to convey to me that my appointment was being further postponed to the first week of August. Remember, the referral from my family doctor was in the first week of November. I am now looking at a waiting period of 37 weeks (excluding the week of Christmas) to see a dermatologist – or maybe longer, if they postpone the appointment yet again. Waiting for almost 9 months to see a doctor may seem like the worst ‘medical outcome’ possible – but it gets even worse than that.
Frustrated with the delay, I went to my family doctor’s clinic and asked the lady at the reception if she could request my doctor to refer me to another dermatologist. I explained that the dermatologist that he had referred me to had kept postponing my appointment, the latest (shaky) appointment being for early August. She told me that she would pass on my message to my doctor – but even if he did refer me to another dermatologist, chances were that I wouldn’t get an appointment with them before August. Apparently, the unavailability of dermatologist services in Brampton is well known within the medical community.
Now, I know well enough not to draw any conclusions about a province-wide system from a single anecdote, but this experience does serve the purpose of helping me to formulate my question: Is any part of my wait of 9 months (and possibly longer) to be able to get to see a dermatologist due to (a) underfunding of healthcare or (b) shortage of workers? Without access to the detailed information (the nuts-and-bolts kind), my tentative answer is ‘No’; the wait is as long as it is because that is the current state of our ‘universal’ healthcare system – at least in Ontario. I have to live with this tentative answer because the media is not interested in finding out, from various sources, as to what the ‘dermatologist capacity’ is in Brampton, as compared to, say, the OECD average or (more preferably) in the best-performing jurisdiction in the world. It the political arena (where much of the mainstream media is a participant), it is more profitable to leave situations vague so that one can derive the fullest possible political mileage from the ambiguity as and when the opportunity arises / the situation demands.
MANAGING BY OBJECTIVES
Nearly every discussion on healthcare involves the following from the government’s side: (a) how much more money ‘we’ (the government) are allocating to it, (b) how many new (hospital beds / ICU beds / LTC beds / nurses etc.) we are providing for, and (c) how bad the situation in healthcare was during the tenure of the previous government. From the oppositions side, all comments boil down how the proposals of the government fall short (on money, capacity, people etc.), and how their presentation of the previous government’s performance is a ‘misrepresentation’. Conspicuous by its TOTAL absence is ANY talk of benchmarks, and a plan / proposal to achieve them, starting from where we are today. For example, a benchmark of a patient seeing a dermatologist within maximum one week from the date of referral by a physician. If Third World can achieve this standard, surely we can? Or, on another metric, we can bring our capacity of hospital beds to the OECD average, which is TWICE what we have in Canada?
Until we bring our debates to this level of quality, I am afraid we will continue to muddle along, throwing not only ever-increasing amounts of money (in nominal terms) but also ever-increasing percentage of our GDP at our supposedly ‘world famous’ universal healthcare system while all the metrics get increasingly worse. For that to happen, we will have to go beyond the bounds of the doctrine that has been built up about that system. Obviously, this has to start with the people whose very job is to inform the public fully. Reading the top-line conclusions of a report and running with it because it suits a political objective will not only not suffice but also contribute to our continuing descent into a complete breakdown.
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