Thursday, January 29, 2009

Is Government Run Healthcare Better?

Bad things happen to those who wait by Mark Steyn

  • he explained that "waiting" is built into the concept of a government health service: "If you need surgery," he said, "it's in my interest to get you in and operated on as soon as possible, because that's money for me. The faster it happens, the better my cash flow. But when the government runs the system, every time you get operated on it costs the government money. So it's in their interest to restrict or delay your access. When you look at the overall budgets - salaries, buildings - it's not hard to understand that the level of service you provide to the patient is one of your few discretionary costs. So the incentive is to reduce that."

  • I have employees on both sides of the border. When my assistant in New Hampshire has a doctor's appointment at 9 a.m., she's in his office by 9:07 and back in my office by 11. My assistant in Quebec, living in a jurisdiction with the lowest doctor-patient ratio in the western world, can't get a doctor's appointment, so she goes to her local CLSC at 9 a.m., and waits, and waits and waits and waits all day to be seen.

    I doubt Chantal's and my loss of economic activity is factored into those health-care-as-a-proportion-of-GDP costs. In Canada, we accept that if you get something mildly semi-serious, it drags on while you wait to be seen, wait to be diagnosed, wait to be treated. Meanwhile, you're working under par. The default mode of the system is to "control health care costs" by providing less health care. Once it becomes natural to wait six months for an MRI, it's not difficult to persuade you that it's natural to wait 10 months, or 15. Acceptance of the initial concept of "waiting" is what matters.

  • A few years back, she felt herself beginning to miscarry. Nobody was at home so she called a cab and went to the emergency room at the Royal Victoria. Knowing what "emergency" means in the Quebec system, she grabbed a novel on the way out - an excellent choice, Mr. Standfast by John Buchan, our late Governor General. It's 304 pages, and my wife had the time to read every single one of them before any medical professional saw her. While she was reading, she was bleeding - all over the emergency room floor, the pool of large dark red around her growing bigger and bigger, until eventually a passing cleaner ran her mop over the small lake and delivered a small rebuke to my wife for having the impertinence not to cease bleeding.

  • Since my wife's experience, the average wait time in Montreal emergency rooms has apparently gone up to 48 hours. So don't pack an overnight bag, take two, and the complete works of John Buchan. The natural consequence of a system built on waiting is that more people do what she did - sit in the hospital, waiting to be seen, bleeding all over the floor until a cleaner (and it's one cleaner per two floors at many Montreal hospitals) wipes it up with a dirty mop and then runs the same mop over the floor in the isolation ward upstairs.

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