CANADA’S HEALTH CARE IS NOT ‘FREE’

I just finished reading Charting the Course: Designing B.C.’s health care system for the next 25 years. It’s not a thriller, but it is gripping.

It’s worse than I thought.

I just finished reading Charting the Course: Designing B.C.’s health care system for the next 25 years, the B.C. Medical Association Submission to the Select Standing Committee on Health.

It’s not a thriller, but it is gripping.
I just blew $50,000 of our money, Canada. It was probably way more. I was in hospital for a week. I figure $50,000 is a conservative estimate; my son was once hospitalized in the U.S. for a few days and I left with a $25,000 bill. The statement was a folded form that accordioned out for metres. I was astonished there was a separate entry for the cost of each of the wee paper thimbles that had held a pill.

So, a week, flat on my back or being wheeled from one diagnostic machine to another, watching one of the best Vancouver summers on record through a window. What’s worse: It was my second trip to the hospital.

I read this because so many of you were in touch on the subject of the health of our health care system. You’re worried; so am I. So I waded through a batch of provincial White Papers and a smattering of scholarly studies on what’s what in the delivery of medical services here, and around the world. I spoke to a variety of doctors and nurses.

I decided that our taxpayer-funded health care system is just as much a part of Canada’s environment as our mountains and waterways and that it should be protected in the same way. Or better. It may not be a natural wonder, but it’s a wonder just the same.

So, here’s my personal triage on the state of B.C.’s health care system. I think it’s fair to say that it reflects the situation across Canada.

Old people! Incoming! In 1976, 10% of British Columbians were over 65. In 2011 that number rose to 15%. By 2018 we’ll have more people over 65 than under 18. By 2036, almost a quarter of all British Columbians will be over 65 and people over the age of 80 will increase to 7.4% of the population. Currently, people over the age of 60 account for almost half of total health expenditures.

Obesity, inactivity and addiction, increasingly, are added burdens to the system. British Columbians like to think of themselves as fit, outdoorsy, even. But guess how many of us actually swim, do sports, go to the gym, golf or play on a team? Go on; guess. I put the number at around 60%. Thank goodness I didn’t bet money. According to a 2011 Ipsos Reid poll, only 9% of us can be considered active. Nine per cent! How does Lululemon make a profit?! B.C., however, has the lowest adult overweight and obesity rate in Canada. Only about 45% of us are significantly overweight. Only! Guess what that figure was back in 1985? The percentage of overweight adult British Columbians was 11%. We now have 51,000 obese children in the province and as many as 20% are deemed medically overweight. But here’s the funny thing: When polled, although 86% of us thought that childhood obesity was a serious concern, most parents said their own child’s activity level and eating habits were not a problem. My kid’s not fat; yours is.

As an aside, it’ll be interesting to watch what unfolds in San Francisco this autumn. In a 2013 Gallup poll, Americans identified obesity as a bigger health threat than cancer and heart disease. To combat this, The City by the Bay will vote on implementing a two cents per ounce soda tax. The revenue generated by this tax — reckoned to reach US$31-million annually — is earmarked for physical activity and school nutrition programs for kids. As you would imagine, the American Beverage Association — Big Soda — has mounted an effervescent counter-offensive to this initiative. This isn’t the first time this idea has been floated, but this is the first time it’s showing a chance of passing. It’s something for B.C. — and the rest of Canada — to take think about … especially in light of the differences in our health care systems. The medical problems associated with excess weight are debilitating, not to mention costly.

Photo by Adhy Savala

In the last five years, St. Paul’s Hospital, the closest hospital to Vancouver’s problematic downtown east side, has seen a 63% increase in patients with addiction and mental health issues. It’s estimated that about 400,000 British Columbians show signs of addiction to at least one substance. Again, the costs add up.

Chronic disease is the variable that draws the most attention. The report states that almost 80% of chronic disease can be controlled by — well, I think the medical term is, not being an irresponsible damned fool.

Many solutions are proposed within the report. Chief among them are lifestyle improvement and clinical preventions. Immunizations and screening tests have proven to be effective in lowering cumulative care costs, but nothing compensates for common sense. Apparently, we’re getting a bit fed up with people making bad choices and expecting be bailed out from them.

“British Columbians are generally supportive of the provincial government taking action to make people more responsible for their own health. Three quarters (76%) of residents agree that ‘the provincial government should do more to hold British Columbians accountable for the decisions they make that impact their personal health.’ ” I can see you all nodding.

Dr. Ahmer Karimuddin, past president of the general surgery section of Doctors of B.C. (formerly B.C.MA), has an impressive overview of the status of B.C.’s medical system.
As a general and colorectal surgeon, as well as Clinical Assistant Professor in the Department of Surgery at UBC, Karimuddin is in the trenches everyday. He’s proud of how well B.C. is meeting its medical challenges, but he says colleagues are worried that the system is stretched to system failure. It’s generally agreed that the Canada Health Act, the basis of our health care system, is woefully out of date and doesn’t take into account our emerging demographics, nor advances in medical technology. Karimuddin says that our medical system is a social contract, designed for everyone to actively participate, but that it isn’t designed to ferret out fraud or misuse — unfortunately. Funding it through benefit deductions, income tax and sales tax doesn’t reflect current user profiles.

Here’s final tidbit: B.C. generates 288 doctors annually; each year we lose 400 doctors through attrition. Go figure.

So, not only are we getting fat and sloppy, so is our health care system. This afternoon, do something nice for yourself and your country: go for a brisk walk and keep Tommy Douglas’s dream alive.

And well.

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