My generation will decide medicare's fate

There are millions of middle-aged people in Canada who have made their own good health an integral part of their lifestyle. They are vigilant about healthy food, pure water, breathable air, daily exercise, and keeping informed about medical discoveries and trends.

When they get sick or hurt, they are liable to try a variety of remedies, from many sources, besides the standard doctor-prescribed possibilities. They have proven themselves open to everything from gastric bypass surgery to acupuncture, to tai chi, to salt-free oatmeal cookies. They expect to be personally and actively involved in the course of their care when they need it.

By virtue of sheer numbers, this is the group that will likely decide the fate of so-called "two-tier" medicine in Canada. As they move past middle age, they will determine whether this country's medicare system remains as is, or whether it evolves in some new way. One of the foremost issues they will settle involves providing public and private services to medical consumers.

Canada is justly proud of its medical system. People in this country expect equal and universal access to health care. Unlike our unfortunate neighbours to the south, Canadians aren't denied treatment if they are poor, and they are unlikely to go bankrupt if their insurance runs out. Tommy Douglas that witty Baptist preacher who is credited with championing universal health care in Canada, was voted the Greatest Canadian of all time in a CBC nationwide contest. This was a testament to his enduring legacy and what it means to us. Medicare is one of our most deeply felt achievements and one that defines us as a nation.

I am sure no one in this country would want to see universal health care disintegrate into anything like the uneven maze that middle class and poor Americans must deal with.

Still, some aspects of our system are worth discussing.

Criticizing the system is OK

First of all, there is no more fundamental human right than the one to ownership and control of one's own body. Doctors, regardless of all the semantic undertones about patients being "cases" that "belong" to them are employed by the "patient" who is ultimately the "boss," — not the other way around. As far as their own professional standards of ethics and protocols, doctors can relate to each other as if patients belong to them in some way, but decisions regarding treatment options must always reside with those needing treatment (providing they are capable adults). If patients want to give that power to a doctor, that's their decision. If they don't, doctors are limited in terms of what they can do with or to an adult patient.

This is sort of basic, and generally understood. But sometimes people talk as if the "system," by virtue of its good intentions, is somehow above and beyond the control of the people who use it. Because most of us agree with the way our health-care system runs, we think we must abide by whatever restrictions or demands it imposes, or else we are opposing it. If we criticize some aspect of public health-care delivery, someone is sure to accuse us of trying to destroy medicare.

But everyone in Canada knows that our health care system is in trouble. People die waiting for all sorts of treatments that used to be more speedily and efficiently provided (back when the doctor- to nurse- to patient ratio was better, and before so many of the professionals trained in Canada went elsewhere to work).

Also, in reality, it is already "two tiered" in some ways. The speed and quality of service and variety of followup resources for a patient with cracked ribs and a concussion is not necessarily the same for a sex-trade worker as it is for a CFL quarterback. High-profile individuals seldom wait in the same lines as the rest of us, or so it seems. Horror stories abound.

And anyway, the Supreme Court of Canada has already ruled in favour of a patient's primary right to choice when it comes to treatment in private facilities as opposed to public ones (the Chaoulli decision). When a person is in need of some sort of care, no system has the right to deny them access to an alternative provider of their choice. Individuals have every right to take their future into their own hands if they can, rather than helplessly wait on the public system while their condition deteriorates.

Many heading for 'Golden Age' of health care

Middle-aged Canadians will press for solutions soon. They are fast approaching that "Golden Age" of declining health and increased need for care.

I suspect that my generation, when it is their turn to need all sorts of life-prolonging interventions, will insist on their right to the best ones they can afford.

In my case, I have no hope at all that I will have lots of money lying around in case I want a hip replacement in a month, as opposed to the typical one-to-two-year wait. I expect I'll use the public system until I vacate the planet. But if rich people want to get out of the line I'm in, that's fine with me.

I realize the biggest fear about private clinics is that they will undermine or sabotage the staffing and operation of public ones. Whether or not this happens depends on which rules and formulas are put in place. There are many countries in Europe that are now grappling with this problem, with varying degrees of satisfaction. Two-tiered, or "parallel" systems of health care delivery are in the early stages of development, and there are a wide range of reactions and perceptions regarding their fairness and effect.

There must be some way the public system can be improved and maintained while at the same time leaving private options available. Personally, I think that if more medical professionals were trained in Canada, and they were paid better (and remained in this country), and if pharmacare was more equitably available to Canadians, and if the foremost emphasis in health care was preventative, especially in regard to children and the poor, we'd see a decreased interest in (or perceived need for) privately insured health care options in this country.

It is unfortunate when debate about this sort of thing is defined by notions of capitalism versus socialism, or rich versus poor, or Liberal versus Conservative. There doesn't have to be a "versus." We're all in this together, as Red Green would say. We're all going to die sometime; in the meantime, we all want to stick around for as long as we can, with the help of adequate health care. It's time we brainstormed ways to improve and preserve an equitable, viable public system, while at the same time allowing for more choice.

Letters

Many of the problems plaguing the health care system today (waiting times in ER and for surgery) is related to nursing shortages and a lack of long-term beds available in the community. When hospitals say that they have "no beds" it doesn't mean that there are no physical beds, it means not enough nursing staff to monitor these patients.

While, at the same time, many of the beds in use are occupied by patients who should be in a long-term care facility, not an acute one.

Many nurses leave the profession every year. Last year a report came out describing the high level of violence nurses experience regularly in the workplace. Perhaps, instead of looking to overhaul the whole system and introducing a two-tiered system which will further spread out the thin human resources we have, we should look at improving the health care system as a workplace and increasing the amount of long-term care facilities.

–Catherine Stansfield | Montreal

As a U.S. citizen I SO admire Canada's commitment to healthcare for all. I have health insurance, but healthcare is still always a worry. Nobody's health and life should be determined by whether or not they have money for care.

–Donnie Budd | rlington, TX