We need better

“It takes all the running you can do to stay in the same place; to get somewhere else; you have to run twice as fast.” (The Red Queen, Alice in Wonderland) OR MAYBE WE HAVE TO RUN DIFFERENTLY? (L. Curry) 

We are running as fast as we can in health care. 50 cents of every dollar spent in every Canadian province is spent on health care. That means that everything else, all levels of education and training, roads new and old, policing, disaster relief, social services, infrastructure support and innovation comes out of the remaining 50cents. As we complain about crumbling bridges, delayed and underfunded social programs and green technology conversions, many feel that we can’t run any faster in health care provision. 

And yet new health care techniques, interventions, machines, drugs are pouring into the market every year. Rarely are these cheaper than what they replace. Individualized medicine is on the immediate horizon and there is a great appetite among both providers and consumers for that improved intervention effectiveness.

For the first time in history the population is demanding a voice in the social contract with medicine. Boomers are demanding good service from the health care system in addition to quality care and accountability. There is widespread public support for tying health care management salaries to measureable improvements in health care delivery.

Many public servants at federal and provincial levels are daily aware of these conflicting pressures as they struggle with their small fraction of the health care issues, their ever constricting budgets and the reality that they are there to implement government policy; policy that is increasingly politicized. As well-meaning as most are, it is almost impossible that real innovation can come from the public service.  We need better.

If we wanted to run differently in health care, where will those ideas, that impulse come from? Not likely from the political parties. They have all treated health care as a ‘third rail’ (the rail that carries the electrical power and therefore lethal to touch). If health care is mentioned at all, it is in general terms with general solutions proffered. Pouring more doctors and nurses into the current system is trying to run faster, not differently. Committing to maintaining the federal transfers to provinces to support health care is committing to the status quo. We need better.

Organized medicine is a pivotal voice in health care throughout the world. That voice had not been much heard, and certainly not pivotal in helping us run Canadian health care differently. Where medicine is engaged in health care innovation, the scope and pace of positive change is breath-taking (i.e. the Veterans Administration in the US, the National Health System in the UK). Canadian organized medicine is still trying to find an effective part to play in the complex problems of real innovation and accountability in health care.  We need better.

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