Canada’s health care system is falling apart.  Every day we are being bombarded by reports that waiting lists are getting longer and that more and more Canadians are racing south of the border to purchase health services on the open market.  Some are travelling as far as India for some treatments.  The critics argue that it is time to dismantle our inefficient public health system and move toward a private system with some kind of charitable relief for those worst off.  Besides it would be fun to make people beg for their lives wouldn’t it?  To plead for services dangled before their eyes but not for them.  

Health care is a Right not a privilege of those who can afford it.  There are problems with the Canadian health care system but they are not insurmountable.  First let’s consider what has caused the problems.  The ideological move to the Right beginning in the 1980s and reaching full stride in the 1990s saw politicians openly state that they wanted to create a crisis in health care and in education for that matter (watch for another post on that subject in the future).  By gutting funding and other tactics they caused upheaval and discord in the system.  So, much of the problem was manufactured just so there would be a problem that these same ideologues could then use as an argument to privatize the system.  But that does not mean that there aren’t real problems.  Health care could use a shaking up.  So I am going to lay out a system that will be efficient, economical and most importantly focus on the needs of the patient. 

First the fee for service system is problematic.  Many doctors who would like to eliminate the public system have used this as a means to undermine it.  All physicians should be salaried.  I am not saying that they should make minimum wage and I would expect to see physician salaries range between $150,000. and $300,000.  That should be adequate for anyone who entered medicine because they wanted to help people and I am sure it is not enough for the many doctors who entered the profession for monetary reasons. 

Second we need to consider what doctors are necessary.  The General Practitioner today is mostly a triage and prescription service.  If a patient has anything serious wrong with them they are referred to a specialist making the General Practitioner not much more than a receptionist.  The old idea of the Family Doctor is long gone.  Few if any General Practitioners today resemble the Family Doctor I grew up with.  A doctor that knew my name and my family, who took time to know who I was beyond a file number, who respected me.  My family doctor didn’t have appointments he was in his office every afternoon except Wednesday and every Tuesday and Thursday Evening and Saturday morning.  It was first come first serve and all of us (his patients) knew one another.  Who can claim the antisceptic emptiness of their doctor’s office today carries that same feeling and the same sense of trust, knowing that you as a person mattered.  The General Practitioner should be eliminated from the system.  Her/His position could easily be replaced by nurses, nurse practioners, and pharmacists.  Nursing training today is quite advanced and nurses are already beginning to expand their role in the system.  Most emergency rooms use nurses to triage patients, sorting them into those who need the most immediate care and those who can wait.  Life and death are already on their shoulders.  With minimal skill enhancement they could completely take over diagnosis and referral to specialists.  Pharmacists and their associations have been arguing for some time that they should be allowed to directly prescribe medicine to patients.  They are more up-to-date on pharmaceutical products.  I can’t tell you how many times my General Practitioner has had to look in the compendium to figure out which drug to prescribe.  Pharmacy hours are also more convenient and pharmacists often get to know their customers better.  Removing General Practitioners from the system would be a huge saving.  Current GPs could upgrade their skills to specialist or take nurse training. 

Third we need to consider the delivery.  A Hub System would be the most efficient.  At the center of the Hub would be the full service, all the bells and whistles, modern hospital.  This would hopefully be the destination of last resort for patients in acute distress.  Surrounding the center would be local clinics with overnight beds for those who require hospitalization for observation and regulation of condition, an emergency surgical set-up, and diagnostic test services.  In this ring would also be the specialized birthing centers and chronic and palliative care clinics staffed by nurses and midwives in the case of the birthing centers.  On the outer ring would be the family medical clinics staffed by nurses, nurse practioners, homeopathic and naturopathic practioners and perhaps dental and vision care professionals.  These clinics would also work as the home base for home care providers, a much needed adjunct to our current system.  Allowing patients to stay in their homes when possible would be a great saving to the system. 

This is the rough outline of a system that would go a long way to making our system more efficient, cost effective and responsive.  It only takes the political will to implement it.

Health care is a Right.  With the above alternative we could realize that Right.

How important is it to elect the first Black president today?  Is it so paramount that we don’t want to look at his character and his policies?  Now before anyone gets their knickers in a knot, I am not saying that Barak Obama is a Marxist.  I can categorically tell you that he is not because I am a Marxist and he has never been to any of the meetings .   On the contrary I am amazed that someone whose policy manual (Blueprint for Change) and whose campaign behaviour has been to run from every progressive cause and every opportunity to challenge America in another direction, is seen as this great agent of hope and change.  Saying it over and over don’t make it so.  On policy after policy in the ‘Blueprint for Change’ Obama fiddles with the knobs without changing the station.  But then why change when everything is going so well.  I mean what is wrong with what is?  American children are illiterate and innumerate in comparison to others countries.  That’s okay, if they can’t read they won’t have their little minds twisted by crazy things like ideas and stuff.  Millions of Americans are dying to see Obama’s new health care package and will continue to do so under it.  And the most popular colour for children’s pajamas this season among working families is sidewalk grey.  Oh no.  Let’s not look at fundamental change because haven’t you heard our fundamentals are strong.  I can sum up Obama’s policy book in one word, safe.  Say as little as possible and nobody will have anything to challenge you on. 

His record?  Well, here’s a man who abandons his friends, forces those who have actually fought in the trenches and sometimes risked their lives to kow tow to him, to humble themselves to a national audience, and reverses his position every time it is politically expedient.  I know those are the qualities I would look for in the leader of the free world.  As a Senator he supports a financial bailout that saves the Wall Street tycoons whose greed created the economic crisis while doing nothing to help the real people whose lives are being destroyed.  On the campaign he rejects public financing after promising to embrace it because he realizes he can out-fundraise his opponent and buy an election.  Much of his money coming from Wall Street and the corporate sector.  ‘Very interesting’ as Arte Johnson used to say on Laugh-In. 

I have waited a long time to see the first Black president of the United States and the first woman president and I could have tolerated Clinton.  Maybe.  Well if I held my nose.  This morning my class watched Mississippi Burning and this election kept creeping into my thougts.  I remembered the great Black leaders of my youth.  Malcolm X.  Bobby Seales.  Medgar Evers, Stokely Carmichael, Martin Luther King.  I thought about Julius Nyerere and Nelson Mandela.  Barak Obama just doesn’t fit.  It is not just that he doesn’t look like the other presidents on the dollar bills but that he doesnt’t act like those men I so admired.  I will celebrate the symbol but mourn the character of an Obama presidency.