Bernie Goes Fishing up North by Pat Conrad MD

Uncle Bernie is at it again (he never really stopped), banging the drum for nationalized health care.  Sanders made his way up to Toronto last fall, where a hospitalized patient assured him that he would not receive a bill for services rendered.  He asked, ““How does it happen that, here in Canada, you provide health care to every man, woman and child, and you do it at 50% of the cost that we spend on health care in the United States?”

And the simple answer is, you ration it.  The Canadians simply don’t have to pay for some things, and other things they centralize.  Canada is a big country, and if you live further out in the wide-open spaces, away from more populous centers, then you simply won’t have as large a hold on the national attention – or purse.  The article makes the point that Alberta’s third largest municipality – Red Deer – has a cardiac mortality rate 50% higher than in Edmonton or Calgary, arguably because they don’t have a cardiac catheterization lab.  Red Deer has been trying for over a decade to get one, and thus far it ain’t happening.

$10 million in pledges have been raised for the cath lab. The Alberta Health Services and their Cardiovascular Health and Stroke Strategic Clinical Network reviewed the need, and gave the Red Deer docs specific guidelines to get the facility.  The steps were completed and reported, the response from AHS was delayed over a year (where no one was identified as having received it), the lead cardiologist of the Red Deer hospital initiative was told to go back and reanalyze it all over again.  Fortunately there were no acute MI’s in the several intervening years.  Just kidding.  “’When we reached that point, we were told all of this needs to be reviewed again,’ says Gustavo Nogareda, MD, Director of Cardiovascular Services at RDRH.  ‘Our work for the last eight or nine months was focused on analyzing the problem again. So, basically, for over a decade we go through reanalyzing the same thing again and again in this bureaucratic process that never finally reaches a conclusion or a plan and wastes tax payer’s funds. It is sad to miss the opportunity to reduce preventable death and disability when it can be done by implementing simple strategies that also reduce operational funds.’”

The geography is interesting.  Transporting an acute coronary syndrome patient from Red Deer to the nearest cath lab presently takes a minimum of four hours.

The article describes Red Deer as a fairly affluent community, with lots of niceties provided by oil money, the major local industry.  They have well-trained cardiologists competent to perform angioplasties.  So why doesn’t the city just…buy a cath lab?  Well, because it’s Canada and you can’t just buy medical stuff for people without going through proper channels to you know, keep it fair.  This kind of decision has to go through the Cardiovascular Health and Stroke Strategic Clinical Network, the majority of whose members reside in the bigger cities, which receive grossly disproportionate per capita revenues compared to the rubes in the central province.

Dr. Nogareda argues convincingly that definitively treating cardiac patients in Red Deer will save money in transport, ICU, and rehab times, not to mention improved morbidity and mortality rates.  Here the author tries to suggest via Nogareda that the conflict is market force vs. equity, with resources following money in the U.S., while it follows the political power in Canada.  I reject such a clear distinction anymore.  Money and politics are so intertwined in U.S. health care that calling it a “market force” really strains the term.

Resources are indeed following a currency in Canada, political currency in a system where all health care is considered a right and thus collectively owned.  That produces the sort of sclerosis that is killing heart patients in Red Deer.  The author curiously states:  “But no matter how irrational it is that for sheer profit (my emphasis), people would prevent a population whose leading cause of death is heart attack from obtaining life-saving technologies …, it is a reality that we must choose to accept and learn from in order to change.”  Hate to break it to the author, but everything that everyone does is done for some sort of incentive.  In the U.S., Big Hospital joins the federal government in utterly corrupt crony corporatist arrangements that chase the private and taxpayer dollars, increasing the redistributive fleecing of some by promising care guarantees to others (think Medicare and Medicaid).

The “profit” being sought in Canada is the power and adoration that accrues to politicians who do good works with other people’s money.  This is the sort of profit pursued constantly by the Bernie Sanders ilk, via a system he would like to further here, where it’s all free if you can survive the trip, and the wait isn’t too long.

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117050cookie-checkBernie Goes Fishing up North by Pat Conrad MD