The Fiddler and the Fire: The Decline and Fall of The Health Care System

The Ancient Roman Empire did not fall in a day. And it certainly didn’t fall because barbarians were knocking at the gate. The decline and fall took hundreds of years while ignorance, apathy and conceit ate away at the soul of empire. Rome rotted from within.

The Canadian health care system is critically ill. We are faced with a rapidly aging population and health care expenditures that consistently rise faster than both the rate of inflation adjusted for population and provincial government revenues. The writing is on our crumbling walls. The signs are all around us. The Canadian health care system is fundamentally unsustainable, yet we shrug our shoulders and trudge on with the confident irreverence of Ancient Rome.

The Liberal Government of Ontario addressed this problem of unsustainability by conjuring the wisdom of charlatan economists. As health care expenditures continue to grow, the government will cut $580 million over two years while demanding that physicians shoulder the burden of increased health care costs through claw backs and reconciliation. An additional 1.3% cut was just announced September 2015, raising total cuts to 6.9% plus reconciliation and inflation. The situation is even worse for family practitioners, particularly new graduates who will be barred from joining Family Health Organizations. Year after year, health care costs will continue to rise. A policy of reconciliation cannot by definition provide a meaningful long-term solution. The government’s unilateral action demonstrates an unwillingness to engage with the Ontario Medical Association (OMA). The Emperor refuses to heed the advice of the Senate.

The OMA has responded with an official policy of public advocacy and awareness. It is well intentioned, but perfectly obvious to all involved that this tact will fail to produce political dividends. Despite its low likelihood of leading to policy changes, some physicians may be appeased by the OMA’s actions. Unfortunately, one can hardly blame the OMA. What else is there for an organization lacking the means to exert any form of meaningful recourse? What else is there but bread and circuses?

This is not a policy brief advocating for any particular kind of action. This is instead a prophecy for Canadian health care. Rome will fall. This article is interested in how it will fall and what will rise from the ashes.

Our public access health care system is one of the biggest misconceptions surrounding the Canadian identity. Canadians pride themselves on the grandeur of our system and mock the Americans for the inefficiencies in theirs. We support the idea of our health care system with a religious devotion, making it immune to critique and impervious to logic. It is almost humorous, that for all our zealotry, the Canadian health care system is one of the worst of any developed nation. Many other countries have much more extensive public systems, offering coverage for optometry, dentistry, home care and pharmaceuticals while costing much less. Dramatic structural changes to the Canadian health care system are not only inevitable, but will likely prove advantageous in the long run.

As doctors gain more public support and the economic benefits of further pay cuts become marginal and untenable, the government will abandon this plan of attack. Instead, the government will scour for cost savings within the health care system. It will find some, particularly within hospitals stifled by expensive bureaucracy, but not enough to offset ever growing health care costs. Next, we will see funded services be cut with increasing frequency in a fruitless effort to stave off costs. It will begin with simple blood tests that few notice missing before progressing to increasingly important treatment options. This is already happening in the United Kingdom, whose health care system shares a similar plight (though perhaps for different reasons). In January 2015, the NHS defunded 25 cancer treatments, cutting short the lives of approximately eight thousand patients. When philosophical grumblings about health care became hard realities faced by baby boomers entering the latter part of their life, health care will become a national issue. The defunding of important services, a decline in the quality of care and even longer wait times are not acceptable when you are in your 70s, 80s, 90s or beyond.

When health care becomes the election issue, each party will present their own vision for what health care ought to be and none will resemble our current system. Variations on similar ideas will emerge throughout the provinces. Hospitals will receive considerable pay cuts as non-hospital medical centers like long-term care facilities receive increased funding. Health care will finally become more distributed with hospitals losing their stranglehold over the heart of medicine. Regulations surrounding billing will gradually loosen as the government embraces elements of the free market. Physicians will begin to splinter off from the public system, resulting in more private practices and clinics. Health care will continue to grow at a rate that exceeds inflation, but this growth will be largely financed by entrepreneurs and willing members of the public without depleting government coffers.

Health care will slowly become sustainable, unfortunately first it will burn.