What if Better Healthcare Just Isn't Possible?
Should the Canadian healthcare debate focus on management rather than perfection?
Canadians never tire of talking about healthcare, and I’m as guilty as anyone: the Audit is only 25 posts old and this is already the fourth post whose primary subject involves public health spending. Anytime we’re stuck waiting for a medical appointment or lab result, it’s always “We never used to have delays like this!” Invariably, that’ll be followed by thoughts on how the system could be improved if only [[insert your plan here]].
But what if it can’t be improved? What if we’ve already maxed-out available funding and run out of useful ideas for attracting the thousands of doctors and nurses we’re missing? What if there’s no solution to the problem of modern healthcare?
Before addressing those questions, let’s add some context.
Is the System Broken?
Not even close. As of 2019 at least, life expectancy in Canada was near the global leaders, at 82.4 years. The Our World in Data coverage of essential health services index placed us near the top at 80.15 in 1990 and 86.7 in 2021. Overall - as of 2019 - we’re spending $5,520 on healthcare per Canadian each year. When divided into our per capita GDP ($49,172), that means healthcare spending consumes more than 11% of our total economy.
That’s not to say it’s all rainbows and unicorns at the walk-in clinic. Those good numbers might be less the result of an effective healthcare system and more due to our relative wealth. Wealthier people, in other words, have the luxury of making healthier choices. The bleak truth is that millions of Canadians lack access to a primary caregiver, wait times for important procedures are far too long, and “avoidable death” numbers are actually moving in the wrong direction.
Avoidable deaths (also known as “amenable mortality”) are “untimely deaths that should not occur in the presence of timely and effective health care, including prevention.” This is an excellent proxy for assessing the overall effectiveness of a healthcare system.
Unfortunately, as you can see from the graph visualizing Statistics Canada data, steady improvements in the metric between 1979 and around 2012 have since been reversing. The significant jumps in preventable deaths during the COVID years (2020-2021) in particular might represent public health officials’ shameful choice to neglect non-COVID illness during that period. But the overall negative trend began long before COVID.
But that being said, as a nation we’re not doing too badly.
Can It Get Any Better?
I don’t think I’ll generate any controversy by observing that the primary causes for healthcare delivery failures in Canada are:
Funding shortfalls (there isn’t enough money in the system)
Labor shortages (there aren’t enough doctors and nurses in the system)
The problem is that those aren’t easy problems to solve. Even if there was still some life left in the “soak-the-rich” playbook, who’s to say that new-found funds should be spent on healthcare? NATO called and they’d like a slice of that pie if it’s not too much bother.
Now don’t get me wrong: I’m all for cutting budgets mercilessly. In fact, I’d wager that each of the 21 non-healthcare posts in The Audit provides very specific and very practical suggestions. But I’m not holding my breath waiting for any axes to drop in those areas. Creating new entitlements is easy. Cancelling them is…unlikely.
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