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July 11, 2016

Health Care: A Book Review

Reuel S. Amdur

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Pat and Hugh Armstrong have brought out a second edition of their blockbuster work Health Care (Fernwood: Halifax and Winnipeg, 2016).

They begin with a brief history of Canadian medicare.  The book then proceeds to a description of the system, gaps, needed changes, and the dangers of privatization.

In looking at what we have, they point to anomalies in the system.  While there have been changing criteria for federal funding, there is no guarantee for stable funding.  Following the Romanow report, which called for a major infusion to permit the provinces to bring services into a more coherent and effective arrangement, essentially nothing changed.  The old system simply gobbled up the money.  There were no federal strings, a big mistake. 

Home care and long-term care are bedeviled by many problems.  The demand for these services is strong, because of pressures on hospitals to move patients out as soon as possible, because of an aging population, and because new medicines and technologies make it possible to provide kinds of care out of hospital.  However, such home care drafts family, especially women, into the role of providing free care.  It deprives them of opportunities to work outside the home or burdens them doubly.  And the system provides inadequate support.  Such programs are often funded on the basis of competitive bidding, with profit-oriented organizations sometimes winning out by providing inadequate services, lower staffing levels, poorer pay, and creating insecure employment.  Long-term care is infected with many of the same problems.

Drug costs are a major drag on health care.  The Armstrong’s point out that Canadian costs are excessive compared to those in the Western world, with the exception of the United States.  Action by government in bulk buying, limiting the life of patents, and preventing drug companies from making miniscule changes in the formularies in order to renew patent protection.  They effectively dismiss the claim that pharmaceutical companies need the money to develop new drugs, showing that they spend more on advertising than on research.  The Armstrong’s also note that Canada is the only jurisdiction with a universal medicare program that lacks pharmacare. 

For the Armstrong’s, privatization is the bête noire, a danger throughout the health care picture.  Its presence has been felt from the very beginning of medicare, with the doctors’ battle to preserve private practice.  Now, it is felt in home care services, long-term care, contracting out of services such as meals, cleaning and laundry, on-call nursing, and 3-P operations—that is, public-private partnerships.

Health Care shows that private services are not cheaper except perhaps when quality is curtailed, but perhaps not always even then.  After all, profit must always be made on top of costs.  And the competitive system, with winners and losers, guarantees losses and duplication of resources.  The drive in this atmosphere creates speed-up and destruction of full-time jobs.  As a result, insecurity and poor pay lead to poorer services for those receiving the services.

So far, so good.  However, there are shortcomings.  As noted, one of the major challenges in Canadian health care is mental health.  They give scant note to that matter.  This was also a major failing of the Romanow report.  Waiting lists are a major concern, both for assessment and treatment.  Autism is a good example.  And while psychiatric care is covered by medicare, outside hospitals and other public facilities and some agencies, psychologists and social workers are not.  The Armstrong’s’ concern about equal access without the wallet biopsy applies here in spades.

There are a couple other matters that merit some comment.  They make a disparaging comment with regard to Viagra-type medicine, remarking in sneering fashion about “sexual dysfunction” (their quotation marks).  Well, sexual dysfunction is real, and such drugs have a role to play in human happiness and positive family relationships.

Finally, they discuss complementary and alternative medicine.  While there are benefits to some, but perhaps not all, these are not without serious difficulties.  Chiropractic manipulation has been shown to be effective in many cases, but reports suggest a tendency to overtreatment, and serious concern has been raised about the practice of some chiropractors who engage in “preventive” spinal manipulation on small infants.  Some alternative medicine practitioners make outlandish claims about ability to cure all kinds of ailments, including cancer, with diet, herbal concoctions, etc.  While some have regulatory bodies, such bodies do not seem to act in such cases.  By contrast, the medical profession comes down hard on doctors making faulty links between immunization and autism, and making claims for such supposed cancer treatments as kebiozen and laetril. 

But do not let these problems keep you from getting your hands on the book.

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