Will the Liberal’s war on wait times change health care as we know it?
Andy Stewart takes a quick glance out the door of his daughter’s hospital room, as two nurses scurry by.
“Ya know, they’re completely overworked and exhausted,” he says, his gaze trailing them down the hall. “The whole week we’ve been here, we’ve seen nurses on the verge of tears because they were trying so hard to get everything done that needed to be done, and they were so shorthanded.”
His daughter, Madison, has been in the hospital for eleven days after a car accident that shattered her femur. A plate and 14 screws were inserted in her leg to replace the broken bone, and months of physiotherapy are needed in order for her to learn how to walk again, but she’s expected to make a full recovery.
“I haven’t had a single financial concern through this whole ordeal, all I had to do was make sure that my daughter got better,”Andy speaks as softly as the pit pat drip of the IV that trails up and into Madison’s arm, so as not to wake her. “The other day I said to myself ‘My God, if I was in the States right now, I’d probably have to mortgage my home to pay for this, and aren’t we a fortunate crowd here in Canada to have public health care.’”
But many in that crowd are beginning to wonder just how fortunate they really are. Earlier this spring, Health Minister Mike Murphy announced that more aspects of our health care will be opened up to the private sector, that it won’t be “a matter of if, but when.” These public/private partnerships form the lynchpin of Murphy’s new “War on Wait Times,” where he hopes to “cut the fat,” and deliver a new, quicker and more efficient breed of health care to the province.
It’s a decision that has many New Brunswickers concerned that their most crucial public service will be run like a business, catering to those with the deepest pockets, and making a profit off the ill.
One of the most outspoken critics of this new incitive is Debbie Lacelle, co chair of the N.B. Health Coalition. She said that the introduction of a private system will lead to a two tier society in health care.
“We’re very concerned about the general direction the minister of health is taking,” Lacelle said. “He’s made it quite clear that he’s not going to adhere to medicare, opening up our health care system for any private initiatives that come along.”
And not only the patients are concerned. Marilyn Quinn is the head of the New Brunswick Nurses Union, and she says many of it’s members are reluctant to wage Murphy’s war on wait times. “Nurses have been on the front lines, at the bedsides,” she said. “We’ve seen it all first hand, and we believe in a publicly funded and publicly delivered system where your care is based on your need, and not on your ability to pay.”
Murphy said that if the private sector is to play any additional role in health care, it would not mean there would be any radical changes in how New Bruswickers receive the service.
“We’re not talking about a two tier system, and we’re not talking about people having to pay above their means,” Murphy said. “Everyone will have a medicare card and be able to acquire the free universal health care they had in the past.”
The Health Minister said New Brunswickers shouldn’t worry about the private sector edging out health care as we know it, because he feels it’s in no position to compete with the human resources of the public system. He said that private companies won’t be involved in emergency services like heart surgery, but rather the “low hanging fruit,” like hernia surgeries and diagnostics. He also said that their increased involvement in these less crucial areas will help reduce overall wait times.
Murphy added that additional private involvement in health care is necessary because its cost has been rising at twice the rate of government revenue- 6 per cent versus 3 per cent. “We’re trying to eliminate that gulf in revenue. And the private sector may be able to provide some assistance, but if we partner with them it has to make a very clear business sense to us in the department of health and a clear business sense to the company that might provide that assistance.”
But Lacelle said it makes little business sense at all to form partnerships between the public and private sectors. She feels that even partnerships that seem successful at first, such as involving companies in construction of hospitals, tend to yield more harm than good in the end.
“Sure, in the short term it gets you though a bit of a budget crunch if you farm construction out to a private company and get them to put the money in,” Lacelle said. “But that means the company then owns the building, and we in turn have to lease it back over the next 25 or 30 years through huge tax payments.”
But Murphy said it makes perfect sense to him, because it gives the government the funds to build facilities as needed, sooner rather than later. “We’re not in the bricks and mortar business, we just can’t afford to keep duplicating and buying new equipment buildings.”
Lacelle said that there are many ways to deliver pristine healthcare as needed without tainting it with the private sector. She said one of those alternatives is obvious- creating a sufficient provincial tax base, so that we won’t be paying for today’s needs tomorrow.
“We have to pay the taxes needed in order to ensure that our services are provided,” Lacelle said. “Farming it out to the private sector and then paying for it 30 years down the road might make certain prospects feasible now, but you’re paying for a significantly longer amount of time. That means taxpayers in this province for this generation and the next will suffer.”
“I think that she’s just saying pour more money into the system,” Murphy said, adding that doesn’t solve the problem of health care growing at twice the rate of government revenue. “Unless you get at the root of the problem, the cost of health care is insatiable- it’ll just go through the roof, eating up the entire budget. So no, we’re not going to raise taxes to pay for health care. We’re gonna fix health care as we have it.”
But Quinn argues that public/private partnerships won’t fix the health care we have, they’ll offer short term solutions with long term debts. “We understand there’s fiacnial concerns,” she said. “But if there are problems with the system we have, a system that has worked for many years, you don’t throw the baby out with the bath water. Instead you ask what needs to be done to address those problems.”
Murphy said that the private sector’s involvement in health care is also a system that has worked for years, from ambulance services to the kind physiotherapy that will help Madison walk again. “This is not something I dreamt up overnight,” he said. “There’s been successful public private partnerships in this province, and across the country, for generations.”
“The bottom line is Minister Murphy’s saying the government can’t afford to pay the cost of health care on its own,” Lacelle said. “But it has never been proven that introducing private services will decrease the cost of health care.”
Quinn agreed and she said, if anything, the costs will increase because a private company needs to make a profit. And she feels that profit would not only be factored into the cost of their service, but into their method of delivering it.
“It could be potentially very dangerous,” Quinn said. “If we’re making our decisions based on how much money we can realize in profits this year, as opposed to what’s required to deliver optimum safe care, then we’re at odds.”
“If a private company makes a profit in the delivery of health care, then so be it,” Murphy said. “That’s their business. As long as we can get our patients treated as quickly and efficiently as possible, that’s what we’re concerned about.”
Quinn said that efficiency should not come at the expense of health care’s universality. “When you have that kind of a thought process, ‘if someone makes a profit so be it,’ I think’s it’s a sad day,” she said. “That’s just turning a blind eye to what the priority should be- universal delivery, everyone receiving the same kind of care at the highest possible quality.”
“I don’t know if registered nurses could work in that kind of system,” Quinn added, because they would be faced with an even deeper ethical dilemma in a growing private sector. “We provide care to everybody who requires it- we never question what the cost is. We try to be cost effective, but not with the very notion that you’d make a profit off of someone’s illness. The minister talks about creating competition in the system- that’s a strange word when we’re talking about health and people’s lives.”
Andy reaches toward Madison’s bed, tucking her covers in a little tighter as she sleeps soundly. “In this hospital, she’s not Madison,” he said, “She’s room 12a- the nurses are working at such a pace that they have to use bed numbers rather than names.”
Andy said he’d hate to see how a private system’s lack of unionization and benefits would add to that strain on nurses, and in turn, their patients.
Quinn shares that sentiment. “Patients need supportive environments to heal, added stress definitely impedes that process.” Andy said he’s grateful he can afford that care and support- being a guidance counselor, he has good coverage, but not everyone is so fortunate. To him, the private aspects of medicine are a necessary evil, especially if they can reduce wait times, and take strain off the system and in turn the nurses within it. But he says the thought of Madison’s care being part of a business, rather than a service, is enough to make him feel ill.
“If health care becomes a commodity, then that goes against the whole idea of living in Canada,”Andy says with a sigh as he glances at his daughter’s injured leg, which has swollen to twice the width of the other during her stay at the hospital. “And that’s not the kind if place I want to live in.”