Health Care Costs Explained In Full

Sometime in the year 2000, Elizabeth Cull (who was working for the Premier at the time) called me up at home. No, actually I wasn’t at home. I was having dinner with my dear friends across the road from my home and, somehow, Elizabeth figured out how to find me and phoned me there. When she got me on the phone she flattered me into becoming the Minister of Health. Health Care was a minefield in the year 2000. Somebody died on TV every night. And not just in B.C. Everywhere in Canada the press had decided that death was not a natural outcome of life and people died on the evening news all across the country. The average term of office of a Provincial Minister of Health in the year 2001 was 11 months. When I went to my first Health Ministers' meeting and learned that statistic, I asked the other Ministers why that was. “Because,” said one, “none of us can stand to have our face connected to death stories for any longer than that without becoming unelectable for life. Give it a few months and you will be begging your Premier for another job, just like we are.” I didn’t want the job. I liked being Minister of Agriculture and Rural Development. I liked it a lot. Elizabeth Cull, though, was a flatterer and I was susceptible to that kind of manipulation. I took the job. My very first week on the job we, in British Columbia, failed to manage a liver transplant and the failure became huge news. It pretty much went downhill from there. In order to try to understand what was happening, the Premier and I set out to tour hospitals and talk to hospital workers and nurses and doctors and management teams. Doctors tended to talk about technology. Everywhere we went doctors wanted more machines. Other professions had other ideas about what needed to be fixed, but the position of doctors, or at least their spokespeople, was that the health care system was broken because of a failure on the part of government to adequately fund capital expenditures on modern equipment. After we had traveled around the province for a few weeks and heard the doctors’ message, I received a directive from the Premier’s office to appear before Cabinet to ask for a special, unbudgeted, uplift to the funding for the Ministry of Health. This was ironic. I couldn’t help but remember that every time this had happened in the past I had objected to such an expenditure. Now, I was going to carry the request and, judging by the person who was telling me to do it, it would pass almost without regard to the quality of my submission. Sure enough, the unbudgeted request passed. I now had a large sum of money (I do not remember the exact amount of money, nor is it relevant to the story) with which to buy, specifically, MRI and CT machines that are precisely those diagnostic tools that the Fraser Institute is now (six years later) complaining we do not have enough of. The next week we had a meeting in my office with at least a dozen people to decide where to put the machines we intended to buy. Many of the senior executive of the Ministry of Health were in attendance. Staff of the Premier’s Office were there. There were even one or two people who worked for me in the room. I put the question of “where should we put the money” and we went around the room to hear each person’s point of view. Some people thought we should simply make a statistical analysis and give the money to those who served the greatest number of patients in a year. Some thought we should put the machines in the major centres around the Province to serve geographic interests rather than just deciding the issue by population. A particularly partisan individual thought we should spend the money in places where it might serve the interests of an electoral agenda. The debate raged on without resolution for some time. One guy in the room had said nothing. I will be somewhat circumspect in my description of this fellow since I think he may still work for the government. Suffice to say that this gentleman (who was, himself, a doctor) was responsible for measuring health outcomes, in the aggregate, for the Province. Eventually I noticed his apparent irritation with the discussion and the absence of his contribution. I asked, “Doctor, you look unhappy and we haven’t heard your opinion. What do you think about the question before us?” I am pretty sure nobody took notes at that meeting. Certainly, I didn’t. Thus, my memory of the doctor’s comments that follows is just that, the memory of a person that was in the room, mediated by the passing of half a decade. I have no idea what he really said. It was something like this: “Minister, you can put those machines anywhere you want. Put them all in Vancouver to shut up the Vancouver press. Put them in your own constituency and see if it will get you re-elected. I am not participating in this discussion because it is utterly irrelevant to the health outcomes of the population.” I objected, “But doctor, people are dying on the evening news every night. I am told that these machines are necessary to stop that from happening. How can you say where we put them is not important to the well being of the population?” “Because, Minister (he talked like that, he was a very respectful and polite individual, even when annoyed), those machines are diagnostic technology. Sure, they are useful to doctors to understand some problems and, therefore, they have value. But they do not address the real issues of the day because they are a technological solution and we do not have a technological problem.” I said, “Please explain. I was a logger before I got elected. I know nothing about the nature of the problem except what I have learned in this work. Why is this technology not of value to the population in the aggregate?” “These machines are very good at diagnosing trauma and disease,” he responded. “We are not dying of trauma and disease anymore. We don’t carry guns or knives. We don’t even drink and drive anymore. We wear seat belts and bicycle helmets. We have so little trauma that we have trouble teaching trauma management techniques in our teaching hospitals. We cured mumps and pneumonia and most everything else our parents used to die of with antibiotics and preventive systems like immunization. Trauma and disease are no longer our big problems.” “So doctor,” I asked, “they are still dying out there, aren’t they? What is it they are dying of if it isn’t trauma and disease?” And he said “Alienation. Alienation is the plague of our time. The people have lost the sense of where they came from and whom they belong with and where they might be going and with whom. They are alienated from their experience and alienation is a medical condition. It makes a vacuum in their lives that they self-medicate. They self-medicate with eating too much, with drugs, with dangerous sex or risky behaviour or alcohol or overwork or with any of a multitude of behaviours that kill them. They are dying of their self-medication from the plague of alienation. We cannot cure this problem with technology.” The most amazing thing about that meeting was the silence after that fellow had spoken. The room was full of people I respected a great deal, intelligent, professional people dedicated to their work and unafraid to speak their mind. People who ten minutes before had been involved an a heated dialogue defending their strongly-held positions, and not one of them said, “Oh, nonsense.” Nobody gainsaid that man’s analysis. The meeting ended. Ever since that day I have believed that we in British Columbia really do need to have a big talk about the nature of care, but none of us know how to begin because none of us is prepared to talk about the fact that we are not talking about our “well-being” so much as we are talking about death avoidance. We measure the number of procedures we do in a month and we pretend that those statistics define something. We have the best health care system in the world and we denigrate it to sell newspapers or to get votes or to make more money. I am appalled that the Fraser Institute should purport to define our health care system by measuring the speed with which citizens are able to access technology. If that be the measure of well being we should all move to Kuwait. I bet those people can buy access in an afternoon. And besides, at least one really smart guy in the system doesn’t think access to the machines means much about how well we are. We need a different kind of conversation, one in which there is more than one definition of “care.” Actually, I am not appalled at the behaviour of the Fraser Institute. They exist to serve the rich and they do it well. They say what they are supposed to say to do their job for the people they work for. I am appalled that we report such claptrap as “news.” No wonder we are alienated. Sincerely, Corky © 2006 Corky Evans. This letter is meant to be read and considered in its whole context and may not, ethically, be taken apart or quoted in segments for partisan gain or media sensationalism. Please honour the intent of this form of communication. [Proofreader's note: this article was edited for spelling and typos on January 8, 2007]