I am a passionate believer in publicly-provided health care. Despite the narrative that seems to be fairly widespread among the Americans I speak to, public health care delivery is a much better model than for-profit care. Like any human system, it has its flaws that should be examined and improved upon. However, as both a method of caring for sick people and a method of controlling health care costs, public systems are the way to go.
The ‘dirty’ little ‘secret’ of health care is that demand will always outstrip supply. There are a nearly-infinite number of things that could qualify as ‘health care’, and we want all of them. As a result, we have to find where the limits are – where we are comfortable saying “if you want this, you’re on your own”. In the fights over health care reform in the U.S., this process got a dirty name for itself: rationing. Sounds scary, right? Your grandma needs a hip replacement, and some government fat-cat comes in and says “nope, sorry, all you are covered for is euthanasia!” Grandma gets wheeled into the back room against her will, and is put down like a stray dog. THANKS, OBAMA!
Of course the reality is that rationing happens in any health care system, including the American one. The difference is in how we ration. Canada and other publicly-funded systems ration by restricting the number of services you can get, but everybody gets something. Usually that something is fairly high-quality care, but occasionally it is sub-standard and people have to fight. That is an outrage, and there are many professionals who dedicate their lives to reducing the frequency of such occurrences. In the United States, rationing occurs by restricting the number of people who actually get anything. By restricting in this way, demand is essentially artificially reduced, which makes up for the (inevitable) shortcomings in supply. It should be noted that the HMO model, which was created specifically to alleviate this, actually incorporates both kinds of rationing, which sucks for pretty much everyone besides the wealthy.
So assuming we can agree that it is both unethical and impractical to reduce demand by striking people off the insurance rolls, we have to find other ways of controlling costs. One method of controlling costs is to ensure that only treatments that have a demonstrated record of effectiveness get funded. So we pay for morphine, but not for homeopathic preparations of nettles. We pay for surgeons, but not for faith healers. We pay for osteopaths, but not for chiropractic:
The provincial NDP says it would reinstate cost-shared chiropractic treatments if elected government, a move that would reverse a cut made by the Saskatchewan Party in the 2010 provincial budget. NDP Leader Dwain Lingenfelter said some people are now forced to forgo chiropractic appointments because they can’t afford to pay, and they end up seeking treatment at medical clinics or emergency rooms.
[Saskatchewan health minister Don McMorris] said there hasn’t been evidence of clogged ERs because of lack of access to a chiropractor. The money the government saved by delisting chiropractic services was redirected into the health system, where priority areas include reducing surgical wait times and ensuring that the province has a proper complement of nurses, McMorris said.
A quick crash course in Canadian politics for our foreign friends: instead of states, Canada has provinces. Legislation makes health care both a federal and provincial responsibility – the feds are responsible for kicking in money, and the provinces control how it gets spent. In exchange, the provinces are required to meet certain standards of delivery. There is no direct analogue to the NDP (New Democrat Party) in the U.S.A. – think the left flank of the Democratic Party. Brits can compare them to the Lib Dems. Everyone else… I dunno, you can judge for yourself.
So the government of Saskatchewan has made the decision to withdraw funding from one type of service (a process known as ‘disinvestment’ in the literature) and reinvest it in other priority areas. This is generally considered good policy – every dollar you spend on X is money you can’t spend on Y, so find the mix of X and Y that has the greatest benefit for the population. Skeptics like myself are also particularly cheered by this policy because there is really no reliable evidence to suggest that chiropractic actually works:
Despite the widespread acceptance of chiropractic as a medical treatment, chiropractic is based on theories that have not been validated by modern science. Though some evidence exists to suggest that chiropractic may be effective in the treatment of musculoskeletal complaints such as low back pain, other research indicates that chiropractic may be no more effective than doing nothing.
While chiropractors commonly promote and practice manual therapy in the treatment of non-spinal ailments, it is important to note that the risks of chiropractic manipulation may be considerable, and currently no scientifically reliable study exist to show efficacy of such treatment in non-spinal conditions.
I live in British Columbia, which is one of the most woo-friendly provinces in the country (if not the most). The reason that this decision cheers me up falls into two main categories. First, it means that there is now precedent to support de-listing some of the more ridiculous things that are covered by our provincial health care plan. As a taxpayer, I am told by the media that I have the right to complain whenever a cent of my tax money goes to something I don’t like, but in this case it is going to fund something that is a waste of money at best, and potentially fatal at its worst. Second, the government is actively defending the decision rather than knuckling under the ire of the populace, and is actually reinvesting the money in places where it’s hard to attack them. This points a clear direction to policy-makers and government officials in other provinces of a way to effectively execute priority setting activities.
Health care is a dirty world full of compromises, human drama, and legitimate suffering even when things are handled well. I believe in evidence-based policy making, and am happy to put this one firmly in the ‘win’ column for Saskatchewan, and hopefully the whole country by extension.
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