Indeed, things are out of control

I had to sign after I read this article about health care in Saint John this morning.    The provincial government spends $2.5 billion on public health care in New Brunswick.   The average household in New Brunswick spends another $2,000+ out of pocket on health care (around $500 million in total) and, yes, even companies pay for health care through sharing health insurance premiums and other costs.  I don’t have an estimate for company/organizational health insurance payments but I would estimate it must be at least in the couple of hundred million dollar range.

Conservatively, the health care system in New Brunswick is costing us about $4,300 per person or about $13,000 per household every year.    To put that in perspective, the average household pays just over $10,000 for the cost of shelter each year and another $10,000 in personal taxes.

In addition, we have been pouring new money into the health care system at rates 2-3 times the growth of the economy and private wage growth for over a decade.

So when the doctor says the “health-care system that is more concerned about the bottom line than anything else”, it confirms my belief that we need to have a serious and rational public discuss about this in a hurry.

I have written on this in the past so I won’t spend too much time on it but the thesis is simple.  There is no other government expenditure where the proponents can play the life or death card.   In addition, in public surveys doctors still are ranked near the top of the most respected list while politicians rank near the bottom.   It’s a toxic mix of fact, fear and respect that leads governments to shovel more and more money in every year at unsustainable rates.

It’s one thing to battle the ‘unions’ or the ‘construction lobby’ or the ‘rich elites’.  It’s another thing entirely to battle the doctors over life and death issues.

I will repeat my view that the doctors themselves need to help us figure out how to control health care costs.  We need to agree on some broad framework for cost escalation tied to GDP growth or as a hard percentage of the provincial budget – it’s approaching 40% of the total budget now.    If we were to fix health care at 40% of the budget (less debt service) what would that look like?

It’s a shame that we can’t have a civilized discussion about this without people using the life and death card.

Now, before I end this, I will say that my comments here have nothing to do with the specific situation at the SJ hospital.  I don’t know enough about it to say one way or the other.   My problem with this narrative is ease of which the doctors use the fear card:

“If you roll the stone into the front door of the emergency department, you’ll save a lot of money. Same thing in the operating room.”

That’s a $3.2 billion stone, sir.

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10 Responses to Indeed, things are out of control

  1. Don Dennison says:

    Fortunately we now have the New Brunswick Health Council, under the capable direection of Stefan Robichaud, to show us where the money is going and what results it is producing by comparison to other jurisdictions. For too long, we’ve only been measuring the dollars going in and not the results in terms of the health of the population. Having more money to spend would be wonderful, but we are not in that position. We have to make more rational use of the funds we have, and research shows us how we can do that. In some cases the medical profession appears to resist such change.
    I was one of many called to participate in a survey conducted for the Health Council last week, and in an extensive 20 minute + session, found I was reporting high degrees of satisfaction with the health care I receive. I did suggest, however, that I think we could be as well served at lower cost under a different management model that utilizes a mix of health professionals and where regular monitoring and care isn’t totally patient initiated.

  2. Before we get all frightened about the huge cost of health care spending in New Brunswick, let’s note that according to OECD, the expense per capita for all of Canada was about $4400 (the same study puts out of pocket expenses at about $600 per year, not $2,000+, so likely the expenditure in NB is more like $3100 per year). So we pay less per person in NB now than all of Canada did a couple years ago (and probably significantly less than the rest of the country now). Here’s the OECD data: http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html

    As we peruse the data in the spreadsheets provided, take the time to scroll down to see the $7500 per capita paid in the United States under the sort of privatized system columns like this one are leading us toward.

    Maybe if we pushed ourselves, we could get out of the realm of health care as provided in the Netherlands, Norway and Switzerland and save $1000 per capita a year – about $80 a month – and get our health care system in Canada system to the level of spending we see in, say, Great Britain. In NB, though, that same $1000 per year saving gets down to the level of health care we see in Eastern Europe (eg., Czech, Slovakia, Slovenia).

    Finally, one more point: the reason health care is costing 40 percent of the budget is because, when you cut all those taxes to rich people and corporations, health care needs don’t go away. And the people of New Brunswick, noticing that they live in Canada, not eastern Europe, are demanding *better* services, enough to bring up up to the level of the rest of the country, not worse.

    So let’s have a serious and rational discussion about health care. But let’s do it with real data, from credible sources. It’s not like we are reckless spenders here in NB; indeed, many of our inefficiencies stem from exactly the opposite problem, that we’re not willing to invest in the system. And let’s be clear about where this discussion is headed: if we continue to undercut government funding, we will push our health care system into the realm of the third world. That’s a fact.

  3. Downes, I have no problem with your posts but your assertion about ‘credible sources’ is offensive. My sources are a) the provincial budget 2010-2011 and Statistics Canada – not some aggregated, homogenized source out of Europe based on older data. You can completely disagree with me on all points but it’s silly to call into question the credibility of my data. Unfortunate given your intellect.

  4. David, I apologize for having offended you. My concern was that the data came across in the post as a seat-of-the-pants calculation, especially the figures for out-of-pocket expenses. Readers like me check your data, so it’s important to cite (and ideally link to) your sources.

    I was also concerned about the tone of the post. My first thought on seeing $4,300 per capita was that it was not out of line at all, consistent with Canadian spending generally, and about half what they spend in the United States. So I do confess to writing my response in less than a positive frame of mind, as it it appeared to me that you were taking costs that were consistent with, and even less than, wider trends, and depicting them as though they were out of control.

    Since your views end up in the newspaper (and since mine will never ever be allowed in print in this province) I hope you can appreciate my sensitivity to sources and tone. Again, I apologize for offending you; I appreciate the work that you do.

  5. I appreciate your response and I welcome your input to this discussion.

  6. mikel says:

    That should definitely be an article by Mr. Campbell, perhaps using the ‘medical tourism’ angle as a cover, because it IS an important topic, and both points are valid. Bryniak wasn’t specifically talking about money,in fact some of the problems he has are that he thinks he could SAVE the province money, but of course they won’t release numbers as to how much they supposedly save by closing off OR’s in the summer.

    But its not just the ‘tone’ that is the point,it is this: “We need to agree on some broad framework for cost escalation tied to GDP growth or as a hard percentage of the provincial budget”. In other words, a ‘cap’ on health care. So what happens if health care needs surpass that cap? Technically they already are, thats why NBers pay more out of pocket than any other province.

    And even more important than education, here we are talking about life and death, NOT just economics and numbers. Again, what we know about the ‘market’ is that it has NOT been the government that is at fault. NB has a bilingual workforce with no union activity and low wage expectations (relatively). The province has the lowest tax on the eastern seaboard. So to blame the government for we KNOW has been massive fraud by unregulated industries which essentially killed the global economy is absurd.

    On the OTHER hand, in this case we should be listening to doctors and nurses. My mother retired as a nurse in the nineties, when Frank McKenna turned health care into an ‘industry’. It went so far as to mean that nurses were no longer to speak of ‘patients’ but instead as ‘clients’. Unfortunately, the business model is pretty nasty in monopoly industries. The province then dumped the RN’s in exchange for BN’s, which meant years of university bookwork, but no practical experience. This lead to a whole new generation of nurses who preferred the administration of nursing as opposed to its practice.

    That doesn’t even scratch the surface, but suffice to say, both Bryniak and David have valid points, and the ‘fear card’ should be used more often to really motivate people.

    When it comes to health care I always like to leave with this story. Port Hope Ontario is where most of the nuclear processing goes on in this country. The federal government spent hundreds of millions in facilities and staff to ‘protect’ the population. A group of workers and citizens wanted their blood tested for effects, a fairly reasonable request. OUR federal government refused, in fact ALL the studies turned out to be based on hypothetical scenario’s, not a SINGLE person was ever tested, in fact it turned out the blood had to be sent to Germany for testing.

    You can pour BILLIONS into a department, and if you don’t know where it goes, you can’t assume that it isn’t wasted. Close by in Toronto, Community housing, meant to provide homes for the poor, was spending 50,000 on christmas parties.

    So by all means, lets see the fear card more often. That doesn’t discount civilized discussion.

  7. Don Dennison says:

    You two are still focussing on the ‘dollars in’ issue. It’s true that Canadian expenditures are not out of line – until you realize that other countries spending muchless than us get better results !

  8. mikel says:

    Which two? In health care it ALWAYS comes down to the dollars, because we know that better health results in fewer dollars spent.
    And I’d like to know what is meant by ‘better results’. Canada’s surgical waits are not out of line with other areas, our mortality is similar, child mortality is similar, hospital lengths of stay is about the same. So what are the better results?

    I think where you’ll find big differences is that in North America there is far more reliance on drugs rather than lifestyle changes, and governments seem totally incapable of making ANY kind of changes except to offer some tax credits for institutional sports (which often have lower exercise potential than simply running).

    We heard noises before about getting more phys ed in schools, but Graham only made small changes there.

    David and the doctors points are not mutually exclusive. It’s very true that health care numbers are scary-but its also true that when lines like that are trotted out, they usually mean fewer services down the line. A pet peeve I have with CBC is there really should be a feature that shows where the money is going and who to. Some of that information is inaccessible, but a lot of it is, but its buried in departmental websites which few people look at.

  9. Don Dennison says:

    Mikel writes “In health care it ALWAYS comes down to the dollars, because we know that better health results in fewer dollars spent.”
    Correct, and it is also true that more dollars spent does not necessarily mean better health.
    NB spends slightly above the national average and has more family physicians than the national average. We’re keeping pace in spending, but where are we in terms of the factors that drag us down-obesity and chronic disease.
    The fact is, in examining determinants of health, only 10% is attributed to health care. 40% is attributed to socio-economic status.
    So we need to focus less on spending more on health care, and more on economic development if we want to improve our overall health.

  10. richard says:

    So we need to focus less on spending more on health care, and more on economic development if we want to improve our overall health.

    Bingo, Mr Dennison. NB has one of the lowest median incomes in the country. Not only is that low income correlated to various health issues, I suspect that also we have more difficulty here bearing the out-of-pocket costs of health care than other parts of the country.

    Unfortunately, health care to most means hospital and doctor access, and that is what gets the politicians attention.

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