Maz Health Care Report

There are mixed opinions about the status of the health care system. Some say it's in a crises, others say that it's just fine. There are probably more sacred cows attached to the health care system in Canada than any other issue. Even talking about making changes is enough to incite fury in some circles.

Right now health care spending is a major portion of the provincial budgets, and it is increasing at least at the rate of inflation, sometimes more. What drives this is people demanding more and better services. Medical services are key to a longer happier life, and who doesn't want that?

Nobody seems to care about the cost on a personal level because "the government pays." What that really means is that we all pay for it through our taxes. On a macro scale it has to balance; our contributions have pay for the services we demand.

The Alberta government seems to be one of the leaders in examining the issue of funding health care, and has taken some heat for doing so. None the less, I have to applaud efforts to understand the issue better. We need to be sure we are transforming tax dollars into delivered health care in the most effective and efficient way possible. Alberta commissioned a council to examine the issue, chaired by the Right Honourable Don Mazankowski. The council just published their report.

I spent a little bit of time today browsing the web looking for reactions to the Mazankowski report. There's certainly no shortage of them. I wondered if the authors of some of them had actually read the report. You can read it for yourself here. I'll admit that I haven't read it all yet; it's a bit much to do in one go, but I plan read it in stages. Watch for more comments.

The report starts off on the right foot by saying that the first priority is to keep people from getting sick. If that's what the system is doing it would be truly appropriate to call it a health care system. What we have now should be called a sick care system.

Having people stay healthy isn't something that Canadians as a society have talked about much. It's assumed that people will do what it takes to stay healthy. Yet figuring out healthy choices is more complex now. Much of the food we eat now contain additives that didn't exist 50 years ago. Our work lives are filled with dangers and stresses that were little known until very recently. When I was a young adult I would have laughed at the thought that one could seriously injure oneself sitting in a chair and typing. Through advances in medical science we now know much more about the factors contributing to various medical problems, and the treatment of those problems. New treatments are usually more expensive than previously known treatments, and under the current system we all share the costs. This is our incentive to improve the system. Cutting medical costs is a worthy goal, but the real payoff comes from healthier citizens.

The report has several specific recommendations on staying healthy. The ones that catch my eye are: education of children and youth, providing better information about staying healthy, providing incentives to stay healthy, and supporting actions to reduce tobacco use.

I don't smoke so reducing tobacco use by others is a no brainer for me. Yet we need to realize that almost all of the smokers that can quit, have quit. The remainder are addicted. It's important to help them cut down or quit, but we need to recognize we may not have a lot of success. The point should be to prevent anyone from getting the habit in the first place. No new smokers means the problems relating to smoking will gradually diminish.

Providing incentives is an interesting point. They list several potential ways of doing so, mainly by trying to monetize the health care system. That is, somehow trying to relate premium payments to actions taken in relation to staying healthy. Our society is much taken with monetary incentives or punishments, and people are generally pretty good about acting in their financial best interest. Yet the whole point of our health system is to spread the risk of becoming sick. Varying the premium based on the status of your health starts to sound like paying for your own medical care.

Part of the problem is that nobody knows how much personal medical services cost. If cost isn't a consideration, why shouldn't one get that last test, or that third opinion? At the end of the year each person should receive a statement of what they cost the medical system that year, with the cost of each item detailed. The statement should include some comparison to an average, so the person knows roughly where they are.

People need to be aware that there is a cost to demanding services. I don't suggest placing a cap on medical spending, or penalizing those who use the system the most. But a system that can produce such a statement is a powerful tool against fraud and medical oversight.

The key point is providing better information about staying healthy, and to make it as easy as possible to make healthy choices. Our society has made it socially unacceptable to drink and drive in less than 30 years. Perhaps we can make is socially unacceptable to make flagrantly bad health care choices.