Reforming health reform

Sooner or later everybody has to go to the doctor. Personally, I probably have to go more often than most, since with HIV, I need regular check-ups, blood work, medication changes and all the rest.

I’ve been seeing the same doctor for years. I can usually see him within a week and if something seems urgent, I can usually get in faster.

A friend of mine in the US is also HIV-positive. He changed jobs a couple of years ago. A new company meant a different insurance plan and a new health management organization – so he had to change doctors. Now, because of the recession, he got laid off. He soon may not be able to go to the doctor at all, unless he can pay for it.

So every time I talk to him I find myself thanking my lucky stars that I live in a country with public, comprehensive, universal health care.

For the time being anyway. Because it’s changing. The right-wing press has been howling for years that there is a crisis in our medical system because of costs and line-ups. They say we need to be more like the Americans and people should have the right to jump the queue and pay to go to the doctor.

Most Canadians disagree even though they acknowledge our medical system is under stress. It’s short of money for two main reasons.

The first is that in order to deliver big tax cuts to reduce the deficit, the federal government has drastically reduced the money it used to give to the provinces to provide health care.

The second is that the feds also changed the patent laws about 10 years ago to allow the pharmaceutical industry patent protection for up to 20 years. That meant drug companies could continue to charge inflated prices for a lot longer.

The Progressive Conservative government here in Ontario has made things even worse, cutting taxes and creating backlogs in services by closing hospitals. To solve the mess they’ve created they’re proposing to hand over the health care “business” to US companies who will provide better service at a profit for their American CEOs and shareholders. As if.

So now we’re faced with many ideas on health care “reform.” A few months ago former PC cabinet minister Don Mazankowski came up with his made-in-Alberta solution: user fees, service limitations and privatization.

Now former NDP Saskatchewan premier Roy Romanow is touring the country – he was in Toronto earlier this month – to get people’s ideas on reform; reports are he likes the idea of user fees and service limitations as well.

So what will it mean for us, especially those of us with HIV, if these “reformers” get their way and replace our public, universal system with a two-tiered one with fees attached? Different reformers have different schemes but here’s how things might look.

First, when I want to go to the doctor, there will be no more simply phoning up for an appointment. I’ll have to be screened. Someone else will decide if I really need to see him or if a nurse wouldn’t do. If I insist on seeing a doctor, I’ll have to pay.

Second, it will take a lot longer to get an appointment. Everywhere where two-tier private medical care has been introduced, doctors have left the public system to earn big bucks in the private sector, meaning fewer doctors and longer waits for those of us without bags of money to spend.

Third, even if the screening process determines that I do need to see a doc, and I can survive the wait, I may have to pay a user fee anyway – billed as a way to discourage abuse.

Fourth, after I’ve jumped all these hurdles and paid my fee, my doctor may not be able to order the tests or prescribe the meds, or refer me to the specialist that he thinks I need, because all of these things will be tightly regulated, rationed out, or delisted. Some of that is already happening.

Finally some of the reformers are proposing that we pay doctors to treat a given number of patients, according to a system called capitation. In that case my doctor may decide he doesn’t want me as a patient at all, since he can make more money seeing a lot of relatively healthy people with an occasional cold or flu than he can treating somebody with a complicated, chronic illness.

These reforms are being sold to the rich by promising them that they’ll be able to get faster, better medical care by paying for it. Ironically it will probably make things worse for them, too. With most people relying on an even more underfunded, understaffed public system, there will be a lot more people who are sicker wandering around.

It’s time to tell the privatizers that they can stick their reforms where the sun don’t shine. A publicly funded, universal, health care system is ultimately cheaper, more efficient and better for everybody’s health.