Let's call it the business model from hell.
The enterprise in question purchases high-priced, state-of-the-art equipment and operates it way below capacity. Average salaries increase 6.6 per cent year over year, compared to 1.2 per cent across the economy, yet the enterprise cannot demonstrate that there was any measurable improvement in outcomes. Managers are constantly pleading with shareholders for more money. Anyone who thinks outside the box is loudly and publicly berated and verbally bludgeoned into silence.
This may sound more like fantasy than reality, but it's not. The enterprise in question is our public health-care system, one of the cornerstones of contemporary Canadian society. Believe it or not, recent studies suggest this is how health care is managed in parts of this country. A report commissioned by an Ontario government agency called Wait Time Strategy found that some hospitals operate their magnetic resonance imaging (MRI) machines at 40-per-cent capacity. A sad performance, but at least administrators in those institutions possessed reliable figures.
Elsewhere, that wasn't the case. "If you went to a hospital and said 'How efficiently are you running your MRIs?' most couldn't tell you because they don't have the data," says Dr. Alan Hudson, head of Wait Time Strategy.
That seems unfathomable, especially given the management salaries at Ontario hospitals. In May, the Vancouver-based Fraser Institute released a survey showing that non-executive high-earners - those making more than $100,000 annually - enjoy salaries averaging $149,000 while presidents and CEOs pull in around $250,000. The number of high earners increased three-fold between 1996 and 2004, and last year payrolls for these employees rose by 18 per cent to $365 million. No wonder, then, that largess at the top leads to salary inflation at every level.
Worse still, more does not mean better. "It is difficult to assess the value-for-money benefits arising from these wage increases," wrote Mark Mullins, author of the study,"as individual- or hospital-level productivity data are mostly unavailable."
These are symptoms of a system that is badly unmanaged and spending that is out of control. But try to change it. Remember the June 2004 federal election? Remember how a desperate Prime Minister Paul Martin beat up on Alberta Premier Ralph Klein because his government was contemplating some mild reforms that involved a dose of privatization? That is how we discuss health care in Canada today.
Defenders of medicare, every bit as blind and dogmatic as old-time defenders of the faith, ratchet up the rhetoric and scare the daylights out of voters the moment anyone has the audacity to suggest an alternative to our centrally planned, state-run monopolies.
It is happening again. This time around, federal Health Minister Ujjal Dosanjh is taking on the Canadian Medical Association (CMA), which plans to hold a debate called Charting the Future - Public/Private Interface in Health Care at its upcoming annual convention in Edmonton.
CMA president Albert Schumacher, a physician, says the country's doctors have an obligation to discuss private delivery of health care in the wake of the ruling by the Supreme Court of Canada that will allow Quebecers to buy private insurance in order to ensure timely access to treatment.
Dosanjh, who hasn't put forward one fresh or stimulating idea since acquiring the portfolio, did not even wait to hear what the doctors had to say before scolding them. "I'm extremely disappointed," he told reporters. "I am wondering where Dr. Schumacher wants to take the CMA. I am disappointed that he wants to take the CMA in a direction where he sees a private health care in Canada."
That isn't what Schumacher wants at all if we can place any credence in his public utterances on the subject. But never mind. This is health care and, with this issue, dogma trumps truth every time. Defenders of the status quo will demolish reformers even if they have to rely on half-truths and outrageous distortions. The Liberals may well win another election by proclaiming themselves the only party that can preserve medicare.
Ultimately, though, Martin and Dosanjh, or their successors, will fail. Medicare will be reformed some day because the system, as it is currently structured, is untenable. Health care is about two things: Life and longevity. The human desire for life and longevity is infinite. But government resources are finite.
No matter how you slice it, you can not meet a demand that is unlimited with resources that are limited. There may be politicians in Canada today who recognize our dilemma. Unfortunately, there isn't one with the courage to do something about it.
(D'Arcy Jenish can be reached at firstname.lastname@example.org)