It’s time to face reality. The economic strains that loom in our health-care system are largely the natural consequence of a myopic society.
When the per-capita cost of health care mounts beyond sustainable levels, as we are gradually seeing in North America, there is only one way to control it – regardless of whether the system is public or private – and that is to limit access.
And there are only two ways to limit access: In the public system in Canada we plug it up (creating longer lineups), in the private system of the U.S. they raise the prices (putting it increasingly out of reach of poorer people).
Neither solution is attractive, but one, the other, or a combination of the two – as we are now seeing in Alberta – is inevitable when the costs start taking over the treasury.
With health care both in the U.S. and Canada eating up ever-greater chunks of gross domestic product, this trend is unsustainable. Something troubling is happening. And it’s not merely the failure of either system, but something more insipid.
With better technology and a more informed public, a normal business model would predict relative cost decreases, but they are not happening. In Alberta’s oilpatch, for example, every time someone invents improved drilling technology or a better extraction method, oil becomes cheaper to draw from the ground, even as the resource becomes increasingly scarce. Why is this logic failing us in health care?
There are two factors that work against managing the costs: one is the economic law of diminishing returns, the other is short-sightedness. I’ll deal with the second first.
I used to think that all the answers lay in epidemiology – the study of the source of disease. My thinking was that with better knowledge of the etiology of diseases, we would able to prevent them, and hence rates of particularly expensive diseases would gradually decrease.
While logical, this notion ignores human nature.
Epidemiology is no magic bullet. We need only look at smoking-related illnesses or type 2 diabetes (the preventable kind) to see that behaviour is not easily modifiable, even in the face of overwhelming evidence that it is dangerous and leads to expensive diseases. Despite well-publicized warnings, huge numbers of people indulge in fatty foods and cigarettes (24 per cent of Canadians at last count), willingly condemning themselves to less health and less life (statistically speaking).
So epidemiology obviously does not work by itself.
What we need is a medical system that is somehow sensitive to especially dangerous lifestyle choices, which even the United States has not perfected.
I can think of many ways to cut expenses by ensuring reduced rates of disease, but virtually all involve severely restricting freedoms and seriously impeding business. We could ban the production and sale of all cigarettes and tobacco products in Canada. We could ban all white flour. We could tax anything containing hydrogenated vegetable oils. We could quarantine people with HIV. We could force-feed beans to everyone.
Does this sound fanciful? It’s not. We may face at least some of those measures to preserve our public health care down the road if something does not change. Either that, or we could collectively improve the way we live (my number-one choice, obviously). We like to pretend that our sex life is our private business, but when someone walks into hospital with a venereal disease, everyone foots the bill.
If sufficient numbers of people in a public system don’t purposefully live better, they condemn all of us to one of two unpleasant scenarios: restricted freedoms or restricted access.
To complain about such natural consequences is fatuous. Collectively, we have to admit that we pay the price for our lifestyles. We have to stop blaming the government and look in the mirror.
That’s not to say that all disease is caused by lifestyle. I am only dealing with the lifestyle illnesses. We know much disease is caused by genetic and environmental factors over which we have no direct control.
This is where epidemiology serves as another illustration of the limits of technological development – what economists call the law of diminishing returns. This economic principle states that the rate of improved productivity becomes increasingly difficult to sustain at a certain level of growth.
It’s a law of nature, basically. For example, the land-speed record was broken about 10 times in the 1960s, but as technology advanced, it became much more difficult to beat, and the land-speed record has been broken only three times in the past 30 years. In the same way, we can’t expect epidemiology to maintain the heady pace it enjoyed from 1850-1950, its early years.
Today, we are not just looking for a single microbe, such as caused the cholera epidemics that were the impetus for the birth of epidemiology. We face increasing incidence of complex diseases such as Parkinson’s and multiple sclerosis, which involve a multitude of factors interacting in still-inscrutable ways. Even though it’s costly, we must ascertain causes, to assist with treatments and prevention.
Today, drug companies face formidable regulatory and drug-development challenges, vastly increasing the costs of the pharmaceutical business. Since the low-hanging fruit has been plucked, we must expect to pay higher drug bills.
High-tech equipment and surgical techniques are improving, drug interactions are being prevented with database technology, human error is being ameliorated by computerization.
But all this equipment, training, research, and such require a great deal of investment today to prevent wasting money tomorrow. So with the demographic shift of Canada heading towards an older, sicker age (as baby-boomers reach 45-65) we have dramatic challenges to face.
So let us not forget that when it comes to our health, the government will never be able to do it for us.
In fact, we are hobbling them. Today, they are wasting so much money treating preventable diseases, they won’t have money to plan for tomorrow (though yesterday’s deficit financing sure didn’t help.)
And if we don’t make our personal health a serious business, it will take everyone else’s down with it.
