23 July 2009

C is for Co-operate

I have a subscription to The Observer magazine. It's a United Church of Canada magazine, and it's extremely well done. The articles aren't fawning or over-the-top. It's well written and well-produced. I don't always agree with the opinion pieces. No surprise there! Based on the letters, many people don't. Though I usually disagree in different ways because I'm young and the UCC is starting to fart dust.

Anyway, this months edition arrived yesterday last week (it took me a week to finish this with all the interruptions and a sick kid!) and I started to read over it. In the first opinion piece, Vanessa Hammond of Fairfield United here in Victoria extols the virtues of health care co-ops.

Here's how healthcare co-ops are supposed to work. One joins the co-op by purchasing a share, and then (usually) paying an annual fee. Government funded services are covered by the government, and then the co-op handles other things above and beyond government coverage, like physiotherapy, counselling, acupuncture, whatever. There tends to be a focus on preventative medicine, because co-ops tend to be better at math than governments (preventative medicine saves money).

Hammond's main thesis is that community-owned health-care co-ops provide the best bridge between the "overburdened public system, and private clinics that place profit before human need". I disagree. I think the public system needs an overhaul. Co-ops are good things. Take it from this socialist, I like them. I do. But not for healthcare.

Hammond says, "Co-ops are organized according to the wishes of their member-owners. Although all follow the principles of democratic governance, each responds to the needs of its community". Really? How? How can this be possible? If the members of the co-op don't democratically vote in a way that benefits the community, doesn't this necessarily mean that one or the other gets the shaft? For example, suppose there is a co-op downtown. There are a number of wealthy people, and a number of poor people who live in close proximity. From millionaires to homeless in one square kilometre. The co-op has a lot of wealthy people in it, and they discover that a disproportionate amount of the money going into the co-op is being spent on the poorer people in the co-op. What's to stop them from deciding to increase rates in a way that excludes all but the wealthy? Human decency? Don't make me laugh.

Healthcare co-ops are a surefire way to get little enclaves of good service for those who can afford it. There would be elite co-ops that are expensive to join, pay for the best doctors, and offer the best services. And there would be crappy co-ops, where the rates were lower, they offer very little, and only the bottom rung of doctors would work there. It's inevitable.

And then there's the fact that they're completely unnecessary. Our public system can do all of the things that the co-ops do if it gets properly funded. Preventative medicine would be a great start. Covering chiropractic and physiotherapy, podiatry, counselling services, offering nutrition classes and providing poor people with good quality food at lower prices (and there are humane ways to do this without it coming to the American food stamp program from Hell). Oh, and using nurse practitioners for many simple problems. Expanding the public health nurse program. Add these to the program and the number of people going to the doctor and ER for garbage visits will drop off enormously. There will be less surgeries for injuries. Less people spending weeks in psych wards for breakdowns. It is cheaper and easier to stay healthy than it is to recover.

Simply put, we'll have healthier people, and everyone will have equal access to the system.

I do have a few ideas for how to better run the system. First, to keep doctors here, set up a program with student loans and subsidies to universities. Government subsidizes medical school training right now. If a student isn't willing to work within Canada after graduating, said student doesn't get a subsidy, and pays full price for their training. If he or she wants the subsidy, then the student must work as a doctor in Canada for several years after graduating in order to repay the subsidy. Less years if the work is done in a rural area.

Second, to reduce the wait lists: let people pay to jump the queue. Stop, don't freak, there's more. :) If I have a metric assload of money, and I want to spend it to get my MRI tomorrow (during off hours), I should be able to. Here's the catch. I have to buy two. One for me, and one for the next person in line. The cost to run the MRIs is in manpower, not equipment, so we both pay to have someone there running the machine when it would otherwise sit dormant. It pays for someone to work, it reduces the waitlist, and it isn't just for the people with money. If there is a flaw in this reasoning, I want to hear it. I've been toying with the idea for years, and I can't find a hole. Tell me if you see something I don't. But I think it's win/win.

Co-ops are a dangerous idea. They allow for elite, quality care for those who can afford it, second-rate care for those who can't, and a good excuse for the government to make cuts. "Oh, well most people are covered for X by co-ops, and if they're not, there are a number of inexpensive ones they can join". Can't you just hear it now?

On a more personal note, I'm highly offended by the way she adds God to the equation, and makes it out like God supports co-ops. "Together, with Gods's grace and inspiration, we can only succeed". *snort* Puh-leeze. Like everyone who has failed in the past has just been lacking God's grace and inspiration. Yeah, sure.