Robert Cooper

This analysis of Canada's healthcare system by an investment banker and corporate trader may be problematic. Why: 1. We have the fundamentals right for great healthcare 2. We have the money for great healthcare if we don't spend it on dumb things 👇👇👇 3. We have unique differences that make comparisons hard. We need to chart our own course. 4. Keeping the market out of healthcare is the right decision because for-profit medicine is worse medicine Kiladze first sets up a convenient straw-man argument that "even Sweden" - a "socialist" Mecca - has privately funded healthcare. False. Sweden is a dual (a) highly competitive, free-market capitalist nation and (b) with a robust social welfare state. Socialist politics died in 1990 in Sweden. Sweden is not "socialist". Next, Sweden is no Canada. Sweden robustly funds pharmacare, homecare, long term care and dental care (huge determinants of health we lack). Sweden has vastly more doctors per capita (to Ontario's credit we've added 2 new med schools). Sweden is small and highly urban. Sweden only has 10.7 million. We have 42 million. Sweden has a true unified healthcare system. We have 13 healthcare systems. So this is not apples vs. apples. We have a steeper hill to climb in Canada. Hate me for saying it, but we have a very good healthcare system in Canada. And I'm a voice when things go wrong. I'm an urban evening night ER doctor. I see the best and worst of everything. If I see 25 patients on a shift, 20 have a reasonable experience, 2 not great and 3 bad. I see 6-8 hour waits. I see too much hallway medicine. But I see comfort and cure daily. My adult and pediatric patients could not say a nicer thank you. I see bedside staff and administrative staff daily innovate to make the system evolve. Even though I often criticize Ontario's government, we have to be honest the median wait time to see an ER doctor is 1.7-2.0 hours. That is solid. The tail of that bell curve can be up to 10 hours, but the median still is meaningful. Canada's healthcare system is not uniformly awful. Not by a longshot. Kiladze raises "private management" as if we don't do this in Canada. To be clear "private management" is not Satan. There are many privately managed medical clinics that are run by doctors. It's called your family doctor's office. Your family doctor, your ER doctor, your gynecologist - in Ontario at least - they are likely all small incorporated businesses. "Privately operated but publicly funded" is extremely common in Ontario. So nothing new to see here. Kiladze argues how bad Ontario's finances are. That's because we spend money on dumb things. -$2.2 billion on an Austrian spa -$1 billion on a new Science Centre -$1.4 billion on early alcohol sales -$3.2 billion on pre-election bribe cheques If the above $7.2 billion was spent on Ontario's healthcare system, Kiladze wouldn't have to write this article. So - don't be fooled - we have the money. Ontario's hospitals asked this year for $2.7 billion more - far below the money Ontario's government wasted. Kiladze says we're allergic to "private models". No we're not. We're allergic to profiteering. We're allergic to paywalls, subscription fees, and hedge fund investors making money off people's misery. We're allergic to the corporatization of healthcare because we know for-profit healthcare is worse healthcare. When you want to see how for-profit medicine failed (forget the U.S.) just look at the UK and Australia. You couldn't find more fabulous failures than there. It happens that when you have investors involved in healthcare whose sole (and lawful) priority is making money - the quality of healthcare diminishes. This is a proven fact. Healthcare is simply not a typical market good. The profit-motive leads to increased mortality. Private-pay proponents want to take themselves out of the queue but they pull with them the limited number of doctors, nurses and technicians we have - making the common line longer. Kiladze's argues Sweden has "a higher life expectancy". 83.7 there vs. 83.1 here (I'm using World Bank data). Really. That's a noteworthy difference? A better diet, more active transport (like bike lanes Premier Ford) and lower wealth inequality would bring Canada on par with Sweden regardless of changes to our healthcare system. Kiladze argues the private for profit schools know how to do "benchmarking, analyzing, and coming to decisions and getting action". If he doesn't think publicly funded hospitals do this all the time, he is sorely mistaken. And good luck asking our hard working family doctors to take a paycut. Net take home pay for Swedish family MD is about CAD $105,000. In Ontario, it's about $165,000. Kiladze has a lot of praise for Aleris Sweden. They're no panacea. They are a leading underperformer in meeting Sweden's statutory healthcare guarantee. There are more problems than just that, like patients feeling they are "numbers on a conveyor belt". Kiladze cites Aleris has faster knee replacements. Yup - because they skim the easy cases, dumping the harder cases on the public system. Great game. With the introduction of for-profit medicine - "Canadians would have to ask themselves how much profit is acceptable". I'm sorry, but the equity-fuelled market we live in wants as much as possible. How could this not be abundantly clear. Greed has no bounds. Why should investors make a profit when that money could be driven back into the healthcare system to pay nurses and personal support workers better. A private investor making money off healthcare doesn't magically create doctors, beds or get surgery done. It just lines their pocket. We should cut them out and fund the real people that do the real work. What is the final analysis? 1. We have the fundamentals right for great healthcare 2. We have the money for great healthcare if we don't spend it on dumb things 3. We have unique differences that make comparisons hard. We need to chart our own course. 4. Keeping the market out of healthcare is the right decision because for-profit medicine is worse medicine theglobeandmail.com/business… @picardonhealth @NightShiftMD @alanna_smithh