Bureaucracy may be necessary, but it is never harmless

There is nothing that bureaucracy cannot make worse

Bureaucracy may be necessary, but it is never harmlessBureaucracy begats bureaucracy, building its own demand and transforming people into managers designed to meet bureaucratic needs. A bureaucracy designed to serve patients ends up serving its creators instead and protects those who work inside. Economist William Niskanen offered a definition of bureaucracies in his book Bureaucracy and Representative Government. Roughly speaking, he says, 1)…

Health care user fees promote equity and efficiency

Offer a small step to solving overconsumption and waste

Health care user fees promote equity and efficiencyTwenty-eight countries have universal healthcare. Twenty-two of them have some form of cost sharing. User fees offer one example. User fees work best as a small, flat fee paid at the point of service. Even a few dollars discourage (rational) people from booking an appointment for what they asked twice previously. User fees shorten the line…

Why health care can’t change

When it comes to fixing health care, governance matters more than policy

Why health care can’t changeFew voters had first-hand experience with hallway medicine or Canada’s world-famous wait times before the pandemic. Lockdowns changed everything. Health policy failure moved from fear-filled headlines into a tangible crisis everyone could feel. Failure begs for better, or even new policy, to fill gaps. Planners and policy writers jump to offer solutions: surgicenters, funding reallocation,…

Wokeism is leading to the fall of fact-based medicine

Patients suffer if society reshapes the medical mind and how doctors process information

Wokeism is leading to the fall of fact-based medicineA medical mind is precious and fragile: hard to create, easy to corrupt. Doctors invest over 10,000 hours learning how to diagnose and treat. The medical mind exists to help patients and should serve no other purpose. But it is easily corrupted and distracted from its primary purpose. If patient care matters, we must protect…

Why Canada can’t reform its ailing health care system

Government, medical professionals, and public-sector unions each hold veto power over any innovation

Why Canada can’t reform its ailing health care systemThe Honorable Monique Begin wrote in 2009, “When it comes to moving health care practices forward efficiently, Canada is a country of perpetual pilot projects.” Governments need “financial control” and remain “leery” of committing to programs. Pilot programs are easy to shut down “to avoid criticism” or if “budget priorities shift.” At first glance, we…

Patient care is too important to suffer under central planning

Canada rations care with wait times, limited investment in technology, and by using family doctors as “gatekeepers” to service

Patient care is too important to suffer under central planningDoctors frustrate governments. They think too little about how much health care costs and too much about their patients who need help. The government of Ontario and the Ontario Medical Association arrived at a mediated Proposed Physicians Services Agreement (PPSA) this month. Doctors started to vote on it yesterday, with voting ending on March 27.…

7 reasons why some doctors become bossy

Pandemic chaos and fear turned some otherwise rational doctors into dictators

7 reasons why some doctors become bossyLeadership carries a high risk for bossiness. Some medical Chiefs gain humility from caring for sick complex patients. It shapes their approach to leadership. Unfortunately, many forget their failures. Others never learned in the first place. Many Chiefs of Staff have never seen sick patients at all. But as chief, they see all the medical…

Trudeau response to Freedom Convoy turned it into a global movement

The world is watching Canada. Trudeau must separate his blend of public health and authoritarianism

Trudeau response to Freedom Convoy turned it into a global movementPublic health doctors created vaccination mandates and vaccine passports. Doctors tabled the ideas. Politicians docilely followed doctors’ advice and turned it into policy. Ideas shaped the policy and policy formed a protest. Public policy made the truckers’ Freedom Convoy a reality. Prime Minister Justin Trudeau’s response turned the protest into a global movement. The historic…

Elites are blowing their response to the freedom protests

If you attack, slander, dismiss or silence your enemy: You. Will. Lose

Elites are blowing their response to the freedom protestsAnyone who serves the public learns how to manage upset customers. When someone says you hurt them, do not argue. Listen. Apologize. When people are angry, upset, or heartbroken, you must stay silent. Offer support. There is no other rational response. Of course, listening has limits. Threats, yelling, or swearing must end the conversation, with…

How to get Canada off the health care teeter-totter

Medicare struggles from funding thrown at the same tired ideas rooted in similar political traditions

How to get Canada off the health care teeter-totterLiberalism works when you are healthy but fails when you fall ill. Classical liberalism emphasizes autonomy, individual freedom, and free markets. These ideas have fuelled centuries of wealth and prosperity. Modern liberalism, in contrast, pursues central decision-making and equality of outcome. Despite similar names and obvious differences, neither type of liberalism provides arguments for everything…

We can celebrate Canada without worshiping or denouncing it

Let us celebrate gratitude for the good, humility for the bad, and thankfulness that failures were not worse

We can celebrate Canada without worshiping or denouncing itCelebration of anything or anyone requires one of two mindsets. The first mindset is make-believe. We pretend something is what it is not. We sing, dance, and light fireworks in false celebration. Eulogies about abusive drunks being great family men call us to false celebration. We pretend the bad did not exist, and we focus…

Canada can’t afford its current approach to health care

How long will Canadian patients put up with substandard treatment?

Canada can’t afford its current approach to health careAs the third wave of the COVID recedes in Canada, watch for the resumption of an old debate about the impact on patients of delayed procedures and treatments. On one side, hospitals, medical associations, and labour unions will point to the many patients who endured cancelled care. On the other, with apologies to Burke, economists…

Patients need doctors to speak up; regulators want them to shut up

When regulators threaten doctors for engaging in public debate, doctors go quiet and patients suffer

Patients need doctors to speak up; regulators want them to shut up“Call for help.” This is one of the first rules in every advanced life-saving course. When you see someone collapse, rush over to assess and call for help. Raise the alarm. Let people know. Doctors and nurses do this all the time in hospitals across Canada. It would be professional misconduct to do otherwise. What…

The horror! U.S. pandemic response far better than Canada’s

A serious blow to our delusion we are better than Americans

The horror! U.S. pandemic response far better than Canada’sWhen it comes to health care, Canadians only seem to care about one thing: Are we better than the United States? As long as we “beat” the U.S., we remain smug about our performance, although this attitude can be hard to square with the tens of thousands of Canadians who get quick access to top-level…

Covid-19 pokes the final hole in leaky long-term care boat

We cannot blame COVID-19 alone for the current LTC crisis, writes Shawn Whatley

Covid-19 pokes the final hole in leaky long-term care boatNursing homes struggled long before the COVID-19 pandemic arrived in Canada. Now, during the second wave, many front-line clinicians say our long-term care (LTC) system has all but collapsed. In the pre-COVID era, patients waited a median of 159 days to get a bed in Ontario, with some areas at 263 days. Thus, it was…