At St. Martha's Hospital in Antigonish, there are three ultrasound machines.
 
The problem is that only one of them is working
 
The other two were old, and were taking "lousy pictures," according to Dr Mike Silver, who heads the department of diagnostic imaging for the Guysborough Antigonish Strait Health Authority. Earlier this week he spoke with Information Morning's Bob Murphy about the problems at St. Martha's.
 
With only one functioning machine, the result is predictable — wait times are, according to Dr Silver and his colleague Dr Dawn Edgar, putting patients at risk.  
 
The underlying problem identified by Silver is that there is no overall provincial system for the replacement of aging equipment. There should, he says, be a best-before date on every piece of equipment, and the equipment should be replaced by that date.
 
That's pretty sensible, so why isn't it happening?
 
The answer, I would have thought, is pretty obvious: there just isn't enough money to pay for the planned replacement of all the equipment in our hospitals.
 
But in his interview with Bob Murphy, Health Minister Leo Glavine spent nine minutes talking about everything but the real issue.
 
Regular readers will know that I have enormous sympathy for anyone in the health minister's chair. I've called it the only impossible job in government. Truly, it's a tougher job than being premier.
 
Minister Glavine could do an enormous service to the province by being frank about the real issues in health care. They are monumental, and pressing. If we're going to solve them, we need to confront them.
 
Instead, the minister uses health district reorganization as a catch-all answer to whatever issue arises, including funding for medical equipment. It gets him through an interview, but it's no answer.
 
So let's look at how funding for medical equipment really works.
 
Every health authority sends in a "wish list."  A committee within the Health Department sets priorities, based on factors like the age and reliability of existing equipment, the medical benefit, and the population served.
 
There is, of course, money in every provincial budget for new medical equipment. But the money available covers only a fraction of the wish lists. In any given year, only the equipment near the top of the priority list gets funded.
 
The government would love to allocate more money to medical equipment, but it can't.
 
Increasing revenue (i.e. raising taxes) is not an option. We all know what happens to governments that raise taxes. 
 
And it's not possible, or fair, to rely on fundraising from local foundations. The gap that needs to be filled is simply beyond their capacity.
 
So that leaves a fierce, continuous, all-against-all battle within the health-care system, and between the health-care system and other components of the provincial budget, for the limited dollars.
 
In this battle, medical equipment is a bantamweight. It can't compete with the heavyweights like physicians and drugs, or even the middleweights like ambulance services and emergency care. 
 
When choices have to be made, it's easy to defer buying that shiny new machine, as long as the old one isn't flat-out broken.
 
Since the equipment budget can't win the bigger battle, we're left with battles for positioning on the priority list itself.
 
In this, politics play a role.
 
Civic leaders, often supported by the local doctor, try to apply pressure with public statements, rallies and petitions.

MLAs, fiercely protective of their local hospitals, are spurred to action, and don't hesitate to use all means — fair or foul — to try to move "their" hospital's needs higher up the list. The opposition sweeps in, and says that they would provide funding if they were in government.  

I've seen all of this.
 
This kind of fighting over priority-positioning always leaves out one simple truth: if one item moves higher up the priority list, other items move down. Something that was supposed to be funded this year gets bumped, again, into next-year country.  

One problem is solved only by creating a new problem somewhere else — and the cycle continues.
 
The St. Martha's situation is not unique. What we saw this week was merely the bubbling to the surface of a struggle for dollars that is always roiling within the health-care system. 
 
St. Martha's will get its new ultrasound machines, and it should. But without a significant, permanent infusion of new dollars for medical equipment, the underlying story will not change.
 
And that infusion is not coming.