My father's death, and why we all need to think about what we cost the health-care system
“Is there a big fix out there for Alberta’s health-care system? I don’t think so.”
My father passed away early on a Sunday morning in February. It was peaceful.
He died at the Sakura House Hospice. It's how he wanted his end-of- life to be.
This hospice is a health-care marvel. My dad was safely tucked into one of 10 beds in a home nestled in the rolling hills near Woodstock, Ont. Pain managed by qualified palliative care experts. Surrounded by caring volunteers. Friends and family members with 24-hour access to his bedside.
It's a not-for-profit hospice. But was created through private/public co-operation.
In his 82 years of living, dad never once spent a night in a hospital bed. That's rare.
Dad recognized his good fortune. He was happy to have paid far more into the system than he extracted. When it mattered, the system delivered.
End-of- life care is the most expensive kind of care.
And my father, even at this point in the journey of his life, understood the cost of his care; understood his choices, our choices as a family, came with a cost to society.
I could not have been prouder of my father than when he asked his doctors whether certain cancer treatments offered him were worth the expense.
As brutal as it may sound ... we must ask ourselves these basic questions
As difficult as this kind of self reflection is, as brutal as it may sound, and counter to the whatever-it-takes desire we have to live, or to keep our loved ones with us one moment more, we must ask ourselves these questions.
When it comes to our health-care system here in Alberta, we have choices. We are confronted with hard choices. Collectively, and individually. We can keep pussy-footing around and hope things just get better.
Or we can recognize our blind spots, and take steps in the direction of improving how we actually deliver health care in our province.
But to do so, we must, must, move beyond the way we currently frame the discussion. We need new ideas in the marketplace of ideas. We Albertans need to think about our personal, individual costs to the system. And we also need the marketplace.
Rigid ideological baggage
In Alberta, we spend $2.4 million every hour on health care — that's $59 million a day.
We have one of the youngest populations and are one of the highest spenders of health-care dollars in Canada. The Canadian Institute for Health Information pegs health spending at $7,329 per Albertan in 2017.
And with innovative new medical techniques, aging boomers and tapped-out taxpayers, the pressure on health-care spending is only going to get worse.
So, we must shed our rigid ideological baggage about health-care delivery.
No, I'm not a "frozen in time" Albertan who believes it's possible to step into the shoes of Ralph Klein and revive his failed private-public health-care crusade. That time has passed. What we need must be more nuanced. Past thinking won't help us. But future thinking about past ideas might.
As Albertans, we have a strange aversion to talking about health-care delivery. This goes for citizens, and even for politicians. Really, even more so for politicians, which freezes our ability to make decisions which must be made.
When I was on our province's Treasury Board, we were tasked with approving the flow of money to government ministries.
Having come out of the private sector, I was familiar with budgets and decision-making. What I found at first intriguing, and then distressing, was the sense that health-care budgets should not be closely scrutinized by politicians.
The health-care budget in Alberta is the largest in government. Yet I was dissuaded from asking probing questions. Likewise, when I served as an MLA, I was told to be careful going inside hospitals or medical facilities lest people think that I was interfering.
We've been doing governance somersaults in Alberta, trying to create buffers between politicians and health-care decisions.
Since 2001, we've gone from regional health boards to one super board in 2008, to an AHS Board accountable to the minister of health.
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It's mind-boggling. It's less dangerous for a politician to talk about a sales tax in Alberta than it is to raise the possibility of changes to how we deliver health care.
Governments, the ones in which I served, and the one in office now, have failed to tackle an impending crisis.
What I'm envisioning here is giving ourselves permission to be more creative with health-care delivery. Hell, forget about giving ourselves permission. Doing health care better isn't an option. Our health-care system is sick. The latest report by C.D. Howe confirms it.
It's time to scale up what works.
And what works elsewhere is worth taking a look at for Alberta. Here's just one example.
We're leery of for-profit companies in health care
Back to the Sakura House Hospice, where my father lived out his final days. It's funded by a creative, financially sound and innovative system.
The physical buildings and land were donated by Toyota Canada; the company has a plant nearby. The Victorian Order of Nurses is a non-profit order that, along with the palliative care doctors, is funded by the Government of Ontario. As well, an army of volunteers and public donations provide support via a charitable foundation.
We in Alberta have got to open ourselves to corporate involvement.
Sure, we're happy taking corporate donations for medical research or to buy state-of- the-art equipment. We're even OK taking corporate dollars to improve mental health outreach, at universities and in communities.
But, we're leery of the profit model tainting pristine health-care delivery.
And we've allowed health care to become too isolated.
What's holding the health-care system back is not more money. It's culture. And a clearer sense of Albertans' shared values.
What are Albertans' health-care values?
Ralph Klein's attempts to make room for private care to allow better access to crowded public medical systems saw him butting heads with unions, advocates of universal care, and federal politicians.
When the Klein government's Bill 11, the Health Care Protection Act, was launched in 2000, people protested in the streets. Their identity as Albertans was being trampled.
Albertans didn't want privatization.
We didn't want health care remodelled along contractual, managerial lines. We didn't want public institutions hollowed out.
The idea that someone else may get better health care (the dreaded two-tier system) was untenable. Universality was the primary value. Even if we had to tax the hell out of people to sustain it. Even if it meant a decline in care for all. And it has.
Yet, in other health-care systems, new ideas are being considered.
Voucher systems in the U.K.'s National Health Service, for example. These are schemes that combine government provision with market allocation of services. We've seen training vouchers for the unemployed and for community care. We've also seen means-tested benefits.
It is time to consider trade-offs among our conflicting values. We must create programs in which the underlying values are those of a shared culture of liberty and responsibility.
A sense of personal responsibility
When I was an MLA, many constituents wanted printouts of their health-care services and the costs. While they may still have asked their doctors for every available test and MRI, they also felt a niggling concern about the costs.
For years, the Alberta government has refused to disclose these costs to citizens. I scratch my head.
There is a disconnect between our expectations of the health-care system and our ability to sustainably fund the costs.
Certainly, I'm not so hard-hearted as to condemn those with the misfortune to suffer sickness. That's not what I'm talking about. It's the expectation of some that they are entitled to every available test, every available procedure, and every new medication.
We're afraid to talk about this, as citizens.
And yet we're talking about public funds.
Looking for a fix
Personally, I don't want yet another top-down governance rearrangement in Alberta's health-care system. I'm exhausted by pilot projects that continuously get launched, flag and are abandoned.
Is there a big fix out there for Alberta's health-care system? I don't think so. Actually, I'm not looking for a sweeping, large-scale change. I'm weary of big experiments.
What I want is a more human focus on health care.
We've poked at health care in the past, with limited success. When Albertans talk of health care, it remains a conversation about whether we're spending too much, or too little. Whether we're over- centralized or decentralized. All very abstract — all a discussion of theory.
So here are a couple things we can do, each of us, right now:
- We can assume personal responsibility for our fair share of health-care services.
A few minutes with "Dr. Google" may recommend a shopping-list of tests. But, we need to ask ourselves, how many tests should we expect? Don't just watch your doctor check off every possible test on the list. Ask the medical tech: What tests are really needed, not just nice to have? We shouldn't take things just because they're offered. They have a cost. So, is it reasonable to ask this cost of fellow taxpayers?
- And we can challenge our politicians to be creative, and open ourselves to the possibility of private involvement in public health care. To abandon the prison of the all-or- none thinking, and some mythic notion of the purity of public care unsullied by even a dollar of private or corporate money.
We must be pragmatic. It is the Alberta way.
No magic wand to spirit away all ills
Medical care has limits. We are all going to die. We can't wipe out sickness.
I'm grateful to a health-care system that made my father comfortable in his dying days.
In the midst of my personal grieving, I'm grateful to a health-care system that made my father comfortable in his dying days. He didn't feel vulnerable. He wasn't a specimen on a table. He died with dignity.
I am thankful for a system where other people helped pay the price to make that happen. At yet, at the same time, I recognize we can and must create a better system. We need to face reality, but face it together — let's open up a real conversation.
You can read more from Donna Kennedy-Glans on her blog, Beyond Polarity.
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More from the series:
- ANALYSIS: Glory days ahead vs. impending doom: The political rhetoric over Alberta's financial future
- ANALYSIS: Alberta's budget: You've heard the spin, now take a look at the real numbers
- IN DEPTH: Jason Kenney's relationship with carbon taxes: It's complicated
- ANALYSIS: Borrow-and-spend vs. tax-and-cut: How Alberta and Saskatchewan deal with deficit