Patient, heal thyself - since no one else will

Will there be an election in 2008? Gosh, it’s so exciting. We journalists hope not because if one is called we’ll have to stop writing about whether it might be, which is more fun than dull stuff like health care policy. Mind you, we can cover an election like a horse race, then start speculating about the next one, so we’re probably OK. Unlike you. For speaking of health care, here’s a boring story to make your hair stand on end, turn grey in that position and then fall out. In Britain, the National Health Service is planning to make people do their own health care to save money.

OK, not appendectomies. But, the Daily Telegraph reported Wednesday: “Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a government plan to save billions of pounds from the NHS budget …”

The report says patients will find themselves: “Monitoring their own heart activity, blood pressure and lung capacity using equipment installed in the home; reporting medical information to doctors remotely by telephone or computer; administering their own drugs and other treatment to ‘manage pain’ and assessing the significance of changes in their condition; using relaxation techniques to relieve stress and avoid ‘panic’ visits to emergency wards.”

New prime minister Gordon Brown naturally spun it as giving “all of those with long-term or chronic conditions the choice of greater support, information and advice, allowing them to play a far more active role in managing their own condition.” But a document obtained by the Daily Telegraph indicates that while the public rhetoric is about empowerment, the private incentive is to save money.

It would be. It’s curious that people attack private markets because providers think about money, but never admit that it’s bad when governments don’t and often worse when they do. A company that cuts costs so much it can’t provide decent service goes out of business. Governments face no such incentives, and it matters.

Indeed, just one day earlier the Telegraph noted that “patients could be required to stop smoking, take exercise or lose weight before they can be treated on the National Health Service, Gordon Brown has suggested.” Offering a startling new definition of universal, he told NHS staff the government would “examine how all these changes can be enshrined in a new constitution of the NHS, setting out for the first time the rights and responsibilities associated with an entitlement to NHS care.”

Bored yet? Britain may seem like just this place where Lord Durham might have been from if he’d had the gall to exist. But actually it has one of those Parliament thingies and is the big powerful country whose cultural influence we used to resent bitterly before moving on to hating the United States. It even pioneered many policy initiatives we later invented, most notably socialized medicine. It is thus highly instructive that their health system, unlike ours, includes dentists and, unlike ours, has a shortage of dentists. Almost as if … nah, can’t be.

My point is, back of the corridor, you boozy, disgusting tobacco-stained fatties. Our governments must reduce medical costs too, whether you like it or not. Mark Steyn boasts of being a demography bore. Amateur! I’m a health provider demography bore. So here I quote Nadeem Esmail in the latest Fraser Forum. “In 2006, 19.2 per cent of Canada’s physicians were 60 or older, and 47.3 per cent were 50 or older.” And older physicians work less, then retire or die.

Just hire more, you say? From where, and with what money? Another Fraser Institute study just warned: “Six of Canada’s 10 provinces will be spending 50 per cent of all revenues on health care by 2035 if current spending trends continue …” You’ll be 28 years older then, and a distinct drag on the system. And how about the C.D. Howe Institute study (by my brother) last month saying “Canadian governments are unprepared for the fiscal impact of demographic change as baby-boomers move closer to retirement, and face a net liability of $1.4 trillion to pay for the current package of public programs …,” of which a provincial liability on health of $1.9 trillion dwarfs expected federal surpluses.

The actual C.D. Howe never did say “what’s a million?” and I hope no one out there now wants to say “what’s a trillion?” But just in case, it’s one of these: 1,000,000,000,000. What a big dull number.

Saaaaaay. Think there’ll be an election?

[First published in the Ottawa Citizen]