Anyone suffering from heart palpitations as a result of last week's Supreme Court ruling in favour of private health insurance and clinics should pour a cold one, watch as the head takes shape and meditate on the 99 per cent of reality that lies beneath the agitated froth of appearance.
Then call me in the morning.
The Supremes, of course, are all members of a demographic in a position to keenly appreciate that time waits for no one, and that waiting time for a new set of hips or knees can seem as important a breach of individual human rights as compulsory retirement at 65.
In their wisdom, they ruled that Quebec couldn't deny private-sector health insurance for private-sector knee surgery to a 74-year-old man suffering while on a waiting list for a publicly funded operation.
People who think this ruling opens the door to privatization of Canada's health care system or to a two-track system for those who can and can't afford the speed of private-sector delivery have enjoyed a sheltered life.
I've been waiting 12 years for modern medicine to discover a back replacement that works as well as a knee or hip replacement. Throughout this waiting time, I've paid my own way at a private-sector chiropractor, as well as a private-sector fitness club and private-sector yoga studio that help strengthen my back, just as others have paid their own bills for naturopaths, osteopaths, massage therapists, Ayurvedic and Chinese doctors, not to mention psychologists, social workers and psychotherapists who can be as helpful as psychiatrists with a medical licence to prescribe Prozac.
Health practitioners who want to go private sector don't have to become A-type entrepreneurs or go to the expense of taking a case to the Supremes. They just have to hang out a shingle that says "holistic and alternative care" and they can be as free-market as a bird. About one-third of recorded health spending in Canada, about $40 billion a year, is already in the private sector. That door is pretty much ajar, and will remain so thanks to the way the Supremes shut the door on ever examing the drug- and surgery-dominated monopoly of public funds by one medical fraternity.
The ruling hinges on waiting times for surgery, a subject about which they know nothing. That's largely because little that's reliable is known - not that such sticky rules of evidence should ever stand in the way of the Supremes' judgment. Dr. Michael Rachlis's excellent diagnosis of waiting lists in his book Prescription For Excellence should be compulsory reading for anyone commenting on medical policy.
To start with, no one has good stats on waiting times. Does the clock start ticking the moment the person senses a problem, sees a family doc, or a specialist, or goes on a formal waiting list? Is the delayed operation urgent or elective? And is the invasive surgery as likely to kill as to save the person? For all we know, the customers may not always be right about the timely operation their loved ones are sure will save them, and waiting times may be a life-extension procedure for people too weak to withstand the latest triumph of technique over mortal limits.
Rachlis's chapter on wait times proves it doesn't take brain surgeons or Supreme Court justices to fix the problem. Nor will a solution cost any new money; it's more likely to save money. Coordinated scheduling based on the latest organizational theory together with proper doses of non-institutional care to free up hospital space will do the trick.
It takes no more staff time or equipment to do all the tests on one day and all the follow-ups on another than it does to spread the ordeal out over months, as Rachlis's reports on leading hospitals such as the Mayo Clinic demonstrate. Likewise, it's easier for the family doc to e-mail test results and talk over the phone with a specialist about five patients and get right back to the patients than it is for five people to be referred to a specialist who will order the same tests and arrange another visit three weeks later.
Without case management techniques to help docs focus on patients' time needs rather than their own schedules, even the private sector can't make an iota of difference.
The ominous threat to the future of medicare in the Supremes' ruling is the indication that the judges don't know what they don't know. Call it Supreme arrogance that leads people to wade into areas where they have no competence.
I work hard to suppress my impatience. I campaign weekly for recognition of rights to food and to a safe and clean environment, so must admit to some professional jealously. It's really difficult to see waiting times for surgery privileged over such issues as the nine-month waiting time for newborns to gain a lifetime of crucial nutrients from a well-nourished mom, or the five-year-max waiting time for toddlers to access nutrients they need for a lifetime of hard-wired healthy physical and emotional connections.
The wait for surgery is being translated into a rights issue by the Supremes using a very dated legal construct - security of the person. This interpretation shrivels the right to health, a hard-won and continually renewed democratic right, and reframes it as a personal rights violation a judge can rule on. But it has little to do with laws affecting the exercise of the right: good food, economic security, clean environment and so on.
To top it off, the Supremes cracked down on the one province that treats public - dare I say collective and social? - health seriously. Quebec has a Ministry of Health and Social Services, areas that are segregated elsewhere. This despite the fact that, as the Ontario government declares on its website, social conditions "have as much or more to do [with] influencing health [as] does the presence of health care practitioners and facilities."
Another Supreme irony is that surgical waiting times are of more concern than public and social measures in the era of mad cow disease, Walkerton and SARS. The real-time crunch is in the realm of public policy.
Don't hold your breath waiting for such issues to be put on the front burner by the Supremes. The old order can rest secure knowing that their persons won't be invaded by such notions of the public good, which are not protected in this new reading of rights and freedoms.