Introduction
This week's blog covers the art of the con as it applies to our health care system. We have a good system-if much more expensive than any one else's -except the USA.
But they elected Trump and their system is about to get a hell of a lot more expensive and much less accessible. Take a quick look at whose stock prices improved since 11/9-
big pharma!
New Brunswick
For those of you who don't know
the province, it is probably the most beautiful
in Canada. It is closer to New England than to Toronto and the people have more in common with that regional group being New England than they do with Canadians. Despite being a 1 hour flight from NYC and Boston,it has one of the highest rates of poverty in the country. 68% of youth under the age of 25 see no future in its largest city, Saint John. And yet, the province itself is: bilingual, is on the coast with remarkable vistas of the Atlantic, has pristine forests, clean water , 5 universities, and, one of its cities (Fredericton) has more millionaires per capita than any other place in Canada.
NB is , by the way, great for hospital access with 27 hospitals for a population of 750,000 people and a first rate primary care system.
Health Care in Canada-The Long Con
US politicians have been apoplectic in their denunciation of Canada's health care system despite the fact that 25 million Americans have no health care coverage. Even so, they are correct to be critical of the Canadian system but they do so the wrong reasons. In fact, our own system is really a long con.
- The Canadian family of 4 pays $11300 in public health care insurance.
- The cost of our health care system has increased 54% over the last 10 years.
- That is:
- 1.5 x the cost of shelter,
- 1.5 x the cost of clothing,
- 2x the cost of food and
- 1.5x the growth of the average income.
Our system underperforms most other western nations with longer wait times and poorer health outcomes. We have more hospital beds than do most other western countries despite the fact that there is no evidence that hospitals necessarily improve a community's health status.
- In fact, Canada spends 36% more per capita than the OECD average.
The Myths
1) We have an health care system.
Uh-Nope
Ours is not a system per se.
It is funded by several different branches of the Ministries of Health . Typically, these branches do not communicate. It is rare that employees of each of these branches know each other, much less communicate. Nor do the agencies programs or providers, for that matter.
2) We deliver health care
nope again
Further, there is no "health" in the system.
Mostly, it pays to treat illness.
It is emphatically not funded to help you, the taxpayer, stay well.
Family physicians, technically the gate keepers of the system are paid only to give you a check up-which you, the taxpayer, are obliged to organize or initiate. The is no government financed eye care, dental care, physiotherapy, OT, meds, home care or long term care. This all privately financed. Where it is not, well, it eats into your assets. In many cases, so that your ill health does not bankrupt your partner, you would do well to get a divorce to save your family assets.
3) Medicare is universal
Sorry but nope again
The Canadian medicare system was designed to pay for the treatment of catastrophic illness so that citizens were not otherwise bankrupted by the cost of care, which was typically hospital based. Out of hospital physician services are also paid for by the state. Just make sure that you don't need rehab, meds out of hospital and things like that.
4)We need all these hospitals to treat our illnesses
Well, actually, no.
The 5 major illnesses in order of cost to society are:
- mental illness
- addictions
- cancer
- heart disease
- diabetes
Typically, the consequences of these illnesses must be treated by the health care system. However, these can mostly be prevented-or their onset mitigated by effective public health policy.
How you might ask
- Sell cigarettes out of liquor stores heavily regulating access by teens,
- lengthen the school day, thereby reducing the incidence of teen pregnancy
- ban the sale of trans-fats,
- introduce mandatory phys ed and extracurricular activities in schools.
- train managers to manage
- Introduce mental health professionals to a family physician's practice.
These are but a few ideas.
5) Our health care professionals deliver value for money.
Sorry, wrong again. See above
Our health care "system' spends 36% more per capita than the average in the OECD. Our wait times are the longest and our health treatment outcomes are amongst the poorest in the Western world.
So-what is a long con??
And why does it apply to our health care system?
And, who is being conned?
A
long con refers to a con which requires:
- planning
- preparation
- a long window of intervention
- with a con artist's target and
- a long time execute
Characteristics
Typically, a long con requires a large crew to relieve the mark of his or her cash
The long con requires time to slowly draw the mark into the con but often results in large pay-outs
It is elaborate
The long con, like most cons, plays on some basic human frailties
The Players
So, who gets to play in a long con?
The Mark: otherwise known as the intended victim....us
The Grifter: a practitioner of confidence tricks...so who?? Well the people who always benefit from siding with spending in health care are the politicians
The Shill: shills are put in place to encourage the mark to act in a desired way. The shill is an accomplice of the grifter but who has no apparent connection to the con. The most likely candidate is the board chairman and the board members, most of whom join a board to advance their own careers or advance their own standing within a community. So, it is in their best interest to expand the services their hospital offers, irrespective of whether or not it makes any sense. Typically, shills have a close connection to us.
The Roper: a member of the crew who identifies the mark and lures the mark in. (S)he
finds a way to get close to the mark, insinuating him/herself into the mark's life. The candidate for this is the doctor who makes the con look enticing by offering the mark what (s)he seems to want. Examples of this include: drugs/meds, rehab, lab tests, diagnostic imaging exams, an operation, and even an hospital stay.
In any case, his/her job is to keep the mark interested in health care services while at the same time seeming to treat the illness.
The Roper is often an older man with a distinguished ( a doctor) or wise appearance or is an enticing woman (a nurse, rehab worker)
The inside man: executes the con. So, specialists.
The Fixer: works near -but not close to-the inside man as a backup and coordinates the resources as the con unfolds. So, this is typically the hospital administrator (and assistant administrators). Today, they enjoy the title of El Presidente or Supremo. It used to be that they were older men of sketchy qualifications. But, they had managed to outlast everyone else in the line of authority. Typically well paid, beyond their worth, today, they might be lawyers, failed doctors or other equally oily individuals who post their multiple degrees on the wall-one of which might be a MBA from a degree mill. Their job is to confuse and obfuscate matters that go to the board of directors for decision. They do tend to look good behind a desk, which pleases the mark and gives the mark and the family the impression that the place is well managed.
The Face: a shill, generally an attractive female used to distract or encourage the mark. Typically a nurse, rehab professional etc.
The Outside Man: A Ministry of Health bureaucrat or some such hack who greases the wheel of hospital health care with money from time to time. These are usually public servants. Their skill is to send out memos which provide the Grifter with a firewall called plausible deniability when things don't do well. They are very good at bending the truth or being loose with the truth. The best hacks are under-educated and have no morals but have worked in the public service for a very long time.
Settings: The long con is executed in 1 or 2 settings. A real world setting would be an hospital. For a long con to work, it requires a team of grfters which play a variety of roles.
Tomorrow, we will put names to these characters and describe in more detail what each gets out of the con.
So, in whose interest does our current system exist???
1) Politicians-otherwise known as the Grifters
Their confidence trick is to convince people that our system is the best! And, they are expected to convince their constituents that they deserve more funding-thereby improving their health status, care for their cancers, diabetes, heart disease, their car accidents.
In this way they can shelve any discussion of what really keeps us safe and secure and, by extension improves our health status. These include:
- an effective, accessible and accountable educational system
- decent, secure employment
- food security
- clean water and air
- recreational opportunities
- engaged communities
- public transportation
Lets call him Charles Ponzi
2) Doctors-the Roper
Doctors typically want to have a hospital in which to place difficult patients. To be fair, they are not given many options. As an example 30% of a family physicians time is spent treating marks with mental illness. This garners 5% of their income. And, they have no support from surrounding programs. Treatment of the elderly, particularly in the last few years of life fall into this category. Lots of time for no remuneration.
Hospital is mostly not just the last the resort. It is the only resort. Then, of course they deal with marks who are their own worse enemies. These include:The obese, the unfit, smokers, etc.
Lab tests, diagnostic imaging tests, a trip to the specialist to deal with diabetes, heart disease, respiratory illnesses and a trip to the hospital to try to undo-or mitigate the impact of these self inflicted wounds. These tests and treatments usually satisfy the mark's morbid sense of dread and makes them feel like the victim.
But, they make decent money. So, lets call them:
Victor Lustig
3) The Medical Specialists-The Inside Men
They oversee the delivery of those services which the mark needs to satisfy his or her sense of dread and victimisation. These services are offered without any consultation with the Family Physician, thereby ensuring that all tests are repeated once the mark is returned to the care of that roper. This ensures that no one knows what is going on with the mark and helps to fuel costs, fees nd increases the chance of re-admitting the person to hospital. This continues to fuel the mark's sense of dread and makes him or her feel a lot better about continuing ill health. It helps that the mark's family is on the outside, wringing their hands and bemoaning the mark's ill health. They help drive the demand for more staff and better services.
This cycle also helps the grifter sell the idea that additional and more sophisticated health services are needed in the community. If successful in his advocacy for more useless services, the grifter is assured of re-election.
Call the inside man Frank Abignail
4) The Hospital Staff-The Face
The hospital staff are the shills who distract or encourage the Mark (you). The nice nurse, physio etc who do the bidding of the specialists. It helps that they admire the specialist as a demi god, incapable of erring.
Call the hospital staff Big Bertha Heigman
5) The Hospital Administrator-the Fixer
The Fixer coordinates the resources as the long con unfolds
call him Soapy Smith
6) The Civil Servant-The Outside Man
Typically, this is the health care bureaucrat who sheds crocodile tears at the amount of money which is spent on the hospital health care system. He writes memos discrediting the work of the administrators and professional staff. This provides plausible deniability to the senior politicians when they pretend to implement austerity measures. It is good that the outside man is under-educated and amoral.
7)The Board (Chairman)-The Shill
As noted, this is typically a self interested person who has pretensions about being a community leader. Having a phony interest in the mark and the welfare of the community, the Shill is always ready to cut deal with the Roper and the Grifter even if it means throwing the Fixer under the bus.
