Health Economics (My Apologies)

Here’s a quick test you can use barometrically when reading what you see from your humble scribe; if you view the actions of government over the last forty years through the lens that they really were trying to recruit and retain family doctors to care for the Canadian population, what kind of a job have they done? If, however, you view their actions through the lens that they were, all this time, trying to discourage and frustrate family doctors, hoping they would retire from the field, what kind of a job have they done?

There’s a story that when Stephen Hawking wrote his book, “A Brief History of Time,” his publisher warned him that he would lose half his readership for every formula he included in the book. In a chapter about health economics, I am cognizant of losing readership for the same reason. I promise to do my vest to keep the discussion on the topics of interest while doing my best to avoid eco-speak.

You don’t get this deep into a doctor shortage overnight. It takes time, some would say it takes planning. The roots of this tree run deep, at least as deep as the nineteen-eighties, when the governments of Canada decided the country had too many doctors and the profession needed a cull. You are forgiven if you find that hard to believe given our present circumstances but our present circumstances very much derive from this idea.

The problem they were trying to address was that the money being spent on publicly funded healthcare was increasing at a rate that alarmed the politicians and bureaucrats who were making the decisions. They wanted to bring the increases under control, but how?

I have a scar below my lower lip that shows why healthcare expenditure was increasing. Before Medicare, one’s ability to access medical care was decided by one’s income. Those that could afford it did, those that couldn’t did their best. When I split my lip open, my family was in the latter category and, while my scar is not all that noteworthy, it serves me as a reminder that those times were not that long ago.

With Medicare to pay the costs, an intended consequence that became an unintended one was that people started seeking healthcare when they felt they needed it, with the bar for “need” moving as the public began to accept that the barrier of being able to pay had been removed. For many, going to the doctor was something you only did when no other recourse was available; now, they gradually got used to the fact that you could go at any time, for any reason, perhaps even one that was not life or limb threatening, and be seen and maybe even helped! They could go see the doctor anytime they wanted.

And they did.

While patients were lowering the bar on what it took to get them to go seek medical help, the 1970’s was an inflationary period generally. Ironically, governments seemed to be operating under the assumption that health costs would not increase with everything else. They made public statements about holding the price of health care delivery level year over year, of “taming” the increased costs of health care delivery. They spoke as if health care costs rising was somehow an unforeseen and unacceptable side effect of public funding. They repeatedly talked about getting health care expenditure “under control.”

It was in this environment that a health economic theory began to gain purchase. It gave the Governments the scapegoat they were looking for – doctors.