Stick A Fork In It: The Healthcare System
Stick A Fork In It: The Healthcare System
TL;DR - All the money in the world can't fix a system that improperly allocates scarce resources
Did people let the healthcare system down during covid? Or did the system let the people down? In his affidavit submitted to the Ontario Superior Court on behalf the Barbecue Rebellion constitutional challenge, expert witness Dr. William M. Briggs, a former professor of statistics and biostatistics at Cornell, referenced statistics from the Government of Canada’s March 2021 epidemiology update, noting that “there is a breakdown of where covid deaths are found… the majority, or just under 92% (12,372 in total), were recorded in long term care and retirement residences. The next largest, at 6%, was in healthcare.” Including prisons, 98.6% of covid deaths occurred in just three settings. And what do those settings have in common? As astute covid policy critic and data analyst Julius Reuchel commented, those are “captive populations that are permanently or semi-permanently segregated from the rest of society inside government-owned or government-regulated institutions.”
Traditionally Canadians have revered their healthcare institutions, but is that faith still justified? Long before covid, Canada’s healthcare capacity had been faltering. According to data from the World Bank, Canada had 6.8 hospital beds per 1,000 Canadians in 1980, declining to 6.0 in 1990, before falling off a cliff thereafter. By 2005, there were only 3.1 per 1,000 Canadians, and as of 2019, there were only 2.5. Current Organization for Economic Co-operation and Development (OECD) data has Canada with the 6th lowest rate of hospital beds per capita out of 37 ranked countries, and the 4th lowest rate of intensive care beds out of 34 ranked countries. What happened? How is it that, over the course of 40 years, both left- and right-wing governments failed to build out or even maintain hospital capacity, especially given Canada’s aging population and high immigration?
It's not as if politicians weren’t aware of the issue – it’s been front and centre for decades. In 2000, the New York Times wrote about Canadians looking for healthcare in the US due to full hospitals. In 2002, Prime Minister Jean Chrétien’s brother was left in a hospital hallway due to overcrowding issues. In 2005, SickKids hospital was stretched thin to the point of running out of intensive care beds, with viral season said to have played a role in the burden. In 2008, the Toronto Star reported on backed up emergency rooms leading to hallway medicine. In 2010, hospital overcrowding was dubbed Ottawa’s biggest local health story of year. In 2011, the Globe & Mail reported how a surge of flu cases were overwhelming hospitals. In 2013, hospitals were again reported as being overwhelmed by the flu. In 2015, yet more reports of hallway medicine and bed shortages. In 2016, a Globe & Mail report highlighted hospitals operating beyond their capacity. In 2017, hospitals were again running out of space. In 2018, overcrowding caused patients to receive “substandard” care across Ontario, leading to increased infections and postponed surgeries. In 2019, the Ontario Hospital Association reported that hospital bed capacity had not increased over two decades despite a 27% population increase. Finally, in January of 2020, just before covid, CBC News discovered dozens of hospitals operating over capacity.
If any of these headlines sound familiar, it’s because many were essentially recycled over the last few years with a spikey new scapegoat, putting into perspective how blaming covid – or for that matter, the unvaccinated – for hospital capacity woes was like blaming the rain because you didn’t buy an umbrella. It’s disingenuous, and it deflects from the bigger picture. The healthcare system is not a wedge to be weaponized against those who fund it. It is a service into which all Canadians pay explicitly for its universal availability. If it is unable to fulfill its obligations, then funding ought to be withdrawn and invested into new systems, or the existing system must address its deficiencies and restructure accordingly. Once again, Reuchel said it best, “[covid] is not a general population crisis; it is an institutional crisis.”
“Overcrowding has become so common in Ontario hospitals that patient beds are now placed in hallways and conference rooms not only at times of peak demand, but routinely day after day… hospital gridlock – a phenomenon that used to be restricted to surges in patients during flu season – is the new normal.”
– Mike Crawley, Senior Reporter, CBC News. January 22, 2020.
There are those who blame the healthcare system’s deficiencies on spending shortfalls, but that oversimplifies the issue. Funding has ebbed and flowed over the last few decades, but in general, Canada’s healthcare spending is in line with many comparable countries. So, why does it typically generate a lower return on investment than its peers? No doubt it would help if the healthcare establishment trimmed some fat, reducing its excessive ratio of administrators-to-doctors, whose paper-pushing requirements divert doctors’ time away from caring for patients. According to the Canadian Federation of Independent Business (CFIB), Canadian doctors spend 18.5 million hours per year doing unnecessary paperwork – that’s the equivalent of 55 million patient visits. Additionally, the healthcare system actively prevents qualified doctors from entering practice. A February 2023 report by CBC News explained how the current residency system is constrained by red tape. It excludes Canadian doctors who train abroad, has a poor placement rate, and has unnecessary vacancies, such as the 115 residencies (mostly in family medicine) that went unfilled last year. All told, Canada’s bloated healthcare bureaucracy yields diminishing returns, drives up costs, and inefficiently allocates scarce resources, stifling capacity and generating backlogs. But those are merely symptoms of the problem. The root cause is an institutional culture at odds with accountability and foresight – and covid put a spotlight on all of it.
In 2020, frontline healthcare staff were hailed as heroes, returning home each night to a chorus of clanging pots and pans. Availing themselves of their newfound popularity, some took to TikTok, supposedly making dance videos to blow off steam. However, a study in the American Journal of Nursing analyzed those videos and determined that many were inappropriate, violating various codes of conduct, including ethics provisions, social networking principles, and social media guidelines. This raises an interesting question – was covid a valid excuse to abandon professionalism? If anything, shouldn’t it have been a reason to renew commitment to, and abide by, professional standards? Moreover, did it not occur to staff and administrators that using personal protective equipment (PPE) as props, which have been in short supply for decades, might send the wrong message to the public, downplaying the purported seriousness of covid and exhaustion of staff?
In 2021, Ontario spent tens of millions of dollars erecting field hospitals that were seldom used, including one in Hamilton with a capacity of 80 patients that had zero visitors throughout its lifecycle. Wouldn’t that money have been better spent on long term capacity or staffing, both of which are always in need? Later that year, healthcare staff who did not bend the knee to vaccine supremacy were forced out of their jobs – experience, immunity, and valor be damned. Did hospital administrators not realize that tossing out qualified staff like yesterday’s trash might exacerbate existing shortages? Did it not occur to them that unilaterally claiming jurisdiction over workers’ bodies and cancelling employment insurance benefits might set a bad precedent, causing prospective employees to think twice before working for them in the future? Then there is the College of Physicians and Surgeons of Ontario (CPSO), which issued a statement prohibiting doctors from speaking out against lockdowns, masks, and other issues that did not conform to public health groupthink. Did the college honestly believe it was sound policy to muzzle doctors from speaking out against the harms they witnessed inflicted on their patients? Did the college not understand that this sort of intellectual immaturity would undermine their credibility?
“I get very uncomfortable with people being fired over this… There’s not much of a spirit of understanding at all… Our goal as health-care works is to make sure that our patients… are making informed decisions… This has shifted to: do we like your decision or not?"
– Dr. Kerry Bowman, Bioethicist, interviewed on CBC’s Cross Country Checkup. October 17, 2021.
Circling back to how all this affects long-term care and retirement homes – where 92% of covid deaths occurred – consider how these government-regulated institutions treated society’s most vulnerable. As with hospital capacity, Ontario’s Minister of Long-Term Care acknowledged that these facilities have been neglected for decades. The increased burden from covid measures were merely the straw that broke the camel’s back. In a May 2020 report by the Canadian Armed Forces (CAF), which were called to assist at a number of these facilities in Ontario in April 2020, they described the conditions there as “heartbreaking,” “horrifying,” and “in a general state of disrepair.” Facilities were infested with cockroaches, fungus, and mould. Vomit and feces were found on floors and walls. The CAF suspected many residents died from neglect and malnutrition, even though covid was blamed.
Similar circumstances were also uncovered in Quebec, where according to the Globe & Mail, a “lack of humanity [was] afforded to dying residents.” At the Quebec Coroner’s Inquest, one nurse said “I had the impression that they were blaming the virus because it would be easier to blame the virus than to acknowledge the hard truth that these people suffered from malnourishment and dehydration. I felt that it was a way to escape culpability.” Once again, deaths attributed to covid in official statistics were more likely the result of onerous restrictions, which expedited residents’ decline by preventing contact with loved ones and interfering with nurses’ ability to provide timely medication, sanitation, and sustenance. Worse yet, some staff abandoned their posts entirely even when there was nobody to replace them, but thankfully many brave staff continued caring for patients despite the unforgiving circumstances.
In the end, the healthcare system that authorities said required saving via sacrifice from millions of healthy Canadians failed miserably in its objective, abandoning those who most relied on it in their most desperate hours of need – and then the system crumbled anyway. What does that say about those making and enforcing healthcare policies? What does it say about those who follow them without question or resistance? What does it say about those who control its purse strings? To whom is the healthcare system and its practitioners ultimately accountable – rent seeking administrators or taxpaying patients? Failing a dramatic change of priorities, no amount of money can fix what’s broken.
“SARS showed Ontario’s central public health system to be unprepared, fragmented, poorly led, uncoordinated, inadequately resourced, professionally impoverished, and generally incapable of discharging its mandate.”
– The Honourable Mr. Justice Archie Campbell, Ontario SARS Commission, Interim Report. April 15, 2004.
This post is part of an article called Stick A Fork In It: The Barbecue Rebellion & The Rude Awakening, which is available in its entirety on my Substack:
