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Shooting from the hip Add to ...

I am a walking testimonial to the daily miracles of modern medicine. Inside my body is one of the best artificial hips available today -- a cobalt-and-chromium implant manufactured by an Iowa company named DePuy Orthopaedics Inc.

It's made in two pieces. The cup sits in my pelvic socket, and the cap fits over the end of my thigh bone. The cap has a short pin, which is inserted into the bone to anchor it. They are machined to fit smoothly, effortlessly together, and to rotate without friction. I can't tell the difference between my artificial joint and my real one, before it stopped working and turned me into a cripple.

My new hip is an amazing piece of design. I got it courtesy of the Canadian health-care system, and it has given me back my life.

Medical progress is a wonderful thing. It's also the bomb that's blowing up the health system. Fifty years ago, nothing could be done for people like me. They were doomed to spend the remainder of their lives in chronic pain, hobbling on canes or confined to wheelchairs. Today, people in need of new joints are overwhelming the system. Last year, Canadians got 50,000 new hips and another 50,000 knees, at a cost of approximately $10,000 apiece.

And that's just a taste of things to come. A generation of creaking, limping, aching, greying boomers are just about to hit their prime joint-replacement years. Demand for new hips and knees will double within the next 10 or 15 years.

Meanwhile, the technology is getting better all the time, and the market of potential patients is expanding. Joint replacements are now being done for people who never would have qualified before because they were either too young or too old.

Needless to say, the medical-devices business is booming, and, like the pharmaceutical industry, it's highly profitable. Drugs and devices are the fastest-growing cost in the health-care system, with double-digit increases every year. Nobody could tell me exactly what my spiffy new DePuy hip cost the taxpayer, but it was probably around $4,000.

Nobody in medicine believes that the system, as it is currently organized and funded, can cope with the demand. Using our resources more efficiently will help. But we also need more resources -- more surgeons, nurses, operating-room time, anesthetists and money, all of which are rationed. Canada performs far fewer hip and knee surgeries than most other developed countries. (On a per-capita basis, Sweden and Britain do almost twice as many.)

But even if some health-care czar decided to double the quota, nothing would change very soon. Orthopedic surgeons aren't like widgets -- they can't be cranked out overnight. It takes at least a decade to train new ones. Keep that in mind as you listen to the politicians falling all over each other to offer guaranteed wait times.

Another shock is about to hit the system -- people like me. Unlike our parents, we are impatient patients. We don't do waiting. We want the best, and we want it now.

When I went shopping for a new hip, what I found was both reassuring and infuriating. I found that, once you get in the system, the medicine and the quality of care are first-rate. The problem is getting in. The other problem -- equally frustrating -- is finding the medical information you need to make the right decisions. Nobody else can solve these problems for you. Like it or not, you're on your own.

I did well. I got my first hip replacement barely a year after my family doctor sent me for some X-rays. I found a young surgeon in Montreal who performs a newer surgical technique that is not well known in Ontario, and uses the latest generation of high-tech implant. Ontario's health-insurance system paid the bill. Most family doctors don't know much about the newer techniques, and most surgeons in Ontario won't tell you about them unless you ask. My prime sources of information were the Internet and the grapevine.

What I got was first-tier medicine in a multi-tier system. Access to first-tier medicine isn't about money. It's about knowing people who are willing to help you get in to see a specialist in days or weeks instead of months or years. I found shortcuts. I asked for favours. I used courtesy and charm, which seemed to help, and also tears. (Believe me, the tears were real.)

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