Here in the heart of Saskatchewan, the ghost of Tommy Douglas haunts the land, and families pass down horror stories about life before medicare. At a local NDP rally, a white-haired grandma of 75 tells me about the time she broke her pelvis when she was a child. Hospitals were expensive, and money was scarce, and her mother would say to her: "You're not sick!"
As the people around here see it, Tommy Douglas brought medicare down from the mountain etched in stone, like the 11th Commandment. In truth, he never envisaged the bottomless entitlement program that medicare has become. But no politician in the land is brave enough to take on the white-haired grannies and the ghost of Tommy Douglas.
Mr. Douglas didn't live long enough to see the day when aging folks could get their joints replaced instead of living out their lives in wheelchairs, or get their aging eyes fixed instead of going slowly blind. What's killing medicare is progress. The gushers of money pouring into health care simply can't keep up with the booming demand for knees, hips, eye surgeries, and fancy new drugs. And the boomers haven't even gotten old yet.
If the system can't provide -- and it can't -- then they're going to take their business elsewhere. Manfred Maack, for instance, is going to go to Germany, where he can get a brand-new hip at a first-rate hospital for around 7,000 Euros, or about $11,300. "I went on Yahoo, and typed in 'hip replacement Germany' and found the information in around 20 minutes," he told me. Wait time: two or three weeks. The German doctors work in the public system during the week and do private clients on the weekend.
If you want a more exotic locale, you can get a hip in Thailand. Have a sweet tooth? Try Belgium, which has one of the top hip clinics in the world, and throws in Belgian chocolate for free. Don't like flying? Then drive to the States, which is closer but twice the price.
Last year, Ontario performed around 24,000 joint replacements. There are that many people on the waiting list. Simply getting a consultation can take a year. "When my hip problem started, I waited six months just to see the guy," says Mr. Maack. "He talked to me for five minutes and said I'd have to wait at least 12 to 14 months. He recommended that if I could afford it, I should go to Germany."
Mr. Maack isn't all that rich. He got hammered in the market. But who wants to wait?
All the new money being pumped into the system will barely keep up with the explosion in demand as boomers begin to demand replacements for their aging joints. But it's not just an age quake that's about to hit us. It's an attitude quake.
"When I tell a 78-year-old she has to wait a couple of years for a joint replacement, she says, 'Oh, that's too bad," says Dr. Michael Dunbar, a young orthopedic surgeon with the Queen Elizabeth Health Sciences Centre in Halifax. But when I get a young executive in, he's done his research on the Internet, and he says, 'I want you to do this hip with this bearing surface, and by the way I want it in the next month because I have a squash tournament.' The next generation is different in their understanding of health care."
In Nova Scotia, orthopedic surgery has been squeezed terribly over the past decade. The reason is that people awaiting new hips and knees don't generally die, unlike people awaiting, say, heart surgery or access to the emergency room. They just suffer. They're grateful for their medicare, and so they don't complain much.
At Dr. Dunbar's hospital, the operating rooms close at 5:30 p.m. sharp. If a procedure is scheduled to start at 3:30 and there are equipment problems, or if the doctor is delayed for half an hour, the operation is called off and rescheduled for another day, and everybody (including the poor patient) goes home. Why? Because the hospital budget doesn't allow for paying nurses overtime.
"This is what blows me away," he sighs. "This is one of the most effective surgeries yet devised, and we're not allowed to do it. We're cancelling surgery because of the nursing budget."
Lots of experts have told the grandmas of Saskatchewan that you don't need to change the system to fix medicare. You just need to change people's behaviour. If only they stopped rushing to the doctor for every little thing. If only they didn't smoke and didn't drink and got more exercise.
If only it weren't for all that progress.