To Doom or not to Doom

I am hopeful that Victor von Doom is the next big threat in the Marvel cinematic universe now that Thanos the Mad Titan has been dispatched! Doctor Doom is an interesting character and something he said really resonated with me in relation to the challenges facing healthcare.So, if you will humour me, hopefully the point will present itself. Doctor Doom is the monarch of the fictional nation of Latveria. There’s a story involving Doctor Doom I find uniquely fascinating—it is Doomworld, a six-part series of comics published in 2010, where Doctor Doom confronts the Egyptian god Bast and Doom to explain his goals says:“My methods are a means to an end. No different than weeds being pruned in order for an orchard to flourish. Those who stand in the way of my vision oppose me because they fear me, but more than that they fear what I represent. Change.”To me that sound similar the situation for healthcare in CanadaRead: Dr. Darren Cargill: On mentors: Honouring the legacy of a palliative care specialistI’ve been privileged to do a lot of reading on the challenges facing us and met some interesting people over the years Dr. Bob Bell is a former deputy health minister for Ontario and orthopedic surgeon and some may accuse Dr. Bell of “villainy.” Now, Dr. Bell, along with Anne Golden, Paul Alofs and Lionel Robins, published “Fixing Health Care” in a Globe and Mail series addressing “10 common problems faced by patients in the public health system across Canada.”I enjoyed reading and debating the solutions proposed by Dr. Bell et al but I find it interesting that his motives are often considered nefarious by some healthcare providers these days. I had the pleasure of working across the table from Dr. Bell during the 2017 Physician Services Agreement negotiations. As lead for the ministry team, he was a hard negotiator but one I respected. We didn’t always agree then and I am certain we may not see eye-to-eye now (dude is like 6-foot something while I am 5-10 if try real hard). My sense of Dr. Bell is that he is often misunderstood and misrepresented but at core he is seeking a a better Canadian healthcare system. Like Doctor Doom, who is a fervent protector of his country, Latveria, I know that Dr. Bell is a proud Canadian who has worked in public service for many years.I am interested to see what new ideas Dr. Bell might have in the future.The change questionI do know this is not the first time or last time the topic of healthcare will be subject to debate. Panels have been stuck. Articles and reports have been written. I enjoyed Dr. Danielle Martin’s “Better Now: Six Big Ideas,” Jeffrey Simpsons “Chronic Condition” and Andre Picard’s “Matters of Life and Death.” Recently, Dr. Jane Philpott is touring in support of her new book, “Health for All.” My favourite chapters were the ones titled “Meaning” and “Purpose.” have even posted some thoughts of my own.But even more so, I am interested in knowing if Canadians reading these books are truly invested in change.We collectively suffer from a unique sense of Canadian exceptionalism, that our system is not only the best but the only system that can work, will work. I’ve written previously about the power of ideas. But ideas remain just that if there is not a will to change.A recent article by Josh Dehaas, counsel with the Canadian Constitution Foundation, outlined one approach in Norway. Dehaas dares to speak heresy and discuss private healthcare. In Norway, for example, 10% of the population has private insurance.Dehaas explained: “Before you label me a monster for supporting the dreaded ‘two-tier American-style healthcare,’ please consider the facts. Canada stands alone among wealthy nations in outlawing privately funded, medically necessary surgical and hospital care, and it also ranks among the worst for outcomes despite spending more than most, 10th out of 11, according to the Commonwealth Fund. As anyone who’s seen the subway ads advertising clinics in Buffalo knows, we already have two tiers: those who can afford to leave the country for prompt care and those who can’t.”The solution? There is an obvious way to find the money: it would simply require amending the Canada Health Act to make explicit that provinces would no longer be penalized if they allowed a small number of willing patients to buy quicker care so that provinces can loosen their rules.This would then free up scarce resources such that provinces could expand public drug coverage beyond their current programs. One might think of it as a policy swap whereby public coverage would be somewhat curtailed for hospital and physician services and somewhat expanded for drugs.Dehaas concluded: “The question we should ask is not whether we can stomach two-tier care but whether most of us would be better off if we allowed a small percentage of people who are unable or unwilling to languish on lengthy waitlists to spend their own money here in Canada to get seen faster.”The Canadian system is currently set up to get the results it does, and it will continue to do so until we acknowledge and accept the need for change.Healthcare in Canada is often referred to as “the third rail.” A political hot potato. Doctor Doom would have the will to grab that rail, hold on and attempt to bend it.Do we preserve our healthcare system in its current form at all costs or do we have the courage to make the necessary changes, no matter how painful those changes might be?Do we have the will to do that which must be done? Superheroes won’t provide us the answer. It will be up to Canadians to decide.Dr. Darren Cargill is past medical director for the Hospice of Windsor and Essex County and lead physician for its community-based Palliative Medicine Program. An earlier version of this blog appeared on substack.

To Doom or not to Doom

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