Health Discord, Part 1

The Health Accord that Paul Martin and the federal Liberals proposed to
the provinces and territories of Canada in 2004 was accepted as the plan
that was supposed to “heal health care for a generation.”

The Health Accord that Paul Martin and the federal Liberals proposed to the provinces and territories of Canada in 2004 was accepted as the plan that was supposed to “heal health care for a generation.” The 10-year Health Accord will be due for renewal in 2014 and the need to “heal” the system is more prominent now than it was in 2004.

According to the Canadian Health Care Coalition (CHC), the federal government gave the provinces a blank cheque with “no strings attached” in 2004, meaning that there would be no significant accountability for financing the provinces, and health outcomes would have no place in the operation of the plan.

Consequently, we have been financing a system that does not produce healthier Canadians. As well, every year, the provinces’ health care budgets increase significantly but our Medicare crisis continues. “Medicare is still on life support, not from lack of money, but because of weak controls on where and how the money will be spent.” says the CHC’s report titled “A 10-year plan to strengthen health care”

At the time this article is being written, the federal government is saying that it may back out of the process completely, and may not even engage in re-establishing a federal health plan (i.e., will not renew the Health Accord). This leaves the provinces to either manage their health care as individual entities or work together, without federal guidance, to forge co-operative relationships for forming guidelines and strategies in, at least, some areas of their health care. This is not without precedent, as the idea of a federal-provincial accord dates back to 1999 and only crystallized into our current formal Health Accord in 2004.

HOW HAS THAT WORKED OUT FOR YOU?
Every year since 2004, Medicare costs in all provinces have escalated dramatically. Despite this, overall outcomes are not necessarily positive as, in fact, we are arguably getting sicker. There is a demand for more doctors and an increasing need for sophisticated diagnostic and therapeutic equipment. By way of formulating a solution, there is a strong drive that does not show any signs of letting up, to train more medical doctors to fill the demand.

Medical care has been widely accepted by governments as the only system that can care for the sick and ailing. Thus, although financed and managed by the provincial governments, our health-care system is under the strict guidance of the medical profession. Other healing arts and alternative care approaches that demonstrate proven clinical merit and successes are, for the most part, excluded. Hence, Medicare is essentially a “disease-care” system that, I would say, is erroneously named a “health-care” system. The fact that the medical approach has not been effective in the prevention of disease, and the maintenance of personal health, seems to carry little weight with the funding agencies. Our society is either paralyzed by the fear of letting up on the allopathic system, and allowing other approaches to take hold, or it has become very complacent as a result of the political support of this dominance by the medical associations.
But let’s examine this situation further. Our current Medicare system weighs heavily in favour of pharmaceutical interventions even in areas where evidence points to other viable solutions. In fact, whereas there are strong policies and committments in all political parties to keep Medicare away from private, for-profit medical companies, governments provide nearly unlimited financing to private, for-profit pharmaceutical companies. It is well known that, in turn, these companies – despite making some positive contributions to medical knowledge – have strong, but sometimes dubious, fiscal relationships with medical professionials.

And so, a loop has formed, locking our society into a predicament where there is, in fact, little or no support for other ideologies that relate well to actual health care, health maintenance and restoration of health as opposed to medical/pharmaceutical based disease care and the relieving of symptoms that, perhaps, could have been prevented. Albert Einstein is quoted as defining insanity as doing the same thing over and over again and expecting different results. As we head into our next era of health care – either via a federal accord or under the auspices of the provinces – don’t we want to avoid spinning our wheels to the detriment of our collective health?

Oh, and one more thing: most doctors work on a fee-for-service basis and as such constitute very much a for-profit industry – one that is paid for through our taxes via political support.

WHERE ARE YOU GETTING ALL THIS?
If you question my description of the situation, the many pitfalls of the medical model have been the subject of studies and books for many years. The author would like to provide you, the reader, with a brief overview of a few of these sources to illustrate that this problem has existed for many years and that what we are facing is, in fact, not new!

In his well-researched book published in 1975 and entitled Medical Nemesis: The Expropriation of Health, Ivan Illich states that “the medical establishment has become a major threat to health” and goes on to prove this point conclusively.

In 1987, Geoffrey York published The High Price of Health, A Patients Guide to the Hazards of Medical Politics, in which he shows clearly that “Medicare is not working: Canadians are using medical services at a rapidly increasing rate, the health costs are spiraling out of control, and we aren’t getting any healthier. What is wrong?” York explores in concrete and validated terms that the cause of the problem is the dominant medical establishment.

In 2005, Dr. Don Nixdorf (a well-known Canadian DC) co-wrote a book with Gary Bannerman called Squandering Billions. The book demonstrated “that the absolute power of medical doctors, pharmaceutical companies, health bureaucrats and hospital administrators, enshrines mediocrity at the expense of patients.” The book goes on to demonstrate, “Evidence shows conclusively that expanded use of community health centres, nurse practitioners, doctors of chiropractic and others can be more effective and less expensive within their area of expertise.”

A quote from Pran Manga, PhD, MPhil, a noted authority on health ideology, makes the point: “The management of our health care system is so inefficient that we not only fail to put patients in the hands of those professionals most qualified to give the best treatment, we actually ensure that the most expensive and least qualified person provides the care . . . the structure of health management in Canada makes the squandering of billions unavoidable.”

WHAT ARE THEY DOING ABOUT IT?
In August of 2010 the Canadian Medical Association (CMA) launched a discussion on the future of Medicare with the release of Health care transformation in Canada: Change that works. Care that lasts. The CMA said, “Based on extensive research, including a study of health care in five European jurisdictions, this document prescribes ways to bring about a health care system that puts patients first and provides Canadians better value for their money.” Then the CMA embarked on a “national public debate,” online and in co-operation with a number of prominent Canadian current affairs publications, with the goal of “engaging as many people as possible in an open discussion of what Canadians envision for our health care system and how to achieve this.” (Source: Health Care Transformation in Canada: Canadian Medical Association: Voices in Action: Report on the National Dialogue on Health Care Transformation) It is interesting to note that the CMA did not study Asian jurisdictions that employ different approaches to health care along with allopathic methodology.

Furthermore, while this may be a valuable survey, it is managed by the CMA. In other words, the very organization responsible for the chaotic situation of our health care was the sole agent mandated to lead a study in order to find the solution to the problems that its own ideology has created. What is wrong with that picture? Do we not see the limitations in this?

In order for the health-care system to really transform, it will have to let go of its absolute adherence to the current medical model of disease care and begin to look at this problem from another paradigm. This ideally would mean fully including those other disciplines that offer more efficient and cost-effective health care that actually produce an improvement in the health of Canadians. This will never be achieved by continuing only the expansion of the disease-care focus in our health-care system, while leaving true health care unattended.

WHAT SHOULD WE DO ABOUT IT?
As a profession offering an alternative methodology that is based on solid ideology and science, we are acutely aware of the many failures of our current health-care system. Furthermore, we know how we, ourselves, can help mitigate some of them. Our profession has, to some extent, been built on medical failures as well as on the outstanding health successes that chiropractic care can provide. So, as health-care practitioners who are knowledgeable of the situation, and who possess some real solutions, I would say we have a professional duty, if not a moral obligation, to get actively involved in this process of bringing real transformative change to our current health-care system and programs.

The chiropractic profession, and our patients, need to get intimately involved in redefining and transforming our health-care system. We need to encourage and facilitate our patients and friends to speak up and make sure that they are heard in order to create a political force for transformation of our health-care system away from an exclusively medical disease-care model to actual health care. Our governments need to understand that this must involve other disciplines, such as chiropractic care, where there is an abundance of positive healing outcomes.

It is imperative that we develop a voice in the new Health Accord in 2014 – or in the new individual provincial constructs, if a federal accord is abandoned – if we are going to influence the federal and provincial governments to look at other paradigms. To be seen as being different from the current medical model, we need to be sure that we have our chiropractic paradigm set towards the correction of problems, at their roots, and the restoration of normal function, and not merely the relief of symptoms! Health is a manifestation of normal function that is independent of constant – and costly – intervention, not whether or not symptoms are controlled. Our patients are looking for this difference in the services we provide and this is the paradigm we need to promote.

Our strength, as a profession, is the fact that we have an excellent source of support from Canadians in all walks of life, especially the trade and ordinary salaried workers. More than that, we have an abundance of satisfied patients who would be happy to see their chiropractic care included equally in a government-funded health-care program. It is their voice that will matter in the Health Accord discussions.

All chiropractic provincial associations need to get involved in encouraging and supporting DCs in organizing their patients in positive political action. This could include petitions or, even better, meetings where patients can voice their concerns to their MPs and/or provincial legislators. Because, while petitions have an impact, the greater impact would be to have serious numbers present their concerns directly to their MPs and/or provincial leaders!

Also, because this is, potentially, a national health event, the Canadian Chiropractic Association (CCA) needs to be involved in spearheading this process for the profession. This means doing what needs to be done to develop political strategies to support provincial associations to do the same in their jurisdictions.

The CCA can concern itself with dealing more directly with the federal governments – should that remain necessary – while the provincial associations can deal with the local MPs and provincial representatives, as well as organizing patient events to urge the changes to transform the system.

In short, we have to show that there is substantial support for a more holistic health-care system that includes chiropractic among other health-care disciplines that go beyond medical care. If we do not become active in doing this, statements by the CMA will be seen as representing us and our patients as well!

The key to success in this endeavour is our ability to manifest a strong patient support base for a serious paradigm shift in our national health program. We can do it! We just have to commit ourselves and get on with it ASAP!

Part 2 of this article will look at a number of options for effective political action on the part of the chiropractic profession and describe strategies for getting our patients fully involved to help bring about change.

Dr. Henri Marcoux graduated from CMCC in 1966 and was one of the founding members of The College of Chiropractic Science. He is a Fellow of the College of Chiropractic Orthopedists and past president of the Manitoba Chiropractors Association.  He was also previously a member of the Board of Directors of the Canadian Chiropractic Association and a member of the Guideline Development Committee of the CCA and CFCREAB.  Dr. Marcoux is a well-known lecturer and teaches a seminar titled The Neuro-Dynamics of Posture, Stress and Subluxation Patterns.