Thursday, January 29, 2015

Fur … Garment or Foul … Animal Rights


I grew up on a farm, we had a mink ranch, we killed mink, it was the way we made money. My Dad was once at an auction and witnessed a man beating a horse; he physically intervened to stop the cruelty. There was no contradiction for him in these two events, one instance was the humane dispatch of mink for fur and one was the inhumane treatment of an animal.  So that is the “cultural” back drop by which I judge the use of animals, it is incumbent on “us” to seek reasonable measures to avoid inflicting pain that the animal can perceive, having done that, they can be utilized for work, food and shelter.

The stewardship and use of animals for food has distasteful aspects, it is the effectiveness of the “industry” in keeping these aspects from view that has opened up the avenue for animal rights groups to move public opinion against the use of animals. That is to say, people having been sheltered from or detached from food at its source have no concept of how to mentally process the distasteful aspects of food production and can be influenced by graphic representations of animal processing.

I am aware of a school teacher, who, in an effort to show kids where food came from took his class on a tour of a slaughter facility. He use to ask the kids before going in the facility, how many had ever killed something – in 1970 over half the class would put their hands, by 1990 one or two would. People, like me, who saw firsthand what killing animals met in the context of “the farm” or hunting, understand and have come to grips with morality required to function in this space – there simply is no moral continuity between animals and people. This is a moral construct that is consistent with the generalized Christian narrative that shaped most of us.

A widespread separation from animal harvest and use by society at large has effected a circumstance where efforts by animal rights groups gain sympathy. The language used in the animal rights movement is highly charged, there is a religiosity in the more extreme elements. The sensitivity associated with the topic emanates from the anthropomorphic inclinations of many in the movement. There is often strong rebuke of big factory farms, as though scale is a determinate of animal welfare. As I like to say, cows are unable to count, they have no means to judge whether their herd is 10 or 10 million, what they do know is whether they are dry, warm or cool and healthy. A cow loaded on a truck to be taken to slaughter has no knowledge of what is to come, no perception of the time it will take. Yet, when you examine the language that is used in various forums on the subject, you find constant reference to the number of cattle in a dairy herd etc. … constant reference to things that would concern you or I, but farm animals have no perception of.  

The challenge I am facing now is, the animal rights movement is unwilling to let me live as I want. My daughter inherited a mink stole my mother had, I am concerned about the violent people who seem to have no bounds on their activities related to the issue, painting fur coats in airports and the like.  I like to hunt, the animal rights movement want us to stop that. I like to go to a rodeo, the animal rights movement wants us to stop that. I like horse sports, animal rights movement want us to stop that. I view animal protean as a healthy part of my diet, the animal rights movement want us to stop that. I am struggling with how to find a co-existence with a group who is horrified by who I am.  

Monday, January 26, 2015

Social Media - Dialog - and The Fur Trade ????

Appreciating Culture and Difference
Guys can I bring a BBQ when I visit:) 

Open Letter to Stephen Forbes

Dear Stephen,

I am somewhat of a neophyte to the Social Media space, that is to say, I have had extended exposure but only recently taken a more intensive interest in its use. This morning a number of comments came through on email announcements in relation to a comment I had made on one of your posts regarding the use of fur. My exact comments are unavailable to me now due to the functionality of Facebook and I believe your “unfriending”, although as I say, I am unsure of the technical aspects of the forum.  So the following comment is based on the assumption, that due to my views, you have chosen to exclude me from any further discussion through your Facebook page on any subject, and specifically the use of fur. 

Firstly, Stephen, when you engage the world on a subject such as the use of fur, a subject that is matter of controversy, you should expect there will be opposing comment; or rather people who want to share their point of view in varying degrees of difference. In fact, is it good to expose oneself to other views, it offers opportunity to open the mind. Secondly, and remember the premise of these comments, it is patently unfair to offer comment on an individual’s views, and or, of analysis of an individual and then cut off that person’s access to debate. Thirdly, Stephen, in stifling association with me on this subject, you stifle an overall association with me based on my views of a single issue – I have more to offer, and on the issue at hand perhaps some moderating influence may help find a rational way forward. The attempt to narrow dialog in any form is unhealthy, and can contribute to a concentration of “opposing narratives” RATHER than a broadening of view of all parties – from here fanaticism emerges. It may be apropos to use a Winston Churchill quote on the subject of fanaticism given the recent anniversary of his death, “a fanatic is someone who refuses to change their mind and never changes the subject”, Stephen you've encountered a fanatic about fair play and complete discourse.  

The use of fur appears too many as a distasteful and cruel process, the photos you offered in support of your position were specifically intended to excite outrage in a population unaccustomed to seeing the less pleasant side of harvesting animals for human use. As a child I remember seeing a National Geographic magazine picture of Inuit children up to their necks in an animal kill, covered in blood eating raw meat, with big smiles – they were unoffended by the prospect because the life’s conditioning had associated raw meat and blood with a good day. There is no more horrific death, than an animal killed by wolves for example, they first hamstring that animal and then begin to eat it – a very dismal prospect, but an act of “nature” none the less – please note the wolves think it is ok. The point I am making and the point made in my comments to you, is that, through media functionality you are attempting to change the view of fur use by the population general; and the change attacks the fundamental cultural underpinnings of many minorities in our society and to a degree, you are attacking my and many others in general in western society. There is legitimacy in your concerns, however, it is the nihilism in your comments and many in “your movement” that is concerning.  

January 25 at 9:54am
I'm always intrigued by the use of peoples wording as well. Often the "way" people say certain things reveal a lot more about what they are thinking. The very fact that Neil refers to it as "humanely dispatched" instead of killing, signifies to me that he feels fundamentally it IS wrong, which is why he tries to word it in such a politically correct, sugar coated way. If he said my family and I killed and murdered animals to make mink coats, I'm sure it would bother him. When fundamentally, especially to that animal, its the exact same thing.

It is always dangerous to speculate on the thoughts of another person, because you’re only playing with half the deck, had you responded with questions Stephen, and permitted response, I would have been able to clarify for you. I am absent any moral impediment for the humane use of animals for food, work and shelter. I share your interest in horses; there is no finer relationship than accomplishing a day’s work together with a horse. The perceptions of the contemporary body general around the use for animals for fur has become “radicalized” do a degree, the discourse that ensued out of our exchange is to a lesser degree emblematic to other societal discourse in society at large – the painting of fur coats in airports for example.  So to clarify, at age seven years, I killed mink to be skinned, so the pelts could be sold, the fat was used for cosmetics and the livers were used for vitamin K I believe. It was my job to collect the livers, bag and freeze them and the proceeds were mine to spend. This sounds a pretty gruesome prospect to a group of people lounging over a latte’ in a 2015 in an urban center, I was however, proud of what I could do, much like the Inuit Children. So at the point of execution I believed what I was doing was more than right, it was good. The sugar coating you refer to, which stands in contrast to your “shock and awe” photos, was applied in an effort to engage people holding a view that challenges my conditioning in a tactful way. My views have evolved, or have been affected by the points delivered from the animal rights community, however, I do stand firm on the use of animals as has been done for centuries – with the proviso, that it continues in as humane a fashion as possible. The challenge is the anthropomorphic inclinations of some in your camp; animals are different than us, which is my belief and the belief of the entire western world in varying degrees. This in large measure finds its origins in the theological separation of humans as having souls and animals absent spiritual consideration in the Christian faith.        

January 25 at 9:27am
I have full respect for first nations people, such as the Inuit, that rely on animals as a source of survival. The reality is that the vast majority of people (for example, less than 2% of the populaton in Ontario is first nations, and of that 2%, only 4% of those are inuit) are not needing to kill animals as a means to survive anymore. The vast majority of people living in developed countries are buying fur, not as a means of survival, but as a grotesque fashion display. And I can be sure that The Bay, and its Fur Salon Trunk Show are not trying to sell pieces to the Inuits for them to survive. In our day and age, for most of us in our developed countries, its become a choice, no longer a necessity.

The use of fur is in no way isolated to the Inuit, there was a generalized use of animals across the full first nations’ spectrum. It is interesting to me that you offer discourse around fur and first nations as a means of survival, when, in the past 400 years, a substantive piece of history, the primary consideration for the harvesting of fur was commercial. Prior to the Animal Rights complex effecting a reduction in fur use, the “modern” first nations’ people trapped and sold fur for the urban markets, this was a source of prosperity for them, allowed them to do more than subsist, it permitted real earned income in remote sections of the country where other opportunity is limited. The absence of the fur market has been very detrimental to many in the first nations, regardless of the degree of validity of your assertions.   

January 25 at 1:30pm

Shannon Cebuliak I am a bit are saying that using leather is just the same as buying fur from an ethical standpoint? It seems like that is what you are saying but then you say the fur industry is horrible ? I am confused.

January 25 at 1:01pm

Wow, Kelly, Stephen does much more for animals than 99% of the population. Take your own guilt elsewhere. People saying it's their own choice to wear fur are out to lunch. The animals do not have a choice. They are tortured for fashion. Anyone that doesn't see how wrong this is has something wrong with their morals and ethics. At least Stephen is making a extremely conscious effort to cut down on the suffering of this world. Eating a vegan diet, buying cruelty free products and the one thing he does have is a saddle. What do you do??

Stephen, it is clear your family both care for you and share your opinions, so congratulations on that. Kelsey is clearly passionate on the subject. The dialog does indicate just how personal people can get, while I do eat meat and believe in the traditional uses of fur products, anyone dedicated enough to eat a vegan diet is worthy of consideration.


Neil Thomson   

Thursday, January 22, 2015

Law, Legislation and Liberty - Judicial Reform - Better Process

The Canadian legal system is exemplary in many ways, in large measure because it is founded on Common Law. The challenge is that many that need access to the system are unable to afford it. It is often posited by the “system” that more funding is required, this may be partially true, I assert what is really needed is reconfiguration – process simplification, specialization and fragmentation.

You know the story, Sally, a teenage Mom by Bill has four children. Sally is smart but, has a grade ten education, Bill the quintessential dead beat Dad and leaves Sally on social assistance, and takes a good paying job up north. Bill’s banking the big bucks and Sally is subsisting with four kids in a two bedroom apartment. How does Sally get justice and Bill get held responsible? The sad truth is, too often nothing happens. Sally and the kids just remain in a very pernicious circumstance.

I had occasion to self-litigate, I have a college education, there may be sharper tools in the shack, but I can almost always get things figured out – accessing the Supreme Court of British Columbia was challenging. Deriving argument, easy, verbalizing my case, easy – negotiating process, difficult – one finds oneself always looking for the right form OR being careful to avoid putting “argument” in an affidavit. Of course there is need for systematization and standardization, but one wonders, how arcane is arcane enough. In British Columbia when Bud Smith was Attorney General, British Columbia “simplified” legal language – good bye Latin welcome plain English. This, in of itself permitted greater access to judicial process and permitted lay people to a greater degree to understand the laws that govern them. This leaves one thing un-remedied process.

No matter how simple we make process, and it should be as simple as possible, there will always be complex legal challenges that require legal professionals to execute. There are also rudimentary legal processes, like Sally’s case, that require no legal professional; these processes are able to be simplified and standardized. Granted there have been some advances in the delivery of family law, the solution always requires more funding, more lawyers on pro bono – what is really needed is a place for Sally to go with less argument and more solution.

Sally should be able to stand before a Magistrate – or perhaps a Master equivalent in the BCSC system, and tell her story. The Master should then issue the appropriate orders to have Bill tell his side of the story – then the Master can pass Judgment. The specialized Master would be up to speed on the idiosyncrasies associated with family law and rule in accord with them. In this way, all Sally has to do, is phone the BCSC family Master program and get an appointment – then show up on time with valid identification. Will some cases offer complication, yes – but the vast majority could be managed this way. The Master can be the one stop shop, the master can advise on process and give direction on collection and presentation of the facts. This would be an “entry” level judicial position or perhaps provision could be made for a “para” judge or technician that specializes in family law – thereby reducing wage requirements.

There are many areas of law that could be simplified, one realizes that there are professionals relying on the system as it is, one realizes that simplifying the system will effect redundancy – one has to manage so as to ensure that present people’s interests are cared for and society at large interests are cared for in the future.

Canada is a great country, governance is required, law is governance – we do need however, to reduce transaction cost in general to enhance regional advantage. Most importantly, Sally needs justice.  

Remember that most often these costs are financed, so in the end they could be triple the original amount - governmental transaction costs really add up, they exist everywhere - oft times they offer no added value. We need to examine this and find ways to balance the interest of service providers and society at large, in Sally's case "transaction costs" preclude even getting due process.

I neglected to point out prior, and was reminded today via commentary on the CBC, that unlike the United States, we pay house purchase transaction costs with "after tax dollars". So for argument sake, lets say interest costs take this number to $70,000, and you're in that highest tax bracket, the overall cost might reach $140,000. 

Monday, January 19, 2015

Self Reliance - The Lost Cultural Artifact

Self-reliance has nearly become unspoken, even maligned to a degree in society at large. Self-reliance is oft times mocked by the left as “anti-government” and promoted by the right to the point where the only things a baby needs are bootstraps. Self-reliance is critical to independence and from independence comes freedom of person, and by extension, freedom of thought. So self-reliance is a gift we can give to all people, a little at first and more as knowledge and resources allow. It is neither to be assumed to be innate or to be assumed to be absent, it is something to nurture, or to acquire in ourselves. The government could be a part of its delivery, too often, however; the quest for power inhibits the extension of self-reliance by the government.

Self-reliance as a cultural artefact has left Canadian society in much the same way as the “pioneer spirit” has. The pioneer spirit, the willingness for a person to enter the wilderness and shape the land by the sweat of their brow into a productive enterprise absent the trappings of civilization, was a large part of the collective Canadian psyche pre-1960. The whole pioneer spirit entity had as large components self-reliance, do it yourself and independence; to be a pioneer has as reality these components by virtue of the physical realities of pioneer life. The local midwife, was the neighbour that rode a horse 15 miles in a snow storm to deliver your baby OR as often as not, was your husband. Pioneers were forced by their chosen life course to find their own solutions, to be self-reliant. The narrative until 1960 supported this pioneering reality as a quality, as a cultural component.

Since 1960 there has been collectivization in Canadian society, granted with some positive outcomes, but at the near annihilation of self-reliance as a cultural artefact. One can contemplate self-reliance as a meam in many ways, a way of "being" passed from one generation to the next.  Self-reliance has been attacked by the migration in the general narrative away from independence as a virtue, to a narrative the increasingly directs people to find a solution from society. The seeking of solution from each other, neighbour helping neighbour is generally a good thing, the relationship is pure functionality, uncorrupted if you will, human by humanity.

The challenge comes, however, when the narrative drives people to self-serving institutions, in main created by or supported by government legislation.  The nature of our political system coupled with the migration to collectivism generates a pernicious circumstance where people become increasingly dependent, and with dependence comes subservience. It is subtle in execution and insidious by nature. Little by little, each year, fewer choices are our own.

You see, the government always has the choice to liberate, to grant self-reliance but rarely does. Contemplate our medical system. Ask yourself, why do we have a shortage of medical services and no government sponsored self-diagnosis websites? Or ask yourself why is the process for getting the 10th same medical prescription the same as the first? Ask yourself, why are we required to have a prescription at all?  When you come up with the quick “obvious“ answer; please ask again.  

Medical care is only one place where there could be more self-reliance, there are many places in society where the extension of more judgment to the individual should exist in the context of personal choice, but more however, more self-direction is needed so that people can exercise themselves in their best interest. 

Friday, January 9, 2015

Fully integrated medical offering - The interface between public and private


The challenge I've experienced, as have many people I've interacted with on the subject of healthcare, is the lack of dialog and control over health issues when interfacing with the medical system as it is typically encountered. General Practitioners are paid by the visit, they are busy people, they have a large clientele they need to process and they have a very narrow field of endeavour, illness. It is my interest to address this deficiency of service by designing a business model that offers the full panoply of medical thought and service under a single roof.

Imagine if you will a “health mall”, a place where all medical services are present in commensurate proportion to market and typical interdependence. As you enter the foyer of the “retail” facility the first things that greet your eye are the merchandised products ranging from nutraceuticals to running shoes and health food. On the second floor, perhaps a visible veranda, there will be  GP’s, Specialists, Naturopathic Dr., Dietitians - an in house lab with “retail” medical testing, PSA, nutrient testing - imaging facilities and retail access to standardized imaging testing - chelation clinic - medical services brokerage … etc. ...

Presently, doctors are constrained as to the breath of testing they can to do, that is to say they require an illness justification for medical testing. Medical testing for nutritional information is limited if it is existent at all in our system at large, by commercializing the offering for retail testing; the development of sufficient market volume will take place to reduce the price of “non-medical” testing to the point of “ready accessibility”. I believe this concept will carry to other aspects of the business, for example, imaging. This thought is supported by the typical occurrence in business that has a given asset able to offer a better value offering due to a high volume of usage.

There are opportunities as well to compete with free by making a better and  more convenient offering for services offered by the government system. By way of example, there are breast imaging technologies that are, by a considerable margin, more effective and less disruptive than the government offering. It is conceivable that the imaging could be offered for as little as $150.00 - for many busy women the superior offering, better treatment and better outcomes would offer great value. Presently an MRI at a private clinic is $1500, by introducing baseline MRI imaging and bolstering the optimal use of assets, perhaps that number could be reduced to under $500; the key here is full optimization of assets and the full exploitation of volume.  

There are executive medical care offerings in larger centers that take a completely holistic approach to management of care, health assessment, nutrition, exercise programing and illness care. The health mall concept takes this approach and melds it with, retail opportunities and government supported services - bringing larger volume to the offerings, generating this superior product at a price where upper middle and upper income brackets can access personalized care.  

A customer would begin their interface with this service by going through an induction process. Pricing would be offered as an all-inclusive health package or a la carte, depending on preference. Upon choosing to initiate association with the health mall, the customer would be brought into an induction process which would have a “complete” health assessment as the primary component. Induction would be administered by a health practitioner who would hit on all the “typical” health markers; body mass index, blood pressure, basic dietary information, general activity profile etc. ... The customer would then be exposed to a standard bank of medical / health testing, perhaps - blood platelet profiles, nutritionally related blood testing, heavy metal testing, screening for common disorders. Imaging would be performed in relation to any specific complaints as well as baseline imagining for future reference. At this point a generalised health profile is developed listing findings, risks, opportunities and any chronic disorders. The nurse practitioner, based on initial findings would then assemble an interdisciplinary team of medical professionals specific to the needs of this individual, they and the customer would meet and a health plan would be developed. From there the customer would interface with the facility at large to execute on the plan.

The goal here is, through systemization of a personalized offering to a broad market, to offer a superior and complete proposition. It may be that through the course of business plan development a franchise structure emerges as optimal, so as to facilitate centers of excellence and to centralize activities best suited to specialized facilities, for example, bulk processing of standard blood testing. Regardless of how it is achieved, people want a means by which to have control over their health, people are more cognizant than ever of health and prevention, people want the full panoply of health treatment and people need convenience and value.  

I’ve spent a considerable amount of time engaging health related industry to find a means to provide the aforementioned imperatives to the public; the present interface with the illness system is awkward, public, fragmented, paternalistic and fails at health and prevention - I believe I can develop a superior offering that consolidates the entire health challenge under one roof at a price point that is comparable to the present aggregated expenditure on health of most middle and upper income people.  

BC Health Care - The Problem with Regionalization

Health Care Reform 

Regionalization took healthcare out of the hands of community and put in the hands of an administrative board, people I never have spoken to – they are even hard to reach. People complain that absent government involvement in healthcare we would be subject to corporations, I would submit that at least with corporations there is a motive to speak to me and see to my needs. The degree of arrogance in health administration, generally, is appalling – regionalization only makes it more aloof. With the introduction of regionalization came more distance from health providers as opposed to less. In British Columbia we have no control over how we access healthcare, we are the treated like a herd of cattle, to take medical care like the anonymous people deliver it, and there is no other option for us. This would be ok if healthcare was coming to us in an adequate way, but it is deficient, and regionalization contributes to deficiency, rather than serving to contribute to the needs and wants of patients.

What was the motive for regionalization anyway, the government of the day would have said, efficiency of course. We can all see that healthcare costs are growing as opposed to lessening. What was saved really by regionalization - some back office expenses – maybe – some consolidation of support services – maybe. What was the cost – distancing administration from services, further bureaucratization and the dismantling of community control over our care. Any benefit that was garnered from consolidation could have been done through inter-community co-operation shepherded by government, instead, regionalization was forced on us by government – top down, we know best.
Regionalization as a solution is contrary to England’s National Health Service’s conception of solution, which, under the Tony Blair Government, privatized hospitals through societizing them. It seems to be commonsense that making an organization bigger is going to make it less responsive, and regionalization has certainly done that.

Regionalization is a part of a more general trend in society at large, which is to professionalize and institutionalize medical services. This is in part due the monolith that has emerged under a single payer system, and in part the credentialization processes and related organization. When I was a child my mother, with five children, had a cure for everything – we never went to the hospital unless, as was once was the case, my brother reported his arm was bent; now people are encouraged to call the doctor prior to engaging in exercise. The point here is that healthcare delivery, despite clear deficiencies, remains solely in the hands of institutions and professionals – worse however, is that the regulations designed to support the healthcare complex prevents us from helping ourselves. Now, with regionalization, the government sponsored institution and healthcare regulatory complex is even further removed from our control. 

There a number of ills with healthcare delivery in British Columbia, regionalization has exacerbated nearly every one. The single factor that maintains service delivery in the system today is the goodwill of caregivers; regionalization is increasingly removing institutional access to that goodwill.           

Sunday, January 4, 2015

British Columbia - Health System Reform


Document Purpose:

To offer comment on Heath System reconfiguration.

Comment on Process

You've made a request to the public for suggestions on ensuring the quality and sustainability of the BC health care system. The bullet points in your bulletin or the points offered in your “letter” as points of contemplation tend to direct response to the tactical level, to solicit, to some degree, suggestions for operational improvement. While for people in the system seeking operational improvement is important, in governance, and for the system as it now is, the challenges are really strategic in nature.

The system requires restructuring, we need to, with an open mind, take the knowledge we’ve gained through the development of this iteration of health care delivery and apply it to the design of a new system. The design perspective and the design process will take us to many of the same places we are now and find us new solution; design process achieves this by liberating us from present modalities of action that limit solution. People seeking solution in the health care space have their heads in a box, the costs of thinking outside that box are dear due to the virulence of the interests that have built it. The people protecting interests are good people, good people in a bad environment, the environment we made for them.

Commitment to Universal Access – Facilitation of Open Discourse

People prefer health over illness and when illness comes it is rarely by choice. Fulsome healthcare is a responsibility for people to garner of their own accord and by their own capacities and in the absence of capacity, the state has a role. The quality of healthcare should be of symmetric in provisioning, regardless of socioeconomic circumstance; quality as per health outcome, as opposed, to the nature of the provision of service. Universally accessible healthcare is a moral obligation of society and any chosen action that impairs the delivery of universal healthcare is an immoral act.       

With an overriding commitment to universal access to healthcare as the premise for discourse, perhaps people can begin to broach the subject absent the political polarisation that has plagued the debate to date. As resources for the provision healthcare garner greater and greater portions of the public purse, as dictated by ever expanding health technologies, demographic realities and the expanding definition of illness, we are going to require enthusiasm AND open minds to meet the challenge. Thus far the debate around healthcare has been hijacked by ideologues touting one political philosophy or another.

The Political Reality

The Canadian public wants healthcare that responds to the needs of all people, delivered on a timely basis.  Tommy Douglas never wanted and nor would any other reasonable person want, people in waiting lines because of some manufactured cultural imperative. The question should be - how do we ensure that Canadians have universal access to excellent and timely healthcare?

The challenge is that Canadians have, at the hands of leadership, chosen to make the present health system a key component to our national identity. The present health system is unsustainable; the reality of the health system being a key component of our national identity and the system’s inability to exist as it does has created a pernicious polarised circumstance where a near religiosity is driving the discourse around the issue.

The monolithic nature of the system has massed operational interests to a point of influence that rational operational modalities are impossible to introduce. The collective influence of all the service providers intimidates government and hence confounds restructuring. This reality has the tacticians holding nearly complete sway over system design and functionality. The institutional inertia that has emerged from this circumstance is precluding the government from managing the system, the system is managing itself and, in an increasing measure, the government.  

Discourse from government has to be directed at the larger body politic; the message must be made clear, concise and delivered at sufficient volume to cut through the constant din that arises at the mere prospect of change.  

State action is only progressive when it is responding to people’s needs and state action is regressive when it is precluding access to healthcare. It is the case with many people holding rigidly to the status quo, that they are failing to trust the good human intent they so ardently seeking to enforce. There needs to be a much larger effort on behalf of government to accurately inform the discourse around this issue so as to facilitate rational debate.  

The reality in Canada however is, there is an almost irrational adherence to centrally controlled healthcare, even when it is to the public’s detriment; so the solution posited to the public must see to this concern, that is to say, the public demands attention to single payer and universal health care.   

The Case for Private Involvement

Most leadership presently exercised in the Canadian health system is reacting to a system that has failed to adopt appropriate strategies. When one observes the delivery of any other service provided in the context of market forces, from food to houses, one witnesses a larger gradation of service providers, heightened absorptive capacity and service provision that responds to demand. We need to liberate ourselves from an irrational perspective that places us in an ideological straightjacket; the overarching goal is the universal provision of health care to Canadians. Our present system, in some cases, is creating a circumstance of universally inaccessible healthcare. We can do better. As Canadians we need to challenge ourselves to give contemplation to the benefits that a market environment provides. We owe so much abundance to what the market system provides in all other aspects of life, it is truly shameful to obstruct access to that same abundance in the case of healthcare

To suggest private enterprise is absent a role in the delivery of healthcare, in the context of the Canada health act, is limiting as a perspective and inaccurate as a reflection of the present health system. Presently, some 30 – 40% of healthcare in British Columbia is privately delivered. There are many compelling reasons to accept the utilization of markets in the delivery of health services, we need only look to other countries successes to guide us; France, Sweden, Japan, to name a few, have benefited from private delivery of service. There is an irrational adherence to “government only” health services in Canada that stifles the debate around our best way forward and confines the breath of solution applied to the healthcare challenge.

Critical, is the realisation that universal access to quality healthcare can occur society wide absent the government delivering the services. We have a commitment in society for universal access to food, this hardly compels the government to start farming – it only compels government to support the underprivileged to purchase food. Enthusiasm for universal access to healthcare must be actuated under the appropriate selection of the modality for universality, in the case of other essentials, such as food, the poor are provided the resources to purchase what they require in the market place - allowing the market to discipline production under the rigors of supply and demand. Presently we control the whole medical system to ensure the same services for all, and end up with many having none.  I am certain, absent distortions caused by regulatory constrains such as in the United States where the medical insurance lobby has far too much influence, that the open provision of medical services would ultimately provide the best outcome.

As a rule of thumb, large centrally planned organizations, such as England’s National Health Service become too bulky to manage. As time progresses, the nature of organization has these entities become more administratively intensive, the professionals’ and or service provider interests over take user interests and there is an inherent inclination of all providers to isolate themselves from accountability. In the absence of market discipline these forces continue to attack both the quality and quantity of care and overall productivity falls. England’s National Health Service experienced this very reality and in response they privatised their hospitals by converting each hospital to a society and adopting a fee for service model of payment for hospital services. This model dismantled global budgeting, allowed the single payer and universal access principles to be respected and still provides incentive to deliver services at a lesser cost. This has also set up a dynamic of inter-hospital competition, as each organization seeks to attract people (people now represent income as opposed to expense). While this program is only partially successful, the entrepreneurialization of medical services has provided improvements.

In Canada we had the Romano Report. Mr. Romano sought to propagate the existing system absent a major overarching strategic change and requested $15 Billion to fix healthcare for a generation. The System has taken that $15 Billion, chewed it up and left waiting lists in its wake. This reality should be evidence enough to make the point, that putting more money into large organizations which are absent a rationalising influence toward outcome, just means the organization uses more money. The present way healthcare is managed in Canada will ensure that the more we pay, the more will be spent and the deficiencies will continue to exist.

The United States system is much maligned by many in the debate around healthcare, as there is an absence of universal provision of healthcare. The key element to advancement of medical services is that ability for a system to be well enough resourced to have sufficient absorptive capacity to utilize new technology. Additionally, innovation is critical as a means to advance medical technology. When one examines other goods and services in society, such as a refrigerator, one witness the following: the people with large resources purchase the frig first and then as the technology gains profile and is proving useful, gradually the frig is purchased by the less wealthy as production volume reduces cost, until finally the marvels of mass production makes it possible for all people to have one - this is called the product cycle. In the context of utilitarian ethics, which is the foundation of universal medical services, if a given technology is undeliverable to all, nobody gets it. This reality stifles the introduction of technologies and retards innovation. In the United States, the bottom socioeconomic groups have very poor medical treatment, but the top 25% of US society has the best in the world. This seems unfair on the surface, but the top 25% of medical treatment in the US is responsible for the mass of the innovation in medical services worldwide. Technologies are being used in this stratum and as they become more widely used they filter through the system until they become ubiquitous. If that supper resourced stratum were absent, the whole of humanity would suffer. This is in no way a theory – it is a fact – a fact that unassessed leaves us all wanting.

Innovation is best initiated through small nimble organisations. In British Columbia, the introduction of a new piece of equipment is difficult, given the monolithic nature of our system, in other countries where service provision is fragmented in to small service providers, the ability to try a new piece of equipment is easier to facilitate – absorptive capacity grows where small nimble actors are looking for an edge or are just inherently innovative. Advancement in any field is most often a product of heuristics, as our system is now structured, heuristically motivated change is virtually non-existent.    

The United States system overall is costly, because there is provision for people to choose medical services and pay for them, standing in contrast to Canada where service is provided but has limited choice. The US system is less than ideal, and I would concede less ideal overall than the Canadian system – for the same reasons – both systems have fallen prey to distorting policy, which retards the effective deployment of best practices. In the United States industry actors have lobbied government for policy that protects incumbent healthcare providers and retards the natural functioning of the market. The United States also has monopolistic professional organisations that effect influence over policy in a manner that is beneficial to them but harms the system overall. The Canadian system requires a lower portion of GDP because the government is rationing services, while in the United States, people are purchasing what they want. There are a number of detrimental occurrences emerging from the US system, but there are valuable lessons to be learned there.        

Restructuring – Under a Single Payer (The ICBC Solution)

The whole issue of capacity is a product of resources flowing to the system, when markets are at play rationing to control costs is absent, as services expand as people’s enthusiasm to pay increases. One of the largest constraints to our system presently is resources flowing to healthcare are retarded by our present mode of financing (single payer) the system. The single payer system seems almost inextricably linked philosophically to universality; this is especially true in the Canadian context. The solution to capacity is critical, I am unsure under a single payer system how we can to address it, except to extract ever greater funding from the citizenry. The only solution to capacity in the present system is better productivity; this can be readily addressed by a single payer system by introducing market forces under a single administrative umbrella – as exemplified by the National Health Service in the United Kingdom and the privatisation of hospitals.  

A medical system uninhibited by monopolistic policies would most certainly serve the public interest better in the long run. However, there is a political realty that dictates that whether another system is better at providing health services or not, the Canadian public are strongly committed to a single payer system. In view of this political reality one needs to contemplate the delivery of medical services in the context of a single government entity. Once this has been conceded, in the light of political expediency rather than the unfettered pursuit of the best solution, one must turn their thinking to ways to introduce market forces in a single payer system. Introduction of market forces into a monolithic system is done by the provisioning of the individual with the resources and then letting the service providers respond to that person with the resources, with services. This is a flow of funds issue, and by provisioning the service user with resources and options, service providers become responsive to the people they are serving. In this way demand is responded to more vigorously with the same resources, as providers seek to increase revenue with their existing asset base.     

In BC we have a single provider of car insurance (ICBC). Everyone gets their insurance from one provider, yet the provision of car repair services is still provided through a vibrant market. I believe this model transfers well to the provision of healthcare in Canada, providing all the ingredients to meet the public requirements efficiently and the political imperative presently projected by the majority of Canadians. Each Canadian would purchase insurance from a single medical insurer and be allowed to seek treatment where they prefer. The forced participation in an insurance program is a breach of the personal choice; however, this breach is then mitigated to some degree by the provision of choice with respect to treatment providers.   

The “ICBC” model would allow for a broader array of services to emerge. The present model is unresponsive to demand and is slow to absorb new technology and hence productivity is retarded. Healthcare services would fracture in the way other services fracture when they evolve under the influence of a rigorous market. One needs only observe other complex services in society to witness the sophistication that addresses the management processes in all industry, to have confidence that medical services, while unique, can be well addressed by the creative application of market mechanisms. All the challenges related to centres of excellence and capacity, are attended to by a dynamic where knowledge is applied most closely to the challenge at hand. Centrally planned systems simply lack the capacity for the spontaneous emergence of phenotypes and the natural clustering of services that is achieved through the unfettered process of human association. The dynamics that emerge from the provision of services in the context of technologies, if brought to bear on the challenge of healthcare, will determine where and the nature of services provided.

The ICBC” model addresses the migration of services and human resources by only having a single insurer. The issue of the absence of competition for the single insurer could be addressed by an exterior bench marking process to other jurisdictions throughout the world. In many ways the “ICBC” model exists now, the only change would be that if private entities saw an opportunity of offer services, they would be allowed to.

A group of doctors may decide to open a small hospital to service an area presently poorly served by the existing hospital network. It is impossible to predict how the ingenuity of human response to the challenge of healthcare provision may end up looking, and that is point really, because free human response to any challenge is unpredictable and when viewed in retrospect, free human response has generally always fostered improvement. Our present system leaves much of that responsive ingenuity in a latent state.

With more service providers working to attract people to services, more and better services will emerge. In this environment productivity is greatly increased and services improved and so rather than rationing the supply of services, overall systemic capacity is increased. We know this to be true, because it is repeatedly demonstrated in the economy at large, where market forces work in the favour of the consumer and society as a whole. This assertion is substantiated by a cursory review of other services in society, there are more gas stations than we need, and gas comes to us in the volumes we need, when we need it and where we need. Redundancy is very important in essential services to ensure when a large scale catastrophic event transpires there is sufficient system capacity to cope – presently our system is over taxed in the absence of any negative events, with day to day demand rendering a circumstance of “hallway medicine”. The private sector provides an abundance of competing services, in this context the pure unit cost of relative assets reduces and more of the same assets are introduced to the market. Instead of one MRI at the town hospital, there would be several clinics dispersed conveniently around the town, like Starbucks and 7 elevens. This dynamic provides more and better services, we know this to be true because, everywhere you look you see it happening – there’s several car dealers as opposed to one – an equally complex set of products and services as medical services.

In order to effectively discuss the transformation of a system as complex as the medical system, one needs to contemplate obstructions to change. The primary obstruction to change at play now are the people who have worked to from the present systems structure – as is often the case. Doctors, Nurses and other personal have established themselves in the system and view change as a threat. Medical professionals in US, France, Japan, Sweden and other countries do equally as well or better than Canadian personnel: so allowing market forces to come into play really offers opportunity. Opportunity, as professionals can extract extra revenue by investing in assets related to the provision of medical services. By allowing medical professionals greater access to more and varied revenue streams related to their respective endeavours, they are better able to be competitive in the application of their skills, thus providing opportunity for reduced immediate operation costs.

The market works elsewhere, we need to have an open mind in the provision of medical services and products.

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