Health care and central planning

This is Joseph

This tweet thread is worth reading in detail. As a recently repatriated Canadian myself, I think that it is spot on. In fact, this statistic is so obviously true to me and explains my amazement at modern Canadian healthcare:

When I got here, I wondered, has it always been this bad? The answer is no. 

Specialist physicians in 2020 reported a median wait time of 22.6 weeks between referral from a general practitioner and receipt of treatment— compared with 9.3 weeks in 1993.

I think that this does highlight one concern about "Medicare for all" -- that if the entire health care sector is planned by the government then you become vulnerable to all of the failings of central planning. I known it is hotly disputed these days, but the central planning of the USSR was not an advantage in its great power competition with the United States. It just wasn't. 

The consequences of it in Canada on the ability of health care to weather an external shock (like covid-19) are clear. Look at this, which leaves people unable to do basic tasks like driving if wait times get too long:

 Manitoba has seen the largest decrease in Canada in cataract and lens surgeries during the pandemic.

We estimate the backlog is 4,945 and growing for cataract surgery.

Or this:

The Winnipeg Regional Health Authority (WRHA) is advising residents of Winnipeg that community health services – home care services, in particular, could be delayed, rescheduled or cancelled due to staff shortages. 

Or this:

Prairie Mountain Health, which services a wide swath of western and southwestern Manitoba, currently has eight rural emergency departments closed, leaving some communities with no open hospital and long drives to access urgent care.

Or this:

Let's say you do a job that requires 14 highly skilled people. Suddenly, you only have 7 people and 3 of them are untrained. Your working conditions remain like that for months. And you keep getting told you’re fine and that you can, in fact, actually increase what you’re doing. 

Or this (from a working MD):

I understand drive to reassure - but IMO hospitals need to stop promising "we've got you." Our politicians have pushed our systems to the edge of the cliff and we don't know what is going to happen as a result. That's the truth. A lot is about to go into freefall. 

The common theme is that a centrally planned system lacks resilience if the politicians in charge (because administrators ultimately report to politicians) decide to let the system crumble. Now think carefully if you want the typical politician making tough decisions about long term health care needs and about how to staff/run the system. Now, it is true that hospitals are currently mostly not run by the government but the group in charge of finance easily evaded that obstacle:

Planning in the hospital sector is subject to many of the same challenges as the medical sector, as most hospitals are privately owned nonprofit organizations. Allocation of resources within each institution tends to be at its own discretion. This is tempered at the provincial level, however, by splitting the planning process into operational and capital planning. Thus, while day-to-day operations are largely institutionally based with some input from the ministry, the decision to build and update facilities or purchase new equipment is subject to more extensive central control. Therefore, even though the institutional sector accounts for the preponderance of provincial health care budgets, provinces have had more planning and financial control than in any other sector

 This is a European report on Canada. Not that they also report on Canada's restrictions on training medical personnel in order to constrain costs. 

I am not saying that socialized medicine is a mistake, it isn't. But I think that there is a very important piece that we need to make sure that the institutions are well planned and robust to political administration types. Good government is key and planning this out in advance may evade some of the surprising challenges Canadian healthcare is suddenly facing.