Recently, I waited in the emergency room in a Saint John, NB hospital with a close friend, a 65 year old man who was experiencing severe hypertension (very high blood pressure) which elevates the risk of heart attack or stroke. We arrived late in the evening. Only one doctor was available. We settled in for a long night’s stay that turned out to be 14 hours. My companion finally was seen by a doctor late the next morning.
The experience set me wondering how it is that our medical system can be so unresponsive, especially to emergencies. I looked into the issue some more over the next few days. I found that a lot of people in my city have had a similar experience. Some have waited much longer. Not only that, but over the past five years especially, news stories have documented instances of long wait times across Canada for people with serious medical issues, including sepsis, heart attack, stroke, severe acute pain, and suicide risk that have sometimes led to the patients’ deaths. I can see how this happens.
While my friend and I waited in our ER a teenager paced back and forth and looked like she might be in a high state of anxiety, possibly suicidal. A pregnant woman looked like she might be in labour and in need of urgent attention. They, too, had to wait.
When I returned home I explored the issue of health care for seniors. What I found on line helped to make sense of my experience:
The health care system has been chronically underfunded in recent years.
Lots of seniors are in hospital who no longer need hospital care but can’t be discharged because there’s no nursing home, special care home, or home care available.
Doctor shortages: New Brunswick has vacancies for ∼50 specialists province-wide. There is a huge family doctor shortage.
A lot of people can’t get doctors’ appointments soon enough so they end up going to the emergency ward.
ERs are short nurses, doctors, and other staff.
Seniors have the longest waits for surgery — cataract, hip, prostate — and when our care is delayed, our conditions worsen and we end up in ERs.
Seniors disproportionately use health services and have more complex needs.
Wait times for surgery, for nursing homes, for doctors and specialist appointments back up everything else and more people end up in ER.
At a recent Socialist Action Atlantic meeting another participant, Alex Gagne, informed us that almost 260,000 people in New Brunswick have not yet been assigned a family doctor. In my case, I waited eight years after moving back to the province in 2015. However, both the previous Conservative government and the present Liberal one have come up with a “solution” - transitioning to new community health centres. Partially municipally-funded, in these centres a nurse on staff and team of medical professionals serve a large clientele with a variety of medical needs. Gagne is concerned that this means one may not receive individualized service from a family physician. Instead, for example, one would see a nurse practitioner for minor issues. In addition, one might see a different nurse practitioner or doctor on each visit. “A nurse practitioner wouldn’t necessarily be worse at delivering services.” said Gagne. “Nurses punch above their weight when delivering care. But it would mean these professionals would be far less familiar with a patient’s history and day-to-day health, increasing the margin of failure within the system.”
Consistent treatment from the same medical staff has long been the core pillar of preventative care, he says. And having strong preventative care is one of the most important functions of the system to save costs and labour hours down the road.
“Giving a diabetic their insulin shots every once in a while, takes far fewer hours of labour compared to treating diabetic acidosis, a serious, life-threatening emergency,” said Gagne.
Collaborative clinics may increase access to the medical system in the short term, but quality of care may be sacrificed as a result. The increase would not be needed if the system had not been undermined over decades.
Gagne stated: “The idea of more collaborative care clinics is like someone offering a beautiful, polished, designed piece of silver jewelry in exchange for your grimy, worn, unmaintained gold necklace,” said Gagne. “The gold necklace is actually worth so much more, but you might feel it’s a worthwhile trade by looking at the two pieces.”
Essentially, the government uses tax cuts to reduce potential budgetary revenue, which compels the government to reduce overall spending on services and privatize them in order to remain solvent. The underfunding of these services leads to more systemic failures such as preventable ER deaths, says Gagne, who has tracked the system for years for the NB Media Co-op.
The underfunding leads to a lack of public confidence in the public system which leads to even more cuts, more privatization and then an even greater lack of public confidence. The process continues in a vicious circle.
“It’s a deeply innocuous process, but also devastating to everyday working people,” said Gagne. Right wing US political pundits in the era of President Regan called the process “starving the beast” (starving the government). The strategy aims to cut government spending by first cutting taxes and forcing the government to spend less, reducing the size of public institutions, federal agencies and social welfare services.
This deliberate starvation of public services by capitalist governments can only be stopped by fighting for a workers’ government.