Throw Up Your Arms, Two-Tiered Healthcare Is Here To Stay
The Saturday Huddle is a weekly column that features opinion, analysis and reflections on Huddle stories, podcasts and business news in the region. Derek Montague is a Halifax-based reporter for Huddle.
Oh, how Canadians love to thumb our noses at the United States and its greedy, profit-based healthcare system. Don’t have insurance? Not rich enough to pay out of pocket? Too bad: you suffer.
We are much more socialist up here in the North, we think. We would never stoop to such lows as to leave people in the cold when they need healthcare the most.
To quote Homer Simpson: “In case you couldn’t tell, I was being sarcastic.”
It doesn’t get as much attention now, but not long ago there was a national debate about the pros and cons of a “two-tiered” healthcare system. Most fought hard against the idea, pointing to the U.S. as an example of what to avoid.
Those who were for it, including many physicians, pointed out the obvious: the public system is broken. The wait times are too long. People needing surgeries were waiting up to a year, in severe pain. If a small group of people can afford to alleviate that by paying for a procedure, shouldn’t we let them?
But, in the end, there will always be a major drawback to a two-tiered system: doctors and nurses move to private hospitals, while public institutions get left behind.
Provinces already compete internationally (and with each other) for healthcare professionals. Imagine the chaos if they were competing in their own backyard with a private system that could likely offer doctors way more money.
That’s not acceptable. We can’t have a small group with deep pockets and good insurance benefits while the 99 percent of work-a-day people suffer even longer wait times. That’s not Canadian! That’s the opposite of a socialist system!
But we are already dealing with a multi-tiered healthcare system. The gap between services has been growing steadily for years. While we were busy debating the merits of private healthcare in Canada, private healthcare was busy becoming a part of the fabric of our country.
There is no better place to look than the truly awful state of our underfunded mental healthcare system. It doesn’t matter which province you live in, if you are seeking urgent mental healthcare, you are being underserved.
But, if you have lots of money, or really good insurance, you are in luck. Since the Covid-19 pandemic began there has been an increased need for mental healthcare. With governments turning a blind eye to the urgency of the issue, virtual and in-person clinics have been popping up to fill the void.
The latest example is in Fredericton, where the Newly Institute just opened a clinic. Tyler McLean wrote about the clinic opening this week and his quotes from Dr. Robert Tanguay illustrate what healthcare should be.
Tanguay told Tyler the institute is looking to pioneer a different kind of intensive outpatient program, one with a personalized approach that’s offered through a bio-psycho-social-spiritual treatment model and supplemented by medically managed therapies, when appropriate.
This is night and day compared to the public system, which has steadily devolved into a pill-pushing operation. Have a complex issue that is causing you mental anguish? Have some antidepressants.
I was once an inpatient in Newfoundland. They promised me comprehensive treatment, only to turn around a week later to tell me they wanted me gone because of pressures from above to free up the few beds they had. Thing were so bad there their plumbing didn’t even work properly.
The last time I saw a psychiatrist in Nova Scotia, the guy was a quack who demanded I get my eyes checked before we dealt with any mental health problems. He then started talking about drugs before I could even finish explaining my symptoms. He also had no plan to wean me off my old mediation. Anyone with any bare-bones knowledge of how these powerful drugs work should know that you can’t just make a sudden switch.
The scariest part is there are still a lot of GPs with only sparse mental health knowledge, but you still have to see a GP to get a referral for a psychiatrist.
Sometimes these GPs will try and treat you themselves. I once had a young doctor, fresh out of medical school, do the unthinkable and switch my medications without weening me off, resulting in horrific side effects.
It’s insane that this kind of treatment is considered acceptable in the public health world. But mental health often takes a backseat when it comes to government priorities. It is secondary to the diseases we can see with the eye and easily measure treatment progress.
The broken public health system is why places like The Newly Institute exist. Tanguay is still in the public system and it’s his experience there that made him realize he can help people better in the private sphere.
“I have a chip on my shoulder because I can’t change the public system but what I can do is step out of it, build something, and prove that we can do it better, cheaper, more effective, and treat people better,” he told Tyler.
In fact, the pandemic has made mental health more profitable than ever. Earlier this year, Modern Health, a company offering mental health services, reached unicorn status, topping $1 billion in valuation.
The fact that more of these private clinics are popping up all over the place, including in Atlantic Canada, shows how big of a void has been left by the suffering public health system.
So, there is a cure out there for our sick public health system. There’s only one problem: you won’t be able to access it without the proper insurance, or lots of money.
It sounds a lot like the fears people had years ago when we were debating a two-tiered system. Well, the debate is over, the system already exists. Unless, of course, we want to maintain the outdated notion that mental health is somehow separate from other health services.
In Nova Scotia, the Houston government at least recognizes that a two-tier mental health system exists. The government has promised to come up with a billing system to end the current feast-or-famine model. But a huge amount of work still needs to be done and it will be very expensive. Even if the government makes headway on this program, the price tag may dissuade future governments from following suit.
The situation is getting so bad that it’s now common to see Canadians fundraising for treatment at private clinics, after being let down by the public system.
If I thought I could afford proper mental health care, I would do it too. I wouldn’t care about the hypotheticals in the tired debate about two-tiered systems versus the good of the public.
When you’re suffering, you want quick relief. The public healthcare system is rapidly getting worse at providing that relief promptly.
Perhaps it’s time to pull a 21 Guns and throw up our arms, embracing the chaos. Maybe the answer is accepting the fact that private care is a growing part of the system. Maybe we just need to demand the right health insurance from our employers, rather than looking to the government.