The Future of Medicare
and of Saskatchewan

FTLComm - Tisdale - April 20, 2001


When the Fyke report was published a week ago I was deeply disturbed by its contents, so much so that sarcasm and contempt were the only things I had to say about it and for that reason I have refrained from writing about the issue until I thought sufficient time had passed for me to discuss the issue of reform of health care in Saskatchewan a little less emotionally. But even as I preface my remarks with this statement of reason, the sadness and sense of profound betrayal will be difficult to suppress.




Being now more than half a century old I remember the emergence of the medicare system that we have in this province. I lived in a home and with family who openly discussed and debated issues so in the late fifties the socialist programme of government supported universal medicare was looked and considered at length around dinner tables and card games for several years. I was then a teenager who wanted to make a positive contribution to my society and for that reason I not only listened but took part in those discussions and debates.




My uncle Karl was a Liberal for all his life and viewed this left wing medicare movement with considerable distrust. My father was more of a pragmatist and as an hourly wage earner consider the merits of a universal medicare system something that would benefit all. I was a Diefenbaker Zealot who considered the discussions about socialist medicare as trivial when compared to national issues like pipelines and American nuclear weapons. Uncle Karl was worried that medicare would not provide universal coverage because government would interfere in the operation of hospitals and the practice of medicine. He said that at some point the government would limit the care given and instead of making medical services available to all it would result in curtailing and restricting medical care. He was afraid that in time the government would be deciding what patients would be treated and who would be deemed to costly to care for and allowed to die.




I can recall my father supporting the government line of the day and stating that Uncle Karl's thesis was just the alarmist rhetoric promoted by the medical insurance companies owned by the greedy doctors. Though father was partly right it indeed appears that Uncle Karl's estimation of things has come to pass.



medical administration

Instead of confining its involvement to funding medical treatment and care the provincial government became directly involved in the administration and operation of all aspects of medical care. This meant that instead of funds going to pay for medical treatment and care, funds were redirected to medical administration and bureaucracy to find ways and means to reduce the cost to the taxpayer of the service.




All of us old enough to remember Elvis Priestly can remember the system that came before Medicare. Our families paid monthly payments to a doctor owned company and when we got see or needed to see a doctor most of the costs were paid for from that insurance scheme. If hospitalisation was involved a provincial programme which we also paid about $23 a month to kicked in to cover the costs of a hospital stay. Such a system meant that for low earning families and farmers with low incomes a major portion of their income was going to look after medical needs.




Universal medicare came in 1962 and began simply by picking up the tab for hospitalisation and the fees we had formerly paid to the doctor's medical insurance programme. The amount of taxes used for this universal system were not extreme and these "were the good old days." We had little hospitals with their own boards and medical practices all over the province and if you were injured or sick medical treatment was available to everyone everywhere, no waiting and no out of pocket expenses.







But somewhere between then and now the federal government became involved providing federal funds, both that level of government and the provincial government ceased just paying for the service but began deciding what service would be provided. Each new involvement by government in the process seemed to further and further curtail what was being delivered until in the mid 90s medical care became a very scarce commodity restricted province wide, more than fifty rural hospitals were closed and the added pressure on the urban facilities was not serviced so that with fewer hospitals there were also fewer medical people available and the cost of medical care rose dramatically proportionate to the lowering of services.




The Fyke commission asked for the input of Saskatchewan people and they gave him their opinions but there is no way whatever of knowing if any attentions was given this input as Fyke simple followed the trend that government has set in the past. Spend more and provide less. This report proposes the closing of all but hospitals in a few larger centres and amazing as this seems to all is that Mr. Fyke says this will increase "quality." No evidence, no basis whatever is given to support such an absurd conjecture yet it looks like the recent past process of closing and reducing service will be followed with equally devastating results.




Doctors will not stay in communities with hospitals and offer medical treatment to patients they too will move to other provinces or to the few larger centres with hospitals and basic day to day medical care for rural people on farms in small towns and everywhere not in a large centre will be a thing of the past. Fyke says that his proposal will mean no one will have to travel more than an hour to get treatment. One hour to, one hour from and three hours wait, will people do that. No, they will not, they will move to those centres or not bother seeking medical help. Quality care will not improve because the majority will receive no care.




But the fundamental issue of the viability of rural Saskatchewan is far more at stake in this paring down of health services. For years my sons played hockey, everywhere around this province. Hardly a crucial issue but think about this as a part of day to day life the sports for our children even our schools all exist within a framework of a support system for life to go on. Would any responsible coach allow his team to play in a rink where the closest medical facility is an hour's drive away in good weather, in winter, when hockey is played travel time is often doubled, a minor injury in a game could easily be life threatening and sports of all kinds including regular physical education in school would be to dangerous with medical treatment more than an hour away.




Mr. Fyke's report is not the death knell of medical care in rural Saskatchewan, it is the execution order for all small communities. This brings to question, should we be living away from either Regina or Saskatoon, where the only major medical services will be provided? Both of these cities, at less than 200,000 are considers in most parts of the world as towns, and they too are just not viable in terms of "quality" medical care. You see, by making size the major component of any service, the viability and reasonableness of life in such places as Saskatchewan are questionable.




Enough Blubbering!



pay the

The solution to the high cost of health care is so obvious and yet so unlikely for government to be willing to get its hands off, pay the piper and shut up. I don't get an accountant to fix my car, I don't get an administrator to build my furniture, install plumbing or wire my house. So why do I have such people running my hospital, deciding who gets treated and when. Take all of the money spent on running the medical care system and use it to pay doctors, nurses and lab technicians and we would have a medical care system better than anything anywhere on this planet.



the bills

Increase the amount we pay doctors, increase nurses wages, open more hospitals as we let each hospital board bill medicare for patients treated and let government confine its involvement to collecting taxes and paying the bills submitted by the doctors and hospital boards. If fee for services is the way we go then let us do that and mind our business.




If people get sick let us make sure they are treated promptly and if they are not let us enact legislation that makes it a crime to restrict treatment and cause undue suffering.




As a school principal, I had to serve my board who represented my customers, the students of my school. My teachers and I had the responsibility to do our best with the training we had and our boards trusted us to do our best. I did not have to run my school based on a budget that was not related to the number of customers. The grant structure of schools is based on the number of pupils needing education. Such a simple process, yet hospitals and doctors are not being given a chance to exercise the training and experience that they have. Don't you think that this is amazing?



kill it

Implementation of the Fyke Report will cost more, not less, it will produce poorer, not better care, and at the same time it will have implications for society that go far beyond the realm of medical care. For this last reason it should be taken to a burial site and interred. In many ways I feel strongly that it is us or the Fyke report, kill it or it will kill each of our communities.




Below is a squall of snow this morning shrouding the prairie landscape and only the trees around the cemetery are visible. Implement the Fyke report and all that will remain on Saskatchewan prairies will be the grave sites of those who once lived here. Desolation and destruction will be complete, adding to rail line abandonment, removal of small grain elevators, depopulation will be final and we will spend our days in retirement in BC talking about the good old days in Saskatchewan.

Timothy W. Shire