'The Health Care System: Part 2'

CAERS SUBSTACK ARTICLE #58

‘The Health Care System: Part 2’

CAERS Substack Article #58

In my previous article I wrote about expectations for the traditional Health Care System (HCS). I wonder if wanting it to prevent all diseases and illnesses, and/or to cure all of them, is asking a little too much? And is it reasonable to expect it to do so without taking into consideration the role the general public, as users of the system, in the process? When I hear people say that the HCS is ‘broken’, I can’t help but wonder if that sentiment might reflect some level of unrealistic expectations. After all, any system that provides a service to the public involves imperfect humans interacting with other imperfect humans. How could we expect such a system not to be imperfect as well?

The shortcomings of the HCS extend beyond the significant limits of medical science’s capabilities alone. They go beyond the fact that health care professionals and patients alike can only deal with probabilities of future events and outcomes. Our imperfections in part arise from the inevitable emotions that accompany matters of health which can interfere with making rational decisions (and that can be quite substantial). And of course, some of the key human imperfections include insecurity, naïveté, ego and even selfishness and greed.

Our innate insecurity elevates our fear and hence vulnerability even beyond what illness and disease themselves contribute. And we often use denial and avoidance to cope. Our naïveté contributes to us not realizing what we do not know; we oversimplify because we are not fully aware of the true complexity of any situation and thus our own ignorance. As a patient, our ego may project a sense of false bravado or prevent us from revealing embarrassing truths. As health care workers, our egos can have us pretend to know more than we actually do. Selfishness may interfere with our ability to see that we are not the only ones suffering and needing the services of the communal HCS.

And then, of course, there is greed. We might think that we live in a binary world that consists of two kinds of people: the non-greedy people like us, and those other people who are greedy. Perhaps that is true, but I suspect that greed lies along a spectrum, and depending on the circumstances we are all capable of occupying any given place on that spectrum. We can be greedy as patients and as health care workers. If a patient wants the latest and the best, it is often expensive and scarce, and everyone else wants it, too, and that is going to cost us all a lot of money. Equally, lots of money can be made by scaring people and then making unrealistic promises about treatments that will soothe their fears.

As technology provides more wondrous things for our lives, I have often wondered if that results in more addictive and selfish materialism, and hence greed? Do we then have a tendency to see our lives through a financial lens primarily? Does money, and what it can buy for us, become the final common denominator, the ultimate currency of a good life?

It is not uncommon for authorities responsible for an apparently ‘broken’ HCS to oversimplify its problems and claim to have the ‘big fix’, and almost invariably their solution in large part requires that more money be thrown at it (which often requires more taxation). But fixing complex systems that are working at a suboptimal level seldom involves one simple solution, and throwing more money into such a system is seldom the primary solution. And it is unlikely that improvements for the HCS will only demand change from the providers and not the users as well.

The HCS has been developed as a mechanism for us to care for one another, and that is not surprising for such a social and compassionate species as our own. But it is run by fallible humans with all kinds of foibles and idiosyncrasies. That may make us feel hopeless, but it can also fill us with the kind of humility that allows us to recognize our shortcomings and find ethical ways to deal with them. During the pandemic, have we manifested the kind of humility necessary to be constructively self-critical, the first step in fixing a ‘broken’ system? It’s not too late to do so, and the sooner the better.

J. Barry Engelhardt MD (retired) MHSc (bioethics)

CAERS Health Intake Facilitator