Watching Adrian Dix (Health Critic), Carole James and the NDP performance on the issue of Healthcare is a clear illustration of why, despite the overwhelming baggage carried by Gordon Campbell and the Liberals, the NDP were rejected in the last election; managing to lose an election that was theirs to lose.

In scrambling to remain leader of the NDP Carole James has abandoned issue based policy that focuses on the needs of the province, its citizens and solutions, to pursue a course that is based on: Can we score political points here? Will this bump up NDP popularity and push down Liberal popularity? Will this serve my desperate need to remain leader of the NDP?

Healthcare is a serious issue with no easy answers and a leader, as opposed to a politician, would be focused on finding workable solutions to the issue – not scoring political points.

Watching Adrian Dix’s performance night after night one is left to conclude that the NDP either do not understand the realities and implications of this problem or else have no clue as to how to go about addressing this looming crisis, other than desperately throwing money at it – causing a domino effect and triggering crises across all provincial programs and their budgets.

Gordon Campbell and the Liberals deserve to be taken to task (have their asses solidly kicked – repeatedly until they act responsibly) over their response to the growing problems in healthcare. Indeed the appointment of Kevin Falcon as Minister of Health suggests Campbell and the Liberals are going to stay the course and simply manage how fast the healthcare system moves from growing problems into crisis. Campbell and his Liberals have shown no ideas, leadership or intention of acting to avoid a healthcare crisis with its serious repercussions for citizen’s access to healthcare and citizens pocketbooks.

No doubt the need for funds to feed healthcare’s voracious appetite for funds helped persuade the Liberals to agree to the HST and the billion plus dollars this agreement will put in BC’s treasury.

Faced with serious challenges to our healthcare system, faced with the serious repercussions such a crisis would have on all aspects of government and government programs neither party leader nor their party caucuses or the parties themselves demonstrate an interest or ability to find workable solutions that will reform the current healthcare system from it’s current Rube Goldberg machine status to an efficient deliverer of services. The healthcare system in BC has become a complex, convoluted bureaucracy whose hallmark is inefficiency.

Aside: Rube Goldberg is best known for a series of popular cartoons he created depicting complex devices that perform simple tasks in indirect, convoluted ways. Indeed Goldberg is the inspiration for various international competitions, known as Rube Goldberg contests, which challenge participants to make a complex machine to perform a simple task. Government has turned the healthcare system into such a needlessly indirect, convoluted system.

The “we want healthcare, we want it now, we want it for free and we do not want to be bothered to have to think, make choices or make decisions’ current attitude of citizens has led to the current (escalating) problems that threaten to topple the unsustainable house of cards we have built or allowed to be built by government to deliver healthcare.

Citizens have to become engaged in making decisions, seeking solutions and making choices, even if hard, or risk having our currently unsustainable healthcare system collapse.

An examination of past and current budgets shows unsustainable increases in healthcare costs. If the trend continues it will not be long, even with the Liberals delaying tactics, before healthcare will need 100% of the provincial budget.

Remember that the Liberal government increased the healthcare budget by $500,000,000.00 and that this huge increase was still not sufficient to feed the voracious appetite for the increasing large sums money that the healthcare delivery system has developed.

$500,000,000.00 and the system demand hundreds of millions more dollars. What would the demands of the health care system been if the Liberal government had not imposed the $500,000,000.00 cap on increased funding?
A $1,000,000,000.00? More that a billion dollars?

The Carole James/Adrian Dix/NDP plan of throwing money at healthcare simply moves the day of reckoning for healthcare up a few years as opposed to when the day of reckoning will come under the Liberals.

With a healthcare system needing yearly increases in the neighbourhood of $1,000,000,000.00, any BC provincial government faces some combination of reducing monies to other programs and tax increases to feed the insatiable appetite healthcare has developed for funding. Even with cuts and tax increases healthcare will reach 100% of the budget in at most a decade.

Just to hold the funding for all programs other than healthcare at this years levels the province would have to raise taxes every year by the amount of the increase needed to fund healthcare. Freezing programs at current levels is the same as cutting funding to these programs every year their funding remains frozen.

Under the course of action being followed or proposed by either the Liberals or NDP the province will, in a few short years, reach the point where 100% of the budget will be spent on healthcare and all other programs will get $0 funding.

Examination of the financial and operating realities of BC’s budget and healthcare system leads to a troublesome conclusion:

Indisputably, the way we currently deliver healthcare in BC is unsustainable.

While denial may seem a more comfortable way to deal with this reality, it makes no sense to continue to ignore the ever growing monster healthcare has become until healthcare/other programs/the budget/the province collapse under the appetite for funding that healthcare currently has.

The intelligent, the rational approach, indeed the only way to avoid losing healthcare, is to address healthcare’s many issues; continuing to pretending everything is and will be fine is a path that will lead only to disaster.

A disaster it is possible to avoid if we choose to act now.

Look around; there are many healthcare systems around the world that manage to deliver healthcare effectively without wiping out all other programs or bankrupting governments and citizens.

To achieve delivery of healthcare to the citizens of BC effectively and affordably BC’s healthcare system is going to require restructuring, drastic restructuring. To accomplish this will require ‘thinking outside the box’, something politicians are loathe to do because of the risks involved.

Politicians love being able to exert control and eliminate surprises. How do you exert control and eliminate surprises in a healthcare system? You build a many layered bureaucracy as BC has done with regionalization.

Bureaucracies are about exerting control and eliminating surprises. Since these are major wants of our current politicians it is not surprising that government become a series of isolated, convoluted bureaucracies that compete, not cooperate, among the differing Ministries.

Unfortunately, while politicians and bureaucrats love bureaucracies, a bureaucracy by its very nature is inefficient, and to varying degrees ineffective.
The more complexity involved in the system to be controlled the more bureaucracy that is required to exert that control.

Bureaucracies, because of their goals of control and no surprises, resist/oppose change and innovation.

Newtonian physics tells us that inertia acts to keep an object at rest at rest. It further states that the more mass (the larger) an object has the more inertia the object has.

Consider the complexity of the task of delivering healthcare to the citizens of BC. As a result of that complexity, exerting control and preventing surprises requires a large bureaucracy that most closely resembles a labyrinth. This results in a healthcare system whose inertia is such that the system is in effect an immovable object when it comes to changes.

This large labyrinth of a bureaucracy not only resists and/or defeats the change and innovation necessary for the healthcare system to avoid ongoing rounds of service cuts and increased waiting times; it devours far to large of a portion of the healthcare budget and inflicts wasteful costs on the portion of the healthcare system that delivers actual hands-on healthcare. Thus much of the healthcare budget is spent on bureaucracy and bureaucrats rather than delivery of actual, hands-on healthcare.

This same money devouring bureaucracy prevents the innovation and change that must take place in order to avoid continuing rounds of cuts to healthcare services year after year or a budget crisis triggered by healthcare’s need for an ever increasing percentage of the BC budget – either of which will result in a healthcare crisis in BC.

The time has come where, in order to avoid a medical crisis for the system and the patients it is charged with providing healthcare to, healthcare in BC requires acute care.

What course do we need to pursue in order to save the healthcare system?

Keep in mind that the healthcare system comprises two components – the component charged with controlling the healthcare system and the component that is involved with the actual delivery of healthcare to citizens (i.e. your local hospital, clinic or doctor).

We have to deal with the bureaucracy that has grown so weighty it is crushing those components of the system that deliver the healthcare services.

How do we reform the bureaucracy?

Remember we are speaking of a large, complex bureaucracy that has evolved into a perplexing labyrinth with inertia such that the bureaucracy resists change, any change.

Part of Fraser Health recently was putting the finishing touches on a new ten year strategic plan since it had been 10 years since the last strategic plan was prepared.

And what happened with the earlier strategic plan? Nothing. Why? Because there was no funding to implement it.

What is the significance? Strategic planning is an organization’s process of defining its strategy, or direction, and making decisions on allocating its resources to pursue this strategy. In other words it is a plan of what you are going to do and how you are going to do it.

Even in a half-assed managed system there is no need of special funding to implement the strategic plan. This is what you are going to do, this is how you are going to do it and you do it. The healthcare bureaucracy is so set on course, so resistant to change that even if it has a change it wants to make – it cannot make it unless a new portion is added to the bureaucracy to try to change behaviour.

In instances where funding was budgeted to make changes, those changes literally take years just to begin to implement. Since all the changes, including ones set in motion more than a decade ago, I am aware of are still, at least to some degree, in process I cannot judge whether they will ever be fully implemented.

Based on my business and management experience I doubt that any plan, no matter how brilliant, would be able to change the current healthcare bureaucracy into the lean, efficient, effective and adaptable management system needed.

Moreover, the government is risk adverse and a control freak and so will support the status quo until crisis forces changes – or citizens do.

Does this mean healthcare is doomed?

That depends entirely on the citizens of BC. If they continue to want and look for simple, easy and neat solutions; if they continue to prefer the platitudes and promises of the Liberals or the nonsensical braying of the NDP; we are going to have a healthcare crisis. A crisis that will trigger a budget crisis and crises in all provincial programs as the funding demands of healthcare drain money from all other programs.

If citizens recognize that we face a looming healthcare crisis, that we need to act to avoid this crisis, that the outcomes of actions that need to be taken are not going to be simple, easy and neat, can reach a consensus on the form change needs to take and demand/force the politicians to act we will need to slog our way through but can avoid the collapse of healthcare.

Caveat: There is another path to avoiding a crisis that needs to be put on the table. Taxes could be raised. Taxes would need to be raised by the amount needed to cover the increased funding needed by the healthcare system – at a minimum.

Should citizens not want to face large yearly tax increases to fund healthcare they need to get involved in the discussion of what course of action to follow, in coming up with ideas (the best way to have a good idea is to have lots of ideas. Linus Pauling) of what changes to make and how, and be involved where possible (hospital boards) in the new healthcare management system.

Any intelligent fool can make things bigger and more complex.
It takes a touch of genius — and a lot of courage — to move in the opposite direction. E. F. Schumacher

If we need to reduce the bureaucratic component but cannot reform the bureaucracy what needs to be done?

Surgery, the cancerous growth must be excised to save the patient, healthcare.

We want to achieve a management system that functions in the manner of a matrix system where there is one layer of management above those facets of the healthcare system that deliver, hands-on healthcare to people – and only one layer. Decision making needs to be pushed as close to the front lines as possible. Management needs to have citizens involved in the system for their input and so that citizens can understand challenges facing the healthcare system and help form the judgement of the best decision to make.

We need to encourage experimentation with best practices from other healthcare systems. If it is decided in different segments of the system to try different best practices – management should accommodate this and facilitate the evaluation and comparison or the results. If they both work then those who will have to implement and work with the best practice need to be allowed to choose the practice they feel would work best in their situation.

Bottom up decision making of what is needed and how things should run.

Flexible, adaptable, embracing of change – a team focused on accomplishing what needs to be done.

Healthcare in BC needs the type of management system the politicians will abhor because, in focusing on the needs of patients and the effective and efficient delivery of services to meet those needs, top down control, lack of change, an absence of ‘situations’ will not be a goal or likely outcome of such a system.

I concede that putting this change in place and managing the situation will not be neat and easy. It will not be as simple in implementation as it is in concept. It will be challenging and interesting.
Consider:

There is no way to play it safe given the current and future circumstances governing healthcare and the budget.

Necessity of action takes away the fear of the act, and makes bold resolution the favourite of fortune. Francis Quarles

Given the importance of healthcare, the complexity of the situation and short (a few years) timeframe we need to act boldly.

In difficult and desperate cases, the boldest counsels are the safest. Titus Livius

Given the need for bold action in cutting away the current bureaucracy, it will not be possible to anticipate and put in place all the people and systems. The people and the system will need to evolve to become the effective and efficient system required.

Sometimes you have to take the leap, and build your wings on the way down. Kobi Yamada

We’ve got serious problems, and we need serious people not our current crop of politicians whose interest is in managing the problems so that they get re-elected, not in solving our problems or providing true leadership.