A new report commissioned by the Canadian Medical Association (CMA) examines the broader health impacts of COVID-19 in Canada. The November report, titled A troubled system, explores a growing range of issues, from mental health issues to substance abuse and the deteriorating social determinants of health. Sadly, the report also confirms a fact many suspected from the start: that delays in care have led to thousands of preventable deaths.
“While it is not surprising that more Canadians died in 2020 than in a typical year,” the authors write, “the excess death toll was higher than can be explained by the single COVID-19. While there may be several factors behind these excessive deaths, delayed or missed care due to shutdown of services and lack of sufficient capacity in overburdened health systems can be a contributing factor. “
After analyzing the data, the authors estimated that delayed and missed health care contributed to more than 4,000 additional non-COVID-19 deaths between August and December 2020. Needless to say, the total number of preventable deaths in the course of the pandemic to date is likely. much higher.
But how bad are delays? Well, the report estimated the backlogs for eight selected procedures. Of these eight procedures, breast cancer surgery had the lowest delay at 46 days, while hip replacements had the longest delay at 118 days.
Source: A troubled system, Deloitte
This may sound like a long time on its own, but keep in mind that these are only the additional the waits caused by COVID-19 and lockdowns, not the total wait time.
To estimate total wait times, we can add the backlog numbers to the Fraser Institute’s 2019 pre-pandemic numbers. Wait your turn report. The report notes that the national median wait time for knee and hip replacements in 2019 was 28.6 weeks (200 days), and the median wait was 18 weeks (126 days) for surgery. cataracts. By adding these to the backlog numbers above, we can estimate the current total wait times at 304 days for knee replacements, 318 days for hip replacements and 231 days for cataract surgery. . In short, now is not a great time to be in the medical procedures market.
The backlog can eventually be cleared, of course, but clearing it comes at a high price. According to the CMA report, the cost of returning to wait times before the pandemic is estimated at $ 1.3 billion.
What about the cost of eliminating the wait altogether? Well, let’s not get ahead of ourselves.
Diagnose the problem
If there is one bright side to this report, it is the fact that people finally seem to be waking up to the negative repercussions of blockages. For months, doctors have warned of the unintended consequences of shutting down “non-essential” services, especially the deadly risks associated with reduced medical care. But maybe it takes some sobering data like this to show people how much the blockages have impacted our health and well-being.
And yet, while lockdowns have certainly played an important and inexcusable role in these delays, they are not the only cause of the problem. As the report notes, another factor that led to these dire results was the lack of sufficient capacity.
Here, of course, is where politicians and experts make their point. According to them, the root of the problem is the lack of funding. If only the system had more investment, they reason, health care shortages like this wouldn’t be a problem. Once this premise is accepted, the healthcare debate turns into an argument about exactly how much money is needed to “fix” the system.
The problem with this policy prescription is that it stems from a misdiagnosis of the problem. In reality, the dismal results of this report are no indication that the system “just needs more funding”. They are an indication that socialized health care just doesn’t work. Indeed, the shortages and delays that have become commonplace in health care in Canada are no coincidence. They are the natural result of banning private markets and replacing them with central, top-down planning.
This is the most frustrating part of health care policy in Canada. No matter how badly the system works, no matter how many people die, Canadians refuse to even consider the possibility that the problem lies in the fact that the system is centrally planned. The cry is always for more funding, and never for more freedom. But spending more money on a broken system will never fix it. The only way to really improve the system is to allow the free market to meet the needs of the people.
Central planning is what got us into this mess. It won’t be the thing that gets us out.
The visible and the invisible
Putting aside the broader issues of socialized health care, there is a more specific lesson to be learned with respect to closures. The lesson, to put it simply, is that well-intentioned actions often have harmful side effects that can be difficult to predict. Frédéric Bastiat underlined this in his 1848 essay, What is seen and what is not seen.
“In the department of economics,” he writes, “an act, a habit, an institution, a law, gives rise not only to an effect, but a series of effects. Of these effects, the first alone is immediate; it manifests itself at the same time as its cause – we can see it. The others follow one another, we do not see them.
The excessive deaths associated with delayed care are a tragic reminder of the enormous unseen damage blockages have created. Of course, it can be tempting to minimize these effects and double down on non-pharmaceutical interventions. But perhaps it is rather time to resuscitate an old principle of medicine that seems almost forgotten: Primum non nocere.
First of all, do no harm.