Plan B

Chinese Lanterns, originally uploaded by The River Thief. Copyright Ruth Seeley 2005

Many years ago, when I worked in the policy development division of one of the Ontario ministries, I asked the policy analyst for whom I worked how government policy was actually made: did it filter down from the top or did it percolate up from the bottom? He said from what he could tell, it was a little bit of both.

The day after I took my friend for her horrendous trip to the hospital I read a response to an article about a proposed power project here in BC. The guy who commented said, basically, 'we have enough fossil fuel resources to support 2 to 3 billion people, and our population is currently 7 billion.' In talking to my friend I said to her, 'These pants don't fit any more, and there's only so much more room we can buy for ourselves by undoing the button, opening the zipper and wearing a long tunic top to cover the bulge.'

I am confused by what's going on with our health care system and saddened that we seem not to have managed to get things right. I'm sure there are some people who abuse the system and run off to the doctor when they'd be better off just taking an aspirin and getting a good night's sleep. But I think there are a lot of us whose response to universal medical care is quite the opposite: as responsible citizens who believe in the principle of universality, know the system is overburdened, and probably delay going to the doctor until our conditions are serious.

Certainly we observed, while waiting for assessment, that people who came in by ambulance were being triaged first. Now you have to pay for ambulance service, and I'm sure it's expensive. But when you consider the loss of earnings experienced by spending nine hours waiting for an X-ray, you start to wonder if you wouldn't have been better off calling an ambulance. Not to mention the trauma of the waiting itself (I mean, I wasn't even sick and I was getting stressed out by the woman in the lobby wondering if she was having a heart attack - she was), worrying about whether the door handle you've touched has SuperBug germs on it, wondering why that group of people are wearing masks and trying desperately not to go to the SARS place.

In the same way that I have never understood how someone who is mentally ill is expected to get better in an environment where all the other patients have their own versions of reality, how are you supposed to get better when you're being exposed to a bunch of people with communicable diseases?

Surely there's another solution though. Why couldn't my friend have paid for an X-ray at a clinic near her home so she could have quickly determined whether she was going to need emergency surgery, and then, perhaps, worked for half a day? Why is it that those who need knee replacements are able to pay for treatment at their convenience, but those who need other kinds of surgery can't? Is it not a win-win situation if wait times for surgery are reduced? And wouldn't they be reduced if those who could afford to pay and who wanted to pay for treatment at their convenience did so?

For those of us who are self-employed, universal health care doesn't come free or at nominal cost because we don't have benefits - when we're sick we're not earning money and not marketing our services. If your surgery is scheduled at your busiest time of year, the economic loss may not be a one-time thing - you may lose the client because you had to refer them to someone else.

My periodontist once joked that I would soon be performing my own procedures, such an avid interest did I take in what he was doing to my mouth. I'm sure I'm a pain in the ass and I'm also sure he knew I wasn't going to start wielding a scalpel myself. In the last two years though it's been determined that I have a Vitamin B12 deficiency. I had to go for shots weekly, then every two weeks, and then once a month. I rebel against this not because I don't believe the doctor that my body is now unable to process the B12 I ingest. I've upped my intake of foods that contain B12 (meat, dairy and eggs) and I've also taken B12 orally. I have had to conclude that the doctor is right: I'm not processing it - I need the shots. What I don't need, however, is to have those shots administered by a doctor - or even a nurse. I also don't need to be exposed to a waiting room full of sick people once a month. Most important for me, though, is that I cannot justify in my own mind consuming medical services once a month. I'm not sick! I have a vitamin deficiency, for crying out loud.

Luckily I have been able to persuade the doctor that my objection is a valid one and got her to prescribe syringes and teach me how to give myself the intramuscular shots. I'm amazed at how many people say, 'Oh, you're brave.' I'm not, I don't think. I probably wouldn't attempt it if I had to inject into a vein. (Although I keep thinking, surely I'm no more or less smart than the average heroin addict.) But for me, this is part of being the change I want to see happen. I'm trying to reduce my demand on a system that's groaning under the strain of too many people, too few doctors and nurses, and far too little money. And I guess my question is, what's your Plan B? And how can you persuade your doctor and your elected representatives to let you implement it?