Part 1: Your Care is Not Free, and It's Only Getting Worse

So Part 1. Let's start with a fact- your health care is not 'free' in that it lacks cost, simply free in that access to it is not hindered by your ability to pay that cost at the point of treatment.

Healthcare, I can attest, is actually gawdamn expensive. There is the physical infrastructure to build and maintain- not just the rooms and buildings themselves of course, but the MRI machines and needles and billions of band-aids. There are highly-educated, highly-skilled people to be made- millions of them operating in concert from front-line patient care to information management to surgical specialties. 

The thing is that it has to be paid for. If prescription drugs or nurses or wheelchairs aren't paid for, they can't be had- medical consequences obviously ensue. This seems clear, but in the land of free healthcare where the point is so easily forgotten it's worth reiterating: this system's health and our health consequently are nobody else's problem but our own.

So, who pays for it? Currently, it's a combination of the federal/provincial government (which leverages a massive economy of scale) and private companies (who leverage some of the few bank balances out there equipped for the job). Consequently, it is these entities who have enormous capacity to influence the structure of the system, and contort it to pursue their goals.

The goal of the governments is easy on paper- make it run as cheaply as possible without causing noticeable problems in the delivery of comprehensive care for all patients in the order of their need. The goal of private companies is even easier on paper- make it run as cheaply as possible.

Both approaches result in patients paying more for their care at the point of treatment, a focus on short-term savings over long-term investments, and combine to contribute to a lack of overall cohesion in messaging, service, and bureaucracy. 

This won't do. The systems concerned flirt with catastrophe with every passing year. The task is not just to keep up physical infrastructure with a population which is living longer than any before, requiring investment in long-term care and assisted living, but also to manage the ever-increasing demand for a wider range of preventative and palliative care. Freezing the budget means cuts in the future. Hiking premiums will price the most vulnerable people out. Yet freezing the budget or raising premiums are the options as presented by a wide range of executives and ministers.

Political groups will navigate this period based on ideology and soundbites. Financial ones will navigate it pursuing profit and efficiency. The practitioners themselves do not pull enough strings on their own the really take control of responses to these challenges- and they're usually busy with other stuff, too.

It is patients (the most inclusive group possible) who must take control. They must speak loudly about their own experiences with the health care system, whether as ER visitors, relatives, long-term care residents, or insurance underwriters. We need to develop as clear an idea as possible of what is not working well and where has the most pressing need- and the thing that's nice about systems is that they're easier to diagnose when there is reliable data from throughout the system.

In Part 2, we'll start talking about what patients can do.