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Jean-Paul R. Soucy: Canada needs better data to confront our health-care crisis

Commentary

When Ray DeMonia of Cullman, Alabama had a cardiac emergency in August of 2021, he was turned away from 43 hospitals in three different states. He later died after being transferred to a hospital 200 miles away in neighbouring Mississippi. Public dataHHS Protect Public Data Hub https://public-data-hub-dhhs.hub.arcgis.com/ assembled by the U.S. Department of Health and Human Services (HHS) quantified the circumstances that led to this individual tragedy. By mid-August, ICU capacity had fallen below 10 percent in five states, including Alabama and neighbouring Georgia and Mississippi. COVID-19 patients filled about half of the available ICU beds in these states.

The HHS dataset enumerates inpatient and ICU bed occupancy by COVID and non-COVID patients for each state and most individual hospitals. This impressive tracking system, derived from an effort by the U.S. federal government to better understand and manage hospital capacity during the pandemic, was first released in July of 2020. Despite a rocky start, Americans have had access to this high-quality overview of their country’s health-care capacity for over two years.

Canada has no shortage of individual tragedies: Canadians are dying in hospital waiting rooms, emergency rooms and ICUs are shuttering, and chronically stressed health-care workers are burning out and quitting. What we lack are the hard numbers to see beyond this growing collection of anecdotes. The kind of comprehensive, near real-time information about the state of our health-care system that Americans enjoy is almost unthinkable in Canada.

This is not to say that useful health-care metrics are not collected in this country. For example, the Canadian Institute for Health Information offers annual reportsYour Health System https://yourhealthsystem.cihi.ca/hsp/?lang=en on an array of valuable indicators for health facilities across the country, such as emergency room wait times, hospital readmission rates, and measures of patient experience. But real-time metrics, even for something as simple as COVID-19 hospitalizations in each province, are unavailable at the federal level. Scouring provincial websites or consulting third-party aggregators will net you only a fraction of the information routinely available to Americans for their whole country.

The limitations of health-care data in Canada will come as no surprise to those who have worked closely with COVID-19 data throughout the pandemic. In early 2021, the lodestar for discussions regarding health restrictions in Ontario was the number of COVID-19 patients occupying the province’s ICU beds. Despite being the most watched value in the province, the publicly presented numbers were misleading and obscured the full impact of COVID-19 on the health-care system. Patients no longer testing positive for the virus were removed from the public total of COVID-19 patients in ICU, despite the fact that they still required critical care as a consequence of the disease. While the true count of patients in ICU due to COVID-19 was used internally, these values could only be gleaned by copying the numbers from slide decks occasionally released on social media. These more accurate numbers would only be officially released to the public in April of 2021, well into the province’s third wave.

In another example, British Columbia acquired notoriety throughout the pandemic by its habitual opposition to transparency. The province played up concerns regarding “privacy” and “stigma” to avoid disclosing more localized and relevant data about COVID-19 risk and vaccination and at one point even decided to stop reporting data to the federal government.

Inadequate data collection, arbitrary secrecy, and other barriers to information access are nothing new in Canada. But the problem is particularly acute in the health sector. The excuse is predictable: health is the sole jurisdiction of the provinces, so we are forever doomed to sift through a patchwork of inconsistent provincial data sources.

This argument rings hollow. The federal government regulates drugs and devices (via Health Canada), is empowered to contain the spread of communicable diseases (via the Quarantine Act), and has a mandate to collect statistics via Statistics Canada and other federal agencies. Most importantly, the federal government transfers tens of billions of dollars annually to the provinces through direct health system funding and through a handful of health research granting agencies.

These cash transfers are given with nothing in the way of health data reporting requirements. This is a mistake, especially since provinces have little incentive to publish data that may be embarrassing or cast them in an unfavourable light relative to other jurisdictions. The United States enforces health data reporting by tying it to the receipt of federal dollars through Medicare and Medicaid. If our neighbour to the south was able to corral its fragmented health-care system to produce a set of coherent, standardized, up-to-date metrics within a few months of the COVID-19 pandemic beginning, surely we should be able to do it after a few years.

The limited data that are available from provincial or local health system websites paint a bleak picture. For example, at the time of writing, 11 of Montreal’s 21 emergency rooms are over capacity, with the worst operating 55 percent above maximum. Overall, the number of patients in the system exceeds the number of beds available across the whole island by 14 percent.

Long wait times in the emergency room are a longstanding issue in Canada, but the depredations of the pandemic and the resulting wave of resignations and burnout have brought the system to a breaking point. The steady stream of stories about deaths in waiting rooms and the desperate attempts to keep hospitals staffed and open illuminates the health-care crisis we often lack the data to describe more concretely.

Canada’s health-care system is in desperate need of reform. Better data will help make this case and careful analysis will help to separate policies that work from those that don’t. The critical issue of staffing will get more difficult to solve: the World Health Organization projects a shortage of 15 million health workers worldwide by 2030.Health Workforce Overview https://www.who.int/health-topics/health-workforce#tab=tab_1 Canada is now competing against every other country in the world to train, recruit, and retain health-care workers. Canadians deserve to confront this crisis with eyes wide open. Only the failed status quo is served by our inability to produce detailed, timely, and accessible statistics about the state of Canada’s unravelling health-care system.

Chris Spoke: To Mars and beyond: Conservatives must embrace an abundance agenda

Commentary

My wife thinks it’s a bit weird that I never cry. But recently, I came pretty close.

It was while watching the final scene of Apple TV+’s For All Mankind season two finale.

The series begins in 1969 and depicts an alternate history where the space race never ends, and both America and the Soviet Union keep pushing the technological frontier to get to the moon and beyond. It’s fantastic.

In that final scene of the second season, you take the perspective of a camera flying across the Martian surface, slowly descending, and finally pausing at ground level. Two human feet in space boots step into frame. A date appears: 1995.

Still image from For All Mankind. Credit: Apple TV+

It’s tragic.

That could have been us! But it isn’t. In fact, we (humans) haven’t even been back to the moon since 1972. There is no lunar base, there are no spaceships capable of taking us to Mars, and there certainly isn’t anyone on Mars now. It’s 2022.

Again, tragic.

I want the future to be radically more awesome than the present.

And not just in terms of space exploration. I want the stuff of utopian science fiction, including radically extended healthy lifespans, energy too cheap to meter, and of course, flying cars.

Which brings me to my politics.

We don’t have flying cars. We don’t have energy too cheap to meter (just the opposite: high and rising). Life expectancies have been increasing in poor countries as they develop but we’re all now kind of converging and plateauing in the late 70s. And we don’t have humans on Mars.

Why not? And what can we do to accelerate the advent of those things, never mind those more basic and pressing concerns like abundant and affordable urban housing?

My conservatism is largely centered on a rich and growing body of thought concerning the causes and remedies to our Great Stagnation.

To describe it well, I’ll have to pull from four important essays that were written just over the last two years.

The first is Tyler Cowen’s post on State Capacity Libertarianism.What libertarianism has become and will become — State Capacity Libertarianism https://marginalrevolution.com/marginalrevolution/2020/01/what-libertarianism-has-become-and-will-become-state-capacity-libertarianism.html In it, he defines an emerging ideological movement that pairs the liberty maximizing priorities of libertarians with a recognition that a strong and competent state is necessary to do those things that it is either best positioned to do, or that a sufficiently large majority of people think it is best positioned to do.

For example, while more libertarianism is probably the right prescription for our high and rising cost of urban housing—namely, through deregulation—a highly capable state is undoubtedly needed to address our bad and worsening urban traffic congestion. Think: subway infrastructure that is delivered rapidly and cost-effectively, dynamic congestion pricing that is implemented efficiently, and that sort of thing.

The second essay is Peter Thiel’s “Back to the Future”.Back to the Future https://www.firstthings.com/article/2020/03/back-to-the-future It’s a review of Ross Douthat’s book, The Decadent Society.

In it, he describes Western cultural, technological, and economic stagnation over the last fifty years.

“Over the last two generations, the only truly radical change has taken place in the devices we use for communication and entertainment, so that a single one of the nineteenth century’s great inventions [running water] still looms larger in our everyday existence than most of what we think of as technological breakthroughs.”

The third essay is Marc Andreesen’s “It’s Time To Build”.It’s Time To Build https://a16z.com/2020/04/18/its-time-to-build/ As in Peter Thiel’s essay, he describes the absence of technological progress across many domains. As in Tyler Cowen’s, he emphasizes the need for a strong and competent state as a complement to strong and competent market actors.

He frames it all as a rallying cry for builders.

“Our nation and our civilization were built on production, on building. Our forefathers and foremothers built roads and trains, forms and factories, then the computer, the microchip, the smartphone, and uncounted thousands of other things that we now take for granted, that are all around us, that define our lives and provide for our well-being. There is only one way to honor their legacy and to create the future we want for our own children and grandchildren, and that’s to build.”

The fourth essay is Derek Thompson’s “A Simple Plan to Solve All of America’s Problems”.A Simple Plan to Solve All of America’s Problems https://www.theatlantic.com/ideas/archive/2022/01/scarcity-crisis-college-housing-health-care/621221/

It takes all of the above and distills it down to a common sense, supply-side abundance agenda. On health care: make it easier to build more hospitals, train more doctors, and have foreign doctors accepted as immigrants. On housing: make it easier to build more housing. On transportation: make it easier to build more subway lines and stations and other infrastructure. On energy and climate change: make it easier to build more nuclear and geothermal and solar.

You get the theme, which ties back neatly to the other three pieces. We haven’t done enough of any of that. We need a strong and competent state that can streamline approval processes and deregulate where required to enable builders to build.

This is how we get to a future that looks more like the Jetsons than it does the Breakfast Club with smartphones.

It’s how we deliver rapidly rising standards of living for all, and it’s how we get to Mars and beyond.