Saturday, March 19, 2011

A small cancer tumour, a giant time bomb - The Globe and Mail

Whose heart wouldn't break for Jill Anzarut? Ms. Anzarut, an immensely sympathetic 35-year-old mother of two, has become the latest victim of our callous health-care system. She was recently diagnosed with a small, early-stage tumour in her breast. Her doctor recommended treatment with Herceptin, a drug that costs upward of $40,000 a year. Just one problem: In Ontario, Ms. Anzarut's tumour is too small to qualify. Now undergoing chemotherapy, she has been publicly campaigning for the drug, in between bouts of exhaustion and nausea. Government denies mom life-saving treatment, scream the headlines.

Journalists and breast cancer advocates have been protesting against the grotesque injustice of it all. After all, other provinces cover Herceptin in cases such as hers. Talk about irony: Early detection is supposed to save lives, yet Ms. Anzarut is being denied the drug that could save hers. Ontario's Health Minister, Deb Matthews, was roundly condemned for responding that health-care policy can't be dictated by headlines.

But, of course, it is, and every health minister knows it. Ms. Matthews's main political assignment is to minimize bad headlines until after the next election. Her main managerial assignment is to keep health-care costs from destroying public finances.

As it stands, that's impossible. One reason is the high cost of expensive new drugs such as Herceptin – whose efficacy for patients such as Ms. Anzarut is debated even among research specialists. Herceptin's benefits for women with very small tumours are, at best, marginal. But if it's your tumour, marginal may be plenty good enough.

"You can't pay for everything," wrote Helen Stevenson in a letter to The Globe and Mail on Friday. Ms. Stevenson once had the unenviable job of running Ontario's public drug programs. On one occasion, after turning down an expensive drug for a critically ill young boy, she cried. "Denying drugs is sometimes a necessary evil," she wrote.

As irrational and arbitrary as our health-care system may be, it's not uniquely callous. Every system has its faceless bureaucrats who serve as Dr. No. In Canada, they work for the government. In the United States, they work for the insurance companies. The difference is, people who run insurance companies don't have to run for re-election.

A perfect storm of circumstances is driving health-care costs through the roof – new wonder drugs, unquenchable consumer demand, an aging population, and a declining base of taxpayers to foot the bills. The boomers neglected to have enough children, meaning that more and more elderly people – the ones who consume the vast majority of health care – will be supported by fewer and fewer young people. It's a demographic time bomb, and it's not unique to Canada. "Prevention" and "efficiency" won't solve the problem, unless we give everyone an automatic expiry date.

Yet, an astonishing number of people in this country still imagine we can keep things pretty much the way they are. These people are dangerous. That's because health care is the vampire that will suck our children dry.

Rising health-care costs eat up nearly half of all provincial budgets. And because most health care is consumed by the elderly, its rising cost will mean a larger and larger transfer of wealth from the young to the old. Not even Tommy Douglas would endorse that.

Which institutions are more important to our future – hospitals or schools? We've already made the choice. As British economics writer Anatole Kaletsky wrote recently, "If this ordering of priorities is maintained, all public services apart from those serving the old and the sick will drastically suffer. Multitudes of public employees will lose their jobs, many more households will sink into poverty, and education will deteriorate – all to ensure that spending on [the National Health Service] can keep growing." He was writing about Britain, but the same goes for us, too. The surest way to hasten the dismantling of the postwar welfare state, he argues, is to defend the status quo in health care.

In other words, if you care about education, decent public services and a social safety net for the worst off, you should be demanding health-care reform. You should be insisting on widespread experimentation, including a large shift of costs and services to the private sector. You should be arguing that, if a mixed public-private system is good enough for France or Sweden or Switzerland, it might even be good enough for us. And the next time someone stands up to defend the status quo, please understand that she's endorsing a set of social policies that systematically discriminates against families and young adults.

That, however, is the debate we won't have. For the sake of re-election, every politician is determined to avoid it. Every politician knows that, any time you pit a suffering young mom against the phrase "cost-benefit analysis," it's no contest.

To nobody's surprise, the Ontario Health Minister's office is now opening the door to giving Ms. Anzarut the drug she wants, on a "case-to-case basis." And Ontario's Ombudsman is getting into the act, investigating whether the government is denying life-saving treatment to other moms. As for Jill Anzarut, who could blame her? If I were in her shoes, I'd probably want that drug, too.