Yet another election – is it still 2008?

No self-respecting curmudgeon would consider the current (federal) election a worthy topic of conversation (the superficial nonsense on health care alone is enough to put one to sleep), nevertheless given the ridiculous fact that it is even happening seems to require some kind of reaction.

Mine is mostly boredom. Well, I do confess a that those appalling conservative attack ads do vex me – ah, Ignatieff didn’t come back for me? Why would he have to? Was I lost? (Perhaps there is some subliminal religious theme here that I’m missing: “I once was lost and now I’m found, etc.” )

Four old white men, desperately trying to seem relevant – tweeting, eating hot dogs, hanging out at Tim’s drinking some weird concoction called a double-double (and you call yourselves coffee drinkers, pah) – wandering around the country in a repeat of 2008. Women my age apoplectic at the sexism and waste of money; young people completely disengaged and why shouldn’t they be when the one time a bunch of them try to get into a Harper rally they are turned away, and older people the only ones paying attention lest anyone go anywhere near their various entitlements. Touch my senior discount sonny and I’ll bean you with my walker.

Sorry. That was uncalled for. Particularly from a person of my advancing years. As, incidentally, we all are.

So, in keeping with the spirit of this corner of the cybersphere, I will focus on one small aspect of the discussion, one that I know a thing or three about, health care. Notably that dastardly phrase in the Canada Health Act, namely that all “medically necessary” services will be provided, ad infinitum and ad nauseum.  For aye, there’s the rub.

What, in this age of in vitro fertilization and knee replacements, full body MRI’s to “rule out” any serious hidden condition and various and sundry (highly expensive) drugs that will prolong life for a few weeks, is actually medically necessary? According to whom? CNN? The magazine you’re reading? The specialist? Your Aunt Sadie?

Things were a lot easier 50-odd years ago. Your grandmother knew when she was sick and needed to go to hospital (well, most of the time, if she didn’t decide she was too busy and couldn’t afford the time). Nobody was breathing down her neck insisting she had all kinds of risk factors that needed treating or pointing out that type 2 diabetes was the “silent killer” and surely someone her age needed to be on a biphosphonate for her bones. Oh, after a bone scan of course. Ah, the good old days.

Today, on average, women live past 80 and men about 78. In all likelihood anyone that age has a few things “wrong”, the question really is whether or not all of these need intervention and whether these treatments and drugs and so on end up often doing more harm than good.

What we need is a genuine, difficult discussion on what “medically necessary” means. For everyone, not just my Uncle Joe or me down the road (which of course must only be the best). Hell, why don’t we go all out and have a discussion about science policy as well. Rather than just the blather – science good, health care, good, oog oog. (For a more nuanced and informed discussion on science policy in Canada, visit my friend frogheart’s blog here.  ( Or you can listen to her being interviewed on Peer Review radio.)

In terms of health care, which everybody wants in on (versus science policy which makes most people run shrieking – forgetting that without policy we remain the commodities market we always were and that, boys and girls, is finite – those forests and minerals eventually will give out – the basics are as follows: Any national health care program has to navigate carefully between being all things to all people (and going bankrupt) and being most things to (almost) all people (there will always be people who end up getting better care than others, that’s life) but then we have to de-list somethings. We can’t do everything all the time. So that means we all have to give up a few things, like getting that MRI right this instant.  In any event, most of the time later on is good enough.

Take a painful knee.  Whether you’re a weekend warrior or a professional athlete, the reality is that joints take time. With or without that MRI your knee needs rest, ice, elevation, an anti-inflammatory and tincture of time. You may never need the MRI, the knee will probably get better. If it doesn’t, well, eventually you’ll need surgery. Again, MRI optional. But our belief in technology is so extreme that we transpose screening technologies with treatments. Simply knowing what something looks like isn’t a solution. But we always want “more”, like that Dickens kid.  And if we don’t get surgery next week? We end up complaining to the media that our health care stinks and all is lost. Like that woman, a gazillion pounds overweight, who whinged to the Globe and Mail a few years because she didn’t make it to the top of the surgical list. Or the alcoholic who’s peeved that his new liver can’t be had on demand.

My prejudices and curmudgeonly asides aside, this is a discussion Canadians need to care about and engage in. What constitutes medically necessary care? It’s not enough to think health care is just the greatest thing since sliced bread. We have to define what it is, what it means – and we all have to be prepared to give up a few things for the good of the all. That’s what ‘public” means.

But that’s the conversation nobody wants to have, which is why this election is really about individual (male) ego. And that’s boring.