Specialists want cancer treatments universally available

By David South

Today’s Seniors (Canada), December 1993

A newly-formed group representing cancer doctors says it is fed up with the inhumane and bureaucratic approach to cancer care in Ontario. 

Dr. Shailendra Verma of Access to Equal Cancer Care in Ontario (AECCO) says he’s had enough. 

“My group has served the government notice that we’re fighting on our patients’ behalf,” says Verma, who faces gut-wrenching quandaries every day in his growing Ottawa practice. “In a public health system, I’m damned if I’m going to be divided into giving one set of patients a Cadillac treatment and the other Hyundai-type treatment; I don’t think that’s why we have a public health system.”

Verma says cutbacks to health care funding have meant that doctors must leap increasingly high hurdles to get the drugs their patients need. 

In jeopardy

While chemotherapy drugs administered in hospitals are still free, he says the important drugs necessary for patient comfort and treatment effectiveness are in jeopardy. 

These drugs were once free under the Ontario Drug Benefit Plan (ODBP), but now their status is tenuous. One drug, GCSF - which is crucial in helping patients between treatments of chemotherapy - is now listed under Section 8 of the ODBP and requires doctors to plead with the government each time for coverage. Often the bureaucracy moves so slowly that the course of chemotherapy is seriously disrupted, Verma says. 

“As an oncologist I’m particularly interested in ensuring everyone has access to all treatment. I think we are at a very sensitive crossroads. Over the last three or four decades we’ve developed certain treatments for diseases that more often kill than cure. And now we are at a point where we’ve got new treatments that can make the older treatments more effective. Or we’ve got brand new treatments that we are hoping to apply, and the one thing that is holding us back is cost.”

Cost

“The decisions are not based on science, they’re based on cost. It would not be an issue if treatments cost a penny a shot.”

Verma says colleagues can’t introduce some new drugs because the costs would be too high to offer it to everyone. So no one gets it.

“We have patients who walk in and say they would like to pay for it,” continues Verma. “Ethically, as a physician do you allow a patient to pay for it while sitting next to a similar patient who can’t afford it?”

Health care on the cutting block: Ministry hopes for efficiency with search and destroy tactics

By David South

Today’s Seniors (Canada), August 1993

It’s search and destroy time at Ontario’s ministry of health: search out savings and destroy inefficiency and waste. But many remain apprehensive that not all the cuts are going to be logical and fear the province’s health and well-being will be affected. 

As part of the social contract deal, the Ontario Medical Association must find $20 million in cuts from the list of services covered by OHIP. The OMA and the provincial government are currently haggling over which procedures and examinations will be cut. 

“We look at services that aren’t medically necessary,” says health ministry spokesperson Layne Verbeek. “Because we were wealthier in the past, we were able to cover some services. We aren’t in that position now. But I don’t see how eliminating medically unnecessary treatments will affect the population.”

The fallout of the Rae government’s attempts to reign in costs and recover lost revenues may take years to unfold, but it is already apparent that Ontarians will be paying more. 

“Access to necessary treatment should not depend on a person’s ability to pay,” says health policy critic Carol Kushner. “What disturbs me about any delisting program is that virtually every medical service could be termed medially necessary. There are very few services that are an out-and-out waste of time.

“We often point to the fact that Ontario spends $200 million a year treating the common cold. Well, most of that is a waste of time. But delisting even that kind of service would be a detriment to the public’s health, because a small group of patients really do need to see a doctor when they have a cold.”

OMA spokesperson Jean Chow says it’s too early to pin down the exact cuts that will be made. “It’s a little premature to try and speculate what the final list will be.”

The newly-created Non-Tax Revenue Group is hard at work finding fees, fines and penalities the government can add or hike to boost revenue from this source from $5 billion to $10 billion a year. 

The spring budget saw the first hit, with the addition of $240 million in non-tax revenue. 

A radical reshaping of medicare is taking place. Private sector services - for which consumers pay directly or through insurance companies - now make up 34 per cent of Ontario’s health care funding, compared to 42 per cent in the United States, according to a recent study by the Canadian Medical Association. 

Health minister Ruth Grier has also floated the idea of widespread hospital closures. Both the Toronto and Windsor district health councils (DHCs) are carrying out feasibility studies on “reconfiguration.” The ministry is remaining tight-lipped about which hospitals will get the chop. 

“One suspects there’s room for efficiency - there are a lot of empty beds in a number of different places,” says ministry spokesperson Verbeek. 

“All hospitals are being reviewed, with a view to closing one or two hospitals,” says health planner Lisa Paolatto, who is working on a feasibility study on “reconfiguration” for the Essex County District Health Council, along with Toronto’s DHC. 

Closing hospitals could present a serious political hot potato for the government. In Britain, the Conservative government is still recovering from the bad feelings surrounding proposals to close world-renowned hospitals in the London area. The public feels great loyalty to local hospitals, a feeling that has been further fostered by hospital charities that raise millions a year from the communities’ good will. 

“This is going to open up new discussions of money between doctors and patients,” says Kushner. “Seniors are a unique group in Canada because they remember what it was like before medicare - what it was like not to be able to pay for the doctor, to forgo treatment that they thought was necessary. They understand the financial hardship that could occur if they were unlucky enough to have a family member who needs expensive medical treatment.” 

Economy Still a Sick Puppy

By David South

Id Magazine (Canada), December 27 to January 8, 1997

It was a year when banks recorded their highest profits ever; it was a year when the economy was supposed to be chugging along as the stock market hit new records. Despite our political and corporate masters telling us otherwise, government statistics tell a grim tale for anybody who isn’t making over $100,000. 

After years of being told high government debt must stop, all three levels of government managed to take debt up another $45 billion, to a record level of $796 billion. It makes you wonder what all the food banks, unemployment and poverty is achieving. 

Prime minister Jean Chretien’s rallying cry of “jobs, jobs, jobs” has not panned out. A combination of high levels of immigration, seniors clinging to jobs for longer and a growing working age population is keeping unemployment high. The percentage of the working age population employed is 58.5 per cent, according to Statistics Canada. It was 58.4 per cent in April 1992, before 944,000 mostly part-time jobs were created. Youth are the ones suffering the most, with only 52.3 per cent actually working, down from 62.7 per cent in 1989. 

If that isn’t evidence enough that 1996 was a bad year, according to the Labour Relations Board, more people are spending time out on the picket line. The number of days lost to strikes in 1996 was 1,783,700, up from 473,000 in 1995. The bulk of those days were lost in the crippling public servants and auto workers strikes. 

Truckus Maximus: The big boys with the big toys do some hardcore pogo at monster truck show

“I got laid off too many times. Now, I work harder for less money. But I get to do what I want to do. Not many people get that.”

By David South

Id Magazine (Canada), February 6 to 19, 1997

The little tiger-striped four-by-four is definitely going too fast. In an instant, the diminutive Suzuki stands balanced, its front wheels squashed at 90 degrees. A millisecond later, it’s on its back like a ladybug flipped over by the wind. The cacophony of the crowd reaches a crescendo. But the noise had been building; the Skydome crowd saw the writing on the wall for the little jeep. 

Frantic helpers pry open the door of the jeep, wrestling free the driver, Dwayne Robichaud. He emerges in an orange jump suit and prances around, looking vaguely like the Oklahoma bomber. The audience lets out an even louder cheer as he walks away, smug and happy. 

Half an hour earlier, two monster trucks, Young Gun and Samson, line up behind a pile of crushed cars, with a dirt ramp at each end. The methanol engines let out a roar like the mother of all hairdryers. The revving turns into a drag race. The pulsating white noise rattles the cavernous Dome. The effect on the audience is almost sexual: the stomach rattles, the heart skips a few beats. It is a short buzz, but it is good. And the noise? I begin to notice that everyone around me has ear plugs and I realize I'm going to regret this in 20 years. 

The exhaust fumes are starting to reach toxic levels 40 minutes into the rally. I shake my head and feel the motion a few seconds later. I’m getting a CO2 buzz, too. It’s the USA Motor Spectacular monster truck derby at Toronto’s Skydome. But monster trucks are just a small part of the show, there for the crowd to ogle while they get off on the noise. There is the amateur truck rally involving the tippy Suzuki and other monster-truck wannabees, and a ridiculous car-eating, fire-breathing robot called Robosaurus for the kids. The metal bashing of the demolition derby serves to satiate the audience’s thirst for damage - and is truly the highlight of the night. 

I can’t get out of my mind comparisons to spectacles in Roman times. Titans of spectacle, the Romans set the benchmark by which all other public entertainment must be judged. On the spectacular scale, Roman bloodsports involving gladiators, wild animals and the sacrificing of Christians definitely rate a 10 - anything else falls below. I figure monster trucks rate about 4. Watching pick-up trucks with over-sized $10,000 tractor tires crush cars can’t match the gore and death of ancient Rome but it will do for now. 

If monster trucks join professional wrestling and American Gladators as today’s answer to blood sports, why does this spectacle seem to lack that je ne sais quoi? Maybe it’s the sanitization of risk. The cabin of a monster truck coddles the driver. There are cushioned seats, a kidney brace, a five-point racing harness, neck braces, helmet restraints and a roll bar. Several drivers tell me that the job only looks dangerous. At half time, Young Gun’s Saskatoon-based driver, Kevin Weenks, tells me he doesn’t seek out danger. “I think some of those (amateur) guys are nuts and want to do the crowd a big favour [die]. You don’t want to run it hard. A win isn’t worth flipping over.” 

Derby destruction

Thirty demolition derby wrecks crawl into the centre of the Skydome. The flag is dropped and an orgy of car crushing begins. It goes on for half an hour. Now I’m not bored. Cars are still driving despite engine fires and rear-ends that stand at 45 degrees. It is down to two cars: one more or less intact, the other driving on its hubs, engine on fire, half its back a mangled piece of crumpled paper. The driver doesn’t give up. His engine stops, then starts again. This is repeated three times until, exhausted, he concedes defeat. 

After the derby it’s time for Robosaurus. The press release claims the hunk of grey metal stands five stories tall and costs $2.1 million. The driver flicks on the switch on a very expensive stereo system and Robosaurus starts to growl like Godzilla. Two guys with radio headsets help direct the beast onto the floor. It burps and farts for a while before picking up a pre-cut car. It crushes it, drops it to the floor and incinerates it with a flame thrower. The crowd roars.

It seems things haven’t changed with spectacles. The Romans drew on slaves, freed men, foreigners and the lower social orders to provide fodder for their spectacles. Monster trucks are driven by farmers hired for six months at a time. The amateur drivers are a hodgepodge of laid-off workers, farm labourers and guys who make a meagre living fixing four-by-fours. 

Wearing a waist-length monogrammed racing jacket is Don Frankish. The shy and patient Alberta grain farmer owns two of the four monster trucks in Canada. He has been racing for seven years and divides his year 50/50 between farming and tours on the monster truck circuit, which mostly takes him through the U.S. 

He is definitely attracted to the excitement of the stadium, but not necessarily a love of death-defying acts. “It’s the rush of the crowd as they get behind you, talking to the kids who look at you as a superhero,” he says. “I like the speed, the unpredictability. We know the risks. There is a danger to it. But the Monster Truck Racing Association makes sure we have a killer radio to shut off the engines if the truck is out of control. The worst I’ve ever seen is a truck going end over end three times - it just destroyed the truck.” I ask him about insurance and he laughs. “We can’t get insurance!”

Pit boys

Down in the pit, the air is thick with exhaust fumes. The pit boys are milling about, patting each other on the back. A sprinkling of pit girls hang around, with hairstyles straight out of Xena: Warrior Princess. The dress for today is black: black t-shirts and black jeans. Don McGuire, 32-year-old partner in the Three Stooges four-by-four shop in Brampton, sports a mischievous grin as he tells me with pride about his chosen vocation: mud bog racing. It’s the messier outdoor version of tonight’s amateur truck rally. McGuire has been a mud bog racer for 10 years and isn’t doing it for the money. “First prize is just $200 - I spring for more money than I would ever win,” he says. “We do this for the pure adrenaline. It’s just heart and soul. It takes bucks per cubic inch to win in this business,” he says resentfully, looking across the Skydome to where the monster trucks are parked. Big Foot’s sponsorship by Ford seems to be a sore point with racers who spend thousands of their own dollars to come here. 

McGuire gave up a $700 a week job to earn $300 a week and race. “I got laid off too many times. Now, I work harder for less money. But I get to do what I want to do. Not many people get that.”

Man out of Time: The world once turned on the ideas of this Guelph grad, but does the economist John Kenneth Galbraith know the way forward?

By David South

Id Magazine (Canada), January 23 to February 5, 1997

It was with hungry enthusiasm that I rushed to hear the great liberal economist John Kenneth Galbraith speak. It was with enormous disappointment that I found a genius emptied of solutions to the current political battles in today’s Ontario.

For those unfamiliar with Galbraith, think of him as a hybrid of the liberalism of former prime minister Pierre Trudeau and the manner of Jimmy Stewart. Now 88, the former Guelph agricultural economist became a servant of the US government just as president Franklin Roosevelt was beginning to introduce the New Deal – today’s rusting welfare state – as a solution to the cruel hardships imposed on Americans as a result of the Great Depression. Galbraith rode out the Second World War in a senior government position as Roosevelt’s price-control czar. He later advised Democratic presidents John F. Kennedy and Lyndon Johnson, before seeing his influence in American economic thought wane under Ronald Reagan’s Republicans.

Galbraith has long followed the ideas of British economist John Maynard Keynes, who believed goverments should keep money tight in good times, but should spend their way out of bad times to avoid undue hardship. Galbraith also made the plight of the poor one of the pillars of his economic theory, and criticized the unnecessary appetites and demands created by the goliath American advertizing industry. He has supported wage and price controls and once, in the 1930s, even wanted to join the American Communist Party.

Last week, Galbraith breezed into Toronto with his ivy league roadshow. Speaking to a stodgy crowd of liberals (and Liberals, including former prime minister Pierre Trudeau and failed Ontario leadership candidate Gerrard Kennedy) at the University of Toronto, Galbraith was at an institution that comes as close as Canada gets to his current stomping ground, Harvard.

Symbolically, Galbraith couldn’t have visited Ontario at a better time. The Conservative government of Mike Harris is in the middle of an ambitious campaign to reverse everything that Galbraith has stood for: budget deficits to avoid depressions; social programmes to prevent poverty; taxes on the rich to fund those programmes; government policy subservient to public good. Harris oozes contempt out of every pore for the pillars of Galbraith’s thinking. In fact Ontario, once the bedrock of Canadian liberalism, is now joining Alberta in dismantling the welfare state.

A graduate of the University of Guelph when it was still the Ontario Agricultural School, Galbraith took his bitter memories of farming in southern Ontario to the University of California, Berkeley and subsequently to the Roosevelt government.

In his day, Galbraith was amongst a rare species of mainstream economists that earned respect from the once-abundant Marxists who cluttered universities. Not that the Marxists liked his compromises and complicity with the American government, or his assertions that he could save capitalism. But they thought he softened up the system for some body blows to be delivered by the workers’ revolution.

I am a member of generation that grew up on government largesse, well-funded public schools, family allowance, university grants, and make-work progammes. But we have seen a lot of that eroded over the past eight years, during a period of high unemployment not seen since the Depression. It was time to see if this titan of liberal thought had something new to say.

Galbraith’s talk had two main points: the market economy is the best system going; he supports a guaranted minimum salary to prevent poverty. Other than that, Galbraith’s speech was a rehash of the same ideas he has been mulling over for the past 50-plus years. It could be called Liberalism 101.

His speech was peppered with euphamisms like the “socially concerned.” Perhaps he was pulling his punches so as not to offend the “distinguished” audience. The most exciting moments displayed his dry wit: “In the United States , the war against the poor having now been won,” or “We, the socially concerned, do not seek the euthanasia of the rentier class.”

He struck out against annual balanced budgets because they have been used as an excuse in the US to cut off benefits to the poor. He also slammed the globalization-uber-alles philosophy that sees welfare policies as uncompetitive – a sentiment that doesn’t seem to be in vogue these days with liberals. Last week, Prime Minister Jean Chretien told the South Koreans they need to remove jobs-for-life provisions to join the global marketplace.

His ideas and his approach to communicating those ideas come from a special historical time. A time when governments under pressure from trade unions and the far-left and right political parties decided to make capitalism a little friendlier. But they needed advisers who could speak the language of the elite. Eloquent, confident, pragmatic – advisers who felt comfortable in the courts of the democratic government. They didn’t want hot-headed union guys or hectoring left-wing demagogues.

Galbraith takes credit for civilizing capitalism and ensuring its survival: “It would not have survived had it not been for our successful civilizing efforts. We, the socially concerned, are the custodians of the political tradition and action that saved classical capitalism from itself. We are frequently told to give credit where credit is due. Let us accept it when it is ours.”

Galbriath’s economic theories have always been grounded by morality, preferring to avoid being a servant to flow charts. It is his most insightful side. When many fear to speak in broad terms about current economic problems, where many fear to make connections, Galbraith has pieced the complex puzzle together, much to the frustration of those who believe capitalism should be left unfettered. It is his worthiest legacy.

The Galbraith Interview

You point out it is reforms that have given capitalism a new lease on life. What policies would alleviate the worst aspects of today’s capitalism?

We still have the oldest problem. (That is) to eliminate the cruelties that are inherent in the system. In the United States, and I imagine also in Canada, we still have the terrible problems of the urban poor, of the people who do not make it. I see one of the central tasks of our time is to do two things: to provide a safety net so that in a modern rich society we don’t let people starve, and that we provide the means for escape from urban poverty.

How would you elliminate poverty?

No novelty about that. Two things are absolutely essential. One, that there be a basic safety net. That we accept in a modern society that there has to be a level of income below which people are not allowed to go. I do not join this attack on welfare, this notion the poor should be allowed to starve. Another thing is a strong educational system, which allows people to escape from poverty in the next generation. Those are the two absolute essentials.

Should government just concentrate on ending poverty and abandon universal programmes like public health care?

You can always have a conversation that separates itself from the reality. I think in Canada if some politician or some political group wanted to repeal the health system, they would soon find themselves in considerable disfavour. If they were committed to allowing the poor to starve, they would get a reputation for cruelty that no civilized society would tolerate. And if they started saving money on the schools, as some already have, we would find out how absolutely essential good education is for economic and social well-being. So we have a difference between what is possible in oratory and what is possible in reality … When the axing comes, it is a good deal less popular than it is in the previous rhetoric.

Who do you think, within or outside political movements, represents the socially concerned today?

I don’t speak generally on this. There is in all countries a substantial voting and politically expressive group. In the United States it is the political left, in Britain it is the Labour Party, in France it is the socialists, in Germany the social democrats. They are broadly committed to the welfare state and I think will remain so.

Would you include the Liberal Party in Canada amongst those?

I would include a substantial part of the Liberal Party in the United States. The Liberal Party in Canada, like the Democrats in the United States, have a double orientation, on one hand to the welfare state and on the other hand a more centrist attitude. Both parties have an internal problem to resolve.

Do you think they have lost interest in the welfare state?

To some extent I regret that. We must take some responsibility for human suffering and human well-being.

You don’t see that with the Democrat Party?

I prefer it to the Republicans.

Are some of these policies like welfare reform in the US making it harder for the poor?

I was not in favour of welfare reform.

I grew up in a very poor household but was able to go to the University of Toronto because of various government policies. In fact, they have kept me from destitution. You have written about a culture of contentment that prevents further social reforms. Will it whither?

Those of us who have been associated with the welfare state have made a lot of people comfortable, happy and conservative. We have undermined our own political influence by our success.

Do you think current levels of high unemployment and economic stagnation might erode that contentment?

No, if we suffer another recession there will be a desperate effort to have the government do something about it. The present conservatism is an aspect of good times. We had it in the 1980s under Reagan.

Are we still in good times?

We still have a lot of people who have a problem. We should have sympathy.

Do you see any political parties in Canada who defend the welfare state?

I’ve lived all my life in the the United States and I’ve always avoided coming back to give Canada advice. As I said in my lecture, anybody who does that should have stayed in Canada for his own lifetime. Let Canadians look after their affairs in Canada.

You said the socially concerned don’t seek income equality. I guess that is where you split with socialists?

I accept the inevitable, that people are going to be different in aspirations, ability and luck and probably different in parentage. All of this is going to mean differences in income.

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