I read with disbelief the Comox Valley Echo newspaper article from Tuesday April 8th, 2014 by Drew A. Penner titled “Olympic-sized companies chosen to finance and build two new hospitals”. What immediately raised flags for me was the overall positive tone of the article. The size and global nature of these joint venture teams vying for the opportunity to finance, construct and operate our new Comox Valley hospital (and the new addition to the Campbell River Hospital) was promoted in the article as not only necessary, but a good thing for the Comox Valley. Given the current state of global issues including constant warring, political unrest and of course the 2008 recession from which we have not yet recovered and likely never will, this gave me cause for concern. I am developing a healthy skepticism to very large, global scale projects and agreements.
I chuckled at the unfortunate description with “Olympic” sized companies. It should be obvious to everyone by now that the institution of the Olympics is on an unsustainable path. Each new games attempts to outdo the previous and to do so the host country expends unimaginable sums of money on infrastructure and security, whether they can afford such extravagance or not. The recent Sochi Winter games spent an unprecedented amount on their games with estimates and claims widely debated but typically published as $51 billion, and like all contemporary games, a large percentage of this amount (in the billions for certain) was spent on games security. It is common for these host countries to amass huge debt and quite regularly this debt is never recouped. From this point alone I think that using the Olympics as a descriptor for any purpose was unfortunate. As a resume item for the hospital proponents, I would be even more concerned. The stories of Russian corruption and embezzling of funds from budgets that are too large to effectively keep tabs on by infrastructure providers give cause to wonder just who we might be hiring, particularly when you consider that the new hospital will be following a P3 (Public Private Partnership) process where “negotiations are strictly confidential” and we won’t be seeing all of “the books”.
One could write chapters criticizing the both the Olympics and the P3 process and there are many writers more qualified in this regard than me. For the time being, I find myself more concerned about the globalization of just about everything, the inability to manager effectively large institutions, the demise of democracy as it was conceived and the declining usefulness of national (federal) and regional (provincial) governments. These are the current troubling issues for me as I struggle through life, trying to keep up with current events and participating as a member of my community, my province and my country. As the news reports every new story, I see how intertwined all of these issues are and more incredibly, how relevant each of them are. I have been struggling with these ideas for some time now and wondering what to make of my thoughts until this week. I attended a day-long seminar by Mark Lakeman, founder of City Repair from Portland Oregon. The session was titled “Re-Becoming Villagers” and Mark spent the morning half of the session talking about their work and many wonderful projects in Portland, taking back the public spaces of our cities and towns and re-establishing the commons, one block at a time. One of Mark’s many stories jolted me upright in my chair and had me scribbling down notes as quickly as I could. He was talking about his neighbourhood in conjunction with the new efforts of the US government in the area of health insurance. Now I will be the first to admit that I know nothing about healthcare funding and economics, nor what he US is trying to achieve, but I heard what Mark said loud and clear. He and his community got together and determined that given their options, it was going to be better for all of them if they got together and hired 3 doctors and some nurses and built their own facility in their own community to look after their own health needs on a community scale. Of course! Why not if that is an option for them? This was the eureka moment for me and the inspiration to tackle this post. Why could we in the Comox Valley not pool our resources (re-channel our monthly medical premiums) and develop our own made in the Valley health and wellness centre in our own vision, for the people of the Comox Valley, designed by us, built by us and operated by us.
Problems with the Current Process
How much ink could be spent writing about the problems with the current health care delivery system and the creation of health care infrastructure? I would suggest quite a bit! The following questions could be chapters unto themselves, exploring a variety of issues and problems with the current system: How long has it taken to get to where we are at with our new hospital and why has it taken so long? Where are we in the development process and how much longer is it going to take? Will the new product be up to date or already outdated when it is finally completed? Why are we getting what we are getting? Do we even know what we are getting? Will it be what we need in the Comox Valley? Who decided and who is in control? How do the economics work? How much spin-off benefit will the local community get from this $400 million plus investment? How exposed are we to global problems faced by the international consortium doing our local project? How much work will result for local contractors and trades vs. the anticipated “influx of workers filling our hotel rooms.”? How much say will we have in the operations of the new facility? Why do we need Olympic sized companies to make this happen? Will local companies be considered by the hospital P3 company for the hospital operations such as local food suppliers?
Now I have no doubt that the development of a new hospital the way the current health care model is set up is incredibly complicated, but I don’t think that it needs to be. I’ll bet that we could do it differently than where we are presently headed, more effectively, deliver more appropriate medical services with better value to patients, staff and the community at large.
Alternative to the Current Process
In the spirit of the visioning sessions facilitated by Mark Lakeman at the “Re-Becoming Villagers” sessions, let us keep our minds open, out of the ruts and free from the tendency to resist invention by letting go of the “we can’t do that” mentality. As I do in all of my group visioning sessions, I will invite you to leave the room before we start (or in this case stop reading now) if you cannot simply let this tendency go and for at least a moment, let yourself think like a child, for children have the ability to cut to the crux of the problem and make specific and often delightful solutions to the most insurmountable of problems.
Imagine us all coming together as a community, starting with a whole series of potluck dinners, to discuss our community health care goals, needs and desires. Let us ask what is working well and what we love about our current system; what is not working and what are we in need of? Let us again, like children without lifetimes of mental baggage, propose solutions that address these issues, encouraging creativity and respecting all input. Engage the local practioners and the operators of the existing facilities. Use their knowledge and expertise to develop the building program that meets their needs to deliver the services that we desire and require.
One of the interesting stories the Mark Lakeman told was how they are able to do incredible things in their communities with little money by taking advantage of local capital in terms of resources, equipment and expertise. Within most communities you will find, if you take the time to look by going door to door and meeting your neighbours, engineers and designers, equipment operators with their own equipment, materials suppliers and tradespeople, many of whom would be delighted to get involved in a local project just to be a part of it! I am pretty sure that we have a rich and qualified resource of many, if not all the expertise that would be required to put together a new facility and to operate it to meet all of our needs and expectations for now and for years to come.
In terms of financing, if we made use of the resources that are collected monthly in terms of healthcare premiums, we would effectively be working towards a manageable and ultimately sustainable healthcare system for our community. If it works for Mark in his community, why would it not work for us in ours. Living within our means would become our issue and not something dictated to us and managed from somewhere else.
How Do We Get There?
What would it take to get to this? Open minds for starters and a willingness to improve our current situation. Just as important would be a commitment to take back responsibility for our health care, keeping it up to date, relevant and well managed. No doubt a very important factor would be convincing the current health care authorities to relinquish their responsibilities for our health care. We would need strong local leadership with a willingness to be inclusive with a skillset that fosters collaboration. Starting with a few potluck dinners to kick this idea around a little bit, I would bet there would be a ground swell of passion to take this on and find a way to make it happen.
I look forward to your comments.