A new report commissioned by the Canadian Medical Association (CMA) looks at the broader health impacts of COVID-19 in Canada. The November report, called A Struggling System, explores a range of growing problems, from mental health issues to substance abuse and deteriorating social determinants of health. Sadly, the report also confirms a fact that many have suspected since the beginning: that delays in care have led to thousands of preventable deaths.
“Although it is not surprising that more Canadians died in 2020 than in a typical year,” the authors write, “the number of excess deaths was greater than can be explained by COVID-19 alone. While there may be several drivers of these excess deaths, delayed or missed care due to shutdowns of services and lack of sufficient capacity in overburdened health systems may be a contributing factor.”
After analyzing the data, the authors estimated that delayed and missed health care contributed to more than 4,000 excess deaths not related to COVID-19 between August and December 2020. Needless to say, the total number of preventable deaths over the pandemic to date is likely much higher.
But just how bad are the delays? Well, the report estimated the backlogs for eight selected procedures. Of those eight procedures, breast cancer surgery had the lowest backlog at 46 days, while hip replacements had the highest backlog at 118 days.
Source: A Struggling System, Deloitte
These may sound like long waits on their own, but keep in mind, these are just the extra waits caused by COVID-19 and lockdowns, not the total wait time.
To estimate total wait times, we can add the backlog figures to pre-pandemic numbers from the Fraser Institute’s 2019 Waiting Your Turn report. The report notes that the national median wait time for both knee and hip replacements in 2019 was 28.6 weeks (200 days), and the median wait was 18 weeks (126 days) for cataract surgeries. Adding these to the backlog numbers above, we can estimate current total wait times to be 304 days for knee replacements, 318 days for hip replacements, and 231 days for cataract surgery. Long story short, it’s not a great time to be on the market for medical procedures.
The backlog can eventually be cleared, of course, but clearing it comes with a hefty price tag. According to the CMA report, the cost to return to pre-pandemic wait times is estimated to be $1.3 billion.
And the cost for eliminating the wait entirely? Well, let’s not get ahead of ourselves.
Diagnosing the Problem
If there’s one silver lining to come from this report, it’s the fact that people finally seem to be waking up to the negative repercussions of lockdowns. For months, doctors have been warning about the unintended consequences of shutting down “non-essential” services, specifically the life-threatening risks associated with curtailing medical care. But maybe it takes some sobering data like this to show people just how much of a toll lockdowns have taken on our health and well-being.
And yet, while lockdowns have certainly played a large and inexcusable role in these delays, they are not the only cause of the problem. As the report notes, another factor that led to these disastrous results was a lack of sufficient capacity.
Here, of course, is where the politicians and pundits make their point. In their view, the root of the problem is a lack of funding. If only the system had more investment, they reason, healthcare shortages like this wouldn’t be an issue. Once this premise is accepted, the debate over healthcare devolves into an argument over exactly how much more funding is needed to “fix” the system.
The issue with this policy prescription is that it stems from a misdiagnosis of the problem. In reality, the dismal results in this report are not an indication that the system “just needs more funding.” They are an indication that socialized healthcare simply doesn’t work. Indeed, the shortages and delays that have become commonplace in Canadian healthcare are not happenstance. They are the natural result of prohibiting private markets and replacing them with top-down central planning.
This is the most frustrating part of healthcare politics in Canada. No matter how poorly the system performs, no matter how many people die, Canadians refuse to even consider the possibility that the problem lies in the fact that the system is centrally planned. The cry is always for more funding, and never for more freedom. But throwing more money at a broken system will never fix it. The only way to truly improve the system is to allow the free market to meet people’s needs.
Central planning is what got us into this mess. It will not be the thing that gets us out.
The Seen and the Unseen
Putting the broader problems with socialized healthcare aside, there’s a more specific lesson to be learned with respect to the shutdowns. The lesson, to put it simply, is that well-intentioned measures often have harmful side-effects that can be difficult to foresee. Frédéric Bastiat famously pointed this out in his 1848 essay, That Which Is Seen and that Which Is Not Seen.
“In the department of economy,” he wrote, “an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause - it is seen. The others unfold in succession - they are not seen.”
The excess deaths associated with delays in care are a tragic reminder of the tremendous unseen harms that lockdowns have created. Of course, it may be tempting to downplay these effects and double down on non-pharmaceutical interventions. But perhaps, instead, it’s time to resurrect an old principle of medicine that seems to be all but forgotten: Primum non nocere.
First, do no harm.