Wednesday Morning Rant

This is not going to be a SOTU post. I managed to stay awake for it - and it was very good and I recommend you watch it if you missed it (or at least watch the conclusion) - but it's too late to write anything about it that will be worth reading.

While "government efficiency" is usually viewed as an oxymoron and said with one's tongue firmly planted in his cheek, it does exist in some cases. Where the thing in question is something that the citizens of the country might want or - even worse - need, the wheels of government tend to grind very, very slowly. These things are also how most people interact with the government and so it is the most common perception. There is, however, an opposite scenario.

When the thing is for the government's own benefit, it can move quite quickly. When the thing is for the government's own benefit and bad for the citizens, it can move in the blink of an eye. It's all about motivation. For a prime example of this, we can cast our eyes north and look at Canada, and specifically at Canadian medicine. Medicine, after all, is something people tend to want and need - and in Canada, it's mostly state-owned.

It is no secret that "Canadian medicine" and "waiting" have gone hand-in-hand for a long time. Late last year, the Fraser Institute published a study about medical wait times in Canada. The findings can be summarized in one word: bad. They break it out by procedure category and in two pieces: the amount of time between referral by a GP to a specialist, and the time between seeing a specialist and beginning treatment. I won't go over it exhaustively, but will pick a few examples.

At the low end of the waiting list is oncology. "Radiation Oncology" has a 1.8-week median wait time from referral to specialist, and a 2.4-week wait time between specialist visit and starting treatment for a 4.2 week median total. "Medical oncology" comes in similarly, at 2.2 and 2.5 weeks, for a total of 4.7 weeks. Canada has been working on cancer, and it shows.

Outside of cancer treatment, which is an outlier, cardiovascular surgery is the next-lowest. It has a referral-to-specialist median wait time of 8.8 weeks and median specialist-to-treatment time of 1.9 weeks - if it is considered "urgent." If it is considered "elective," the latter median wait time is 10.8 weeks. So either 10.7 or 19.6 weeks total. Not great. I hope your ticker isn't too bad. But it could be worse. You could need gynecology.

Gynecology has a median referral waiting time of 25 weeks, and a median wait time of 15.6 weeks after than for treatment to begin. 40.6 weeks. Nearly 80% of a year spent waiting for many gynecological procedures. If you're looking for a "War on Women," don't bother looking on this side of the border. Just cast your eyes El Norte.

But that's only one side of the story. There are parts of Canadian medicine that are astonishingly fast and efficient. You might wait months for gynecology and nearly a full year for neurosurgery, but you won't have to wait for everything. You will not, for example, have to wait to die. Canadian medicine is nice and quick on that front. Yes, of course this is about MAID - "Medical Assistance in Dying." It's Canada's state-sponsored Kevorkian program.

According to the recent report from Ontario, MAID has remarkable efficiency since the mandatory 10-day cooling-off period between MAID request and execution (literally) was repealed in 2021. Per the report, 2024 saw major speedups. Of 4,528 Ontario MAID requests in that year, 3,749 of them - 82.8% - were completed within 90 days. That's pretty good as compared to most specialty medical procedures in Canada, but that masks the really high-speed bit.

Of the 3,749 MAID executions, 154 of them (4.1% of completed requests; 3.4% of total requests) occurred on the day after the request. Snappy indeed, but it could still be faster. 65 of those deaths (1.7% of completed requests; 1.4% of total requests) occurred on the same day. Now that is speedy service!

If you need a knee replacement, your combined median wait time in Ontario is about 34 weeks, or 238 days. If you're depressed over your chronic joint pain, MAID can get you taken care of in about a third of that time. If you're really lucky, they'll put your toe tag on you within a week.

See? Efficiency. All it takes is the proper motivation.

posted by Joe Mannix at 11:00 AM

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