Banana Republic?

I am often asked whether I like living in Winnipeg or Toronto better. Sometimes friends assume that San Francisco or Zurich must for sure have been better places to live in than the prairies. My answer usually is that each has its pros and cons and that these are so entirely different places that one cannot fairly compare them with each other. Feeling the chill of Pacific fog sucked through the Golden Gate on a hot summer day, paying over 5 Swiss Francs for a tiny espresso in a coffee shop by the lake, stuck bumper to bumper on the 400 on a Friday evening trying to get to cottage country, or starting to talk to a foreigner on your dog walk in Assiniboine parc just to discover that you have the same friends and acquaintances, have all a totally different vibe, are unique and not comparable.

The charm of Winnipeg is it’s being a confined, “little big city” centered in a huge agricultural area. This, in my opinion, heavily influences its atmosphere and the mentality of its population: a bit heavy and down to earth, but hearty and friendly, helping each other out. Another side of this is that Winterpegers (and Manitobans) often sell themselves under their value, and tend to be self-centered in the following way: They grow up in Winnipeg, go to school in Winnipeg, study in Winnipeg, maybe spend one year (if any) outside of Winnipeg, then return, get a job in Winnipeg, raise their children in Winnipeg – and eventually are laid to rest in Winnipeg. No wonder everybody knows everybody here – and this can be a problem – which brings me to the Banana Republic.

The Banana Republic starts when the everybody-knows-everybody mentality creates perceived or actual conflicts of interest and affects decision making in matters that should be driven strictly by data and policies. Unfortunately, health care is no exception to these pitfalls. In fact, the more political the decision-making matters become, the greater is the risk that decision making is influenced by such conflicting relationships, sometimes as heavily as bordering on abuse of (private) connections. Public-private collaboration (to use government lingo) is in and serves as a scapegoat for at least borderline behavior. Too much of that and you end up with a Banana Republic. Sometimes lately I had the choking sensation that we may be, if not there yet, not far from being there.

But the Banana Republic does not start nor end with government. We all are at risk of creating a Banana Republic. We all including our highly esteemed experts, researchers and scientists are at risk of falling into the trap of not following due process, but rather using connections to jump the queue and get what we want (for whatever reason). And if only one individual (whoever it may be) is successful with this approach, it sets a precedent, and animates others to follow the slippery trail leading to Banana Republic.

Let’s be wiser than that, as tiring and frustrating as it may be. Nobody will gain on the long run in a Banana Republic.  Let’s stay humble, stick to facts and data, argue persistently to the content, and follow due process, even if it is cumbersome and takes longer. Winnipeg, Toronto, San Francisco, Zurich – the location may change, but we remain who we are.  

3 thoughts on “Banana Republic?

  1. Your comments are on the mark. For the past 5 years we’ve struggled with a bureaucratic structure that seems politically directed to dismantle a public health system through under resourcing in favour of parsing out services to local private companies. Covid advanced the argument that we can’t trust the public system to perform. This becomes a self fulfilling prophesy when you control the purse.
    We’ve seen this with the Air Ambulance and more recently with sleep medicine and orthopaedic surgery.
    It was recently suggested by waitlist task force personnel at a meeting to which I was summoned , that they might be able to arrange a rescue through private US contractors to address the waitlist in MS clinic. I pointed out that the waitlist was a product of the government’s complete negligence in providing resources which was eventually corrected only after engaging the national and local media. The MS clinic will be fully staffed by October.
    Private enterprise is a necessary component of health care everywhere. It becomes malignant when it is allowed and encouraged to provide services and encroach on public policy. A patient becomes a product to be monetized.

    If one needs proof look south of the border. Americans pay twice our per capita cost for health care and have a declining life expectancy , two years shorter than Canada.
    The most heavily weighed company on the Dow 30 is United Health Group who’s Wikipedia entry looks like a criminal rap sheet. Find a major private provider that hasn’t been sued in the last 5 years by multiple states for fraud , systematic over billing or knowingly contributing to the opiate epidemic.
    Banana republics have a consistent feature. Business interests trump public interests. We need businesses but we can’t rely on them to be accountable , compassionate or even moral.
    According to WHO there are 28 countries ( all public systems) that outperform Canada in multiple respects. Only one spends more per capita on health care. If our health care system is to improve we need more doctors to engage , lead and develop some conviction or at least stop being complicit.

  2. I am in agreement with your comments Dr Renner. It has never been more important to make sure that policy is based on sound advice sought out in a unbiased way, and advancement is based on intellect and the ability to think independently and challenge faulty ideas rather than nepotism.

    I have witnessed the politicization of both the provincial civil service in Manitoba over the last 20 years with purges each time the government changes and a lack of ministerial trust of bureaucratic and professional expertise within their ministries.
    In Medicine, physician leadership have found themselves perceived to be biased with respect to assessments of health care needs whether rightly or wrongly.

    We need to insist on transparency and due process, in hiring, appointments, decision-making and professionalism.

    If Covid 19 has taught us one thing, it is that top- down decision- making in a silo by an old boys club is not optimal.

  3. Thanks Drs. Renner, Roberts and MacDonald for your comments. Do you believe this is a recent phenomenon or restricted to private enterprise ? Good or bad (depends upon how you look at it) connections will always remain paramount and supersede evidence and data. In Manitoba, they have for the last 20 years at least.

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