March 28, 2016
By Margie Coloian, MSJ
An interview with Ryan, Meili, MD, vice chair, Canadian Doctors for Medicare; and executive director, Upstream. Meili is a participant in the symposium titled A Vision of a Better System: Barriers and Opportunities, which takes place on Sunday morning at the 4th Annual Lown Conference, April 15-17 in Chicago.
Most Americans probably haven’t heard about Upstream, the Canadian organization that Meili heads. Upstream is a movement to create a healthy society through evidence-based, people-centered ideas that focus on social determinants of health to build a healthier society. Upstream’s premise is simple. Address what will have the greatest influence on health—income, employment, education, early childhood development, housing, nutrition and the wider environment.
Why Upstream? Its website elucidates: From the emergency room, to homeless shelters, to the prison system, we see the consequences of downstream thinking all around us. Upstream thinking means investing wisely for future success rather than spending all of our time and resources responding to and perpetuating failure. (See the group’s explainer video on how it got its name.)
Meili emphasizes that “We know that some patients go without and have inadequate resources. “We work with outreach workers, policymakers and different organizations to help patients get the services they need and to get the public’s attention. But more needs to be done, he said. “We need a system change,” Meili insists. “We need to reduce poverty, increase income levels and have greater access to housing.”
A family physician in Saskatoon, Meili works within a publicly funded universal health insurance system, known as Medicare, and is passionate about treating patients in his poor community. “Single payer is a more efficient system. Our system allows patients to get the best care without worrying about costs. Care is based on need, not the ability to pay.”
Canadian health outcomes, too, are very noteworthy, especially in avoiding preventable deaths, Meili stresses. “We compare our outcomes to those of the U.S., which are not good, and then we get complacent,” Meili says about his fellow Canadians. “Our system is imperfect, but it is better than the U.S.’s. However, the Nordic countries’ outcomes are better, and we should be comparing ourselves to the countries that do the best.”
What about the American system? Meili believes that Obamacare has done much to improve care by covering more people. But there remain gaps. He knows that in the U.S., while there is great health care, it’s not always accessible, and health outcomes don’t measure up. He is quick to point to the system’s failure to take into account inequality and inequity when considering health and priorities.
Meili looks forward to meeting colleagues from America and elsewhere at the annual conference in April. He’s interested in learning more about the overuse of technology and imaging, in particular. He also looks forward to hearing Jeff Brenner’s hot-spotting session and about the myths surrounding American medicine.
“Right now, the United States is at an interesting point. Bernie Sanders talks about single payer, and Hillary Clinton is committed to Obamacare. Yet this is a strange moment in your country; there’s polarization, and in fact, things could get worse with health care.”