All I want is a good death. Is that too much to ask?

Like most Canadians, I’d like to die in my home surrounded by friends and family.

Or second best, a home-like setting like the lovely Kamloops Hospice House.  That peaceful setting is where my wife spent her last days as she was dying of cancer.

Kamloops Hospice House. image: CFJC Today

But contrary to Canadian’s wishes, only 15 per cent die at home.

More often we die in hospitals; more than comparable countries.  Most Canadians, 61 percent, die in hospital. Far more than the Netherlands at 30 per cent. And although we like to boast about our health care system, only 20 per cent of Americans die in hospitals according to a report from the C.D. Howe Institute (Globe and Mail, Oct. 26, 2021).

We die in hospitals in the most unpleasant way, hooked up to tubes and machinery that unnecessarily delays the inevitable. Our lives may be prolonged slightly but the declining quality of life is hardly worth the price of suffering.

Canadian cancer patients have the highest rates of hospitalization in their last six months of life (87 percent), compared to England (83 percent), the Netherlands (77 percent) and the US (75 percent).

It’s so unnecessary.

Cancer patients whose condition is stable or reacting positively to treatment don’t require hospitalization. Those dying of cancer, as was my wife, typically require assistance with activities of daily living only in the final weeks or months of life. Terminal cancer patients differ from those dying of almost every other illness -those dying of other illnesses typically require assistance for many months or years before they die.

Older Canadian cancer patients are more likely to die in hospitals and less likely to receive palliative-care.

Palliative care primarily focuses on improving comfort and quality of life, often avoiding hospital-based, invasive, costly and potentially inappropriate care. Palliative care is preferably delivered outside of acute care settings, including in patients’ homes.

It’s not the fault of doctors in hospitals or because healthcare workers are unfeeling or uncaring. It’s because of the way the system is structured.

There are too few palliative care beds.  Canada has one-half the number of hospice and palliative-care beds as the United Kingdom. 

Treating patients at end of life in hospitals, rather than palliative care beds, is expensive.

Our per capita hospital costs are US$21,840. Canada’s costs are 18 per cent greater than that of the U.S., 100 per cent greater than Netherlands, and 233 percent higher than England. Canada’s relatively poor performance in terms of costs and quality of end of life care is clearly related to the high use of hospitals.

The authors of the report suggest the following remedies:

1 Canada must stop treating end-of-life care as acute care.

2 Palliative and end-of-life care must be provided across multiple healthcare settings. It cannot be the sole responsibility of hospices and palliative care facilities.

3 Training for clinicians, caregivers, even for patients must be provided recognize the end of life period.

We must have a frank discussion about death. Unless we know the signs of death’s knock on our door, we will be poorly prepared.

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One big grid is the solution to secure electricity

Professor Michael D. Mehta of Thompson Rivers University makes a number of good points in his article regarding a secure electrical system (Armchairmayor.ca, March 6, 2021).

However, he’s thinking in the wrong direction when he suggests that the solution is microgrids.

image: Student Energy

The recent electrical blackouts in Texas have focused the problem of electricity security. In a state that prides itself on independence and abundance of energy, it was the height of irony that they should suffer from an electricity shortage that left people freezing in the dark.

Texas’ problem was that its electrical grid was too small. In an attempt to avoid federal regulation, Texas constructed a grid that is a virtual island.  So when the cold snap hit, when wind turbines froze and natural gas generators quit, they had only themselves to rely on.

But not so for all of Texas. El Paso in eastern Texas did just fine, thank you. That’s because they were not connected to the Texas grid but rather to the much larger Western grid.

You see, there are three major electrical grids in North America: the Eastern Grid, the Western Grid and the Texas (ERCOT) Grid, El Paso picked a winner.

The big problem facing green energy is storage. Wind turbines and solar panels are great when the wind blows and the sun shines. But they usually produce too much power when we don’t need it and too little when we do. Storage seems like the answer.

However, as Professor Mehta mentions, no affordable storage system exists with the capacity needed. A number have been proposed; batteries, small-scale pumped hydro, compressed air, and flywheel technology.

Mehta suggests that the solution is not a bigger grid but smaller microgrids: “A microgrid is a local network of generators, often combined with energy storage.”

“Such systems can increase reliability and drive down carbon emissions when renewable energy is used,” says Mehta. “When combined with smart meters that reconcile inflows and outflows of electricity, microgrids provide real-time energy data. When a microgrid goes down, it only affects the local region and not an entire state or province.”

With one big continental grid, there is no storage problem and no one has to go without electricity.

One big grid solves the storage problem by virtue of its size.

The demands on one big grid are predictable. Cold snaps can be are forecast. In that case, thousands of generators, from big hydro dams to small run-of-river, solar and wind generators can be activated.

On an ordinary day, demands on one big grid are even more predictable. As people rise and shine on the Atlantic coast and turn on toasters, heaters, air conditioners in the summer, the demands on the West coast are minimal.

As the sun rises across the four and one-half time zones of our continent, the demand follows the sun. While the demands are not exactly constant they are predictable.

Of course, Canada doesn’t have a cross-country grid and neither does the U.S. Most of our connections are oriented in the worst way: they are North-South, in the same time zone where demands occur at the same time.

As Professor Mehta says, transmission lines are costly to build and lose power. The power loss can be minimized through use of High Voltage Direct Current transmission lines.

The construction of lines is a political problem, not one of cost. When the Trudeau government decided that the Trans Mountain Pipeline was in the national interest, he bought it and built it.

I was wrong about the Site C dam

Despite what I said earlier, Site C is a mistake. The massive dam is being built in the Peace River region of northeastern British Columbia.

image:

Dams are not a mistake. Hydroelectricity has made B.C. the envy of the world with cheap, renewable electricity produced with nothing but water falling through turbines.

Unlike other renewable sources of electricity, hydroelectricity is always on. In 2015, I effused:

“Unlike other sources of green energy, hydro power is ready to go when the sun doesn’t shine and the wind doesn’t blow. Water–filled dams are like a huge battery, fully charged, ready to produce power at the flick of a switch.”

Can you really have too much green electricity?, I thought.

Dams are good but not Site C. Let me list the problems:

The first is the cost. As a concept, the cost of Site C started out at $3.5-billion. When plans were actually drawn up, price tag rose to $6.9-billion. Then the estimate rose to $8.8 billion after the BC Liberals approved it in 2014. When the NDP government decided to go ahead with the dam, the estimate was rose to $10.7 billion. The costs are sure to go up further due to the next vexing problem:

The soil at the dam site is unstable. Soft sedimentary shale underlies the construction site and the problem was evident from the start. Harvey Elwin, one of the country’s most experienced dam engineers noted that he’s never seen such appalling foundation conditions for a project of this scale. The Canadian Centre for Policy Alternatives found that a proposed fix would that would make matters worse -pouring massive amounts of concrete into the site would exacerbate instability and “could cause the notoriously unstable shale rock to move even further.”

Then there is the problem of demand. By the time the dam is scheduled to be completed in 2025, there is expected to be little need for the power it produces. Right now, we have 50 per cent more electricity than we need. And that doesn’t include the large quantity available under rights of the Columbia River Treaty.

To recover the costs of the dam, the price we pay for electricity will not be cheap. The new price will be $120/MWh, even more than the $87/MWh from Independent Power Producers -a rate considered to be too high; and much more than the price of $30/MWh under the Columbia River Treaty.

The politics of the dam, always convoluted, are simpler than the construction of the dam. BC Liberal Premier Christy Clark vowed to push Site C through in 2014. When NDP Premier Horgan inherited the project, he claimed that the project had been developed beyond the point of no return.

The real reason Horgan went ahead with Site C was because to cancel it would have given the opposition BC Liberals a chance to tag the NDP with the usual “anti-business” label. And the BC Liberals could hardly oppose a project they had started.

Now that Horgan has a majority government he will reconsider the future of the dam, cut his losses, and pull the plug on Site C.

You heard it first here.

Mexico could ease Canada’s cannabis problem

The plan to drive illegal cannabis growers out of business is going slowly.

The problem is supplying enough legal cannabis to lower retail prices. Eventually illegal sellers will be a quaint memory, something like the bootleggers of alcohol of the past. For that to happen, a plentiful supply of cannabis has to be available and it’s going to take years for that to happen with Canadian growers only.

image: Greenhouse Canada

The cost of legal cannabis remains nearly 50 per cent higher than potleggers according to crowd-sourced data obtained by Statistics Canada. The cannabis store Kamloops seems to fairly well-stocked but in some parts of Canada like Quebec, stores have had to close on some days of the week due to lack of supply.

One way to lower retail prices immediately is to reduce taxes; a solution favoured by the cannabis industry. In addition to provincial sales taxes, the federal government charges one dollar per gram excise tax and an annual cultivation fee of 2.3 per cent of revenue.

Some jurisdictions in the U.S. with legal cannabis markets, such as California, are considering such temporary tax reductions to lure customers away from the illegal market after disappointing early sales.

I don’t think lower taxes are the solution. The whole idea of legalization of cannabis is generate revenue so that other taxes could be reduced. Like other “sin taxes” on recreational drugs such as tobacco and booze, taxes on cannabis provide revenue on a product not currently taxed.

Regardless, Canada has no intention of following the U.S. lead. A Canadian Finance Department spokesperson said: “There are no planned changes to the existing duties at this time (Globe and Mail, February 4, 2018).”

Another way to reduce legal cannabis prices is to increase supply.

Mexico plans to legalize cannabis. The new interior minister of the Obrador government has introduced draft legislation to regulate cannabis. Mexico has been studying Canada’s model of issuing licences for the cultivation, processing, packaging, sale and possession of cannabis.

Mexico has something going for it that Canada doesn’t -climate.  Cannabis doesn’t need to be grown in greenhouses there. The president of Mexico’s National Association of Cannabis Industries says:

“We’re going to be able to create a new industry based on new regulations, to produce cannabis for the rest of the world – our geographic situation and our labour [pool] gives us a major advantage (Globe and Mail, November 8, 2019)”

Enthusiasm is mutual on this side of the border. Canada’s Canopy Growth Corp. is looking at investing in Mexico. Their co-CEO said:

“We think [Mexico] is a real opportunity. When you’re on both sides of America with really well-positioned products, this could be a very good platform to reflect both sides of the border with the U.S. and enter an economy that is substantial.”

However, Mexico faces hurdles. Much of Mexico is controlled by drug cartels who oversee the growth of illegal marijuana. Seizing control of agricultural land will be a challenge. Also, Columbia is also poised to compete in the legal cannabis market and have a workforce experienced in its growth.

Of course, Canada’s fledgling cannabis industry needs to be protected but controlled importation could help our supply problem.

Provincial health ministers should stop bickering

The provincial health ministers should resolve in the New Year to stop bickering, take the money from the feds, and use it as intended.

 

It’s a recurring bad movie says Canadian Medical Association president Granger Avery: “The Groundhog Day-type discussions where political leaders bat around percentages and figures at meetings in hotels have to stop. Our system needs better, and most important, our citizens deserve better (Globe and Mail, Dec.19, 2016).”

The provinces have had thirteen years of increases from the feds at 6 per cent a year to improve health delivery. “The transfers have been growing quite generously,” says Livio Di Matteo, a health-care economist at Lakehead University in Thunder Bay. “If you go back to about 2007, if you look at public-health spending, which is largely provincial, it’s grown about 40 per cent. The Canada Health Transfer to the provinces has grown about 70 per cent.”

We need to spend smarter. Canada spends more on health care than Australia, for example, with poorer outcomes as measured by life expectancy and infant mortality.

The provinces have not fixed the problem during times of plenty and now are faced with problems of an aging population. In addition to increased funding at 3.5 per cent a year, the feds have offered $11.5 billion for home care and mental health. I don’t know who writes the province’s absurd scripts: let’s refuse the offer, even though it’s what we want, because we want more.

Provincial health ministers don’t get it. B.C. Health Minister Terry Lake worries that if B.C. were to take the money offered, and start home-care programs, that the programs wouldn’t be sustainable when funding dries up. That would be true if hospital costs remain the same when home-care programs are added.

Home-care programs would reduce hospital costs. Hospital beds cost $1,100 per day whereas home care is one-quarter that cost according to the Canadian Institute for Health Information. Seniors take up 85 per cent of those expensive hospital beds and one-half of them remain in beds even though they are well enough to be moved because there are no long-term care facilities or home care.

Take the money spent on hospitals and spend it in the community. That would mean that four seniors would be cared for at the same cost as one in a hospital -and they would be happier.

The politics and perception of health care would have to change. Hospitals have become a measure of a politician’s success because they are highly visible monuments to health care; something that you can be sure the B.C. minister will point to often in the campaign leading up to the provincial election next May.

It’s a problem of perception, too. Home care is virtually unseen except by the few affected. It’s hard to point to the thousands of seniors happily living at home as a measure of success. British Columbians will have to change perceptions of health, from hospitals as shrines were doctors are the high priests, to a flatter hierarchy where care is diffuse and in the hands of other professionals.