I wake up one morning and I actually agree with a hospital CEO. The world changes overnight.

Perhaps you've heard about the much-publicized decision by some hospital CEOs in Ontario to free up beds by transferring patients awaiting placement in long-term care beds to other regions of the province where these beds are available? If so, then you have heard about the fee—according to one CBC report, as much as $1200/day—charged to anyone who refuses the transfer.

It's a difficult issue. All Canadians should get health care in a timely fashion, and they should get it in their own neighborhood, within reason. But at present the system is clogged with long-termers occupying acute-care beds. On the ground, this means that surgeries are being cancelled because there are no beds to put the post-op patients in; it means that emergency room beds are chronically filled with people waiting to make it to wards inside the hospital; and it means that acute-care patients are transferred to other facilities because they literally can't get into their own hospital.

Many commentators have pinned the blame on a lack of long-term beds in the community, which is indeed a problem. But whose problem is it? I would argue that it is the acute-care patients who are getting squeezed the most. These are the folks that are jostled aside by patients waiting for long-term placement. What to do about the problem? Well, one obvious solution is to keep blaring the Medicare
anthem—more money, more money.

I've often heard it said that "these old folks paid their taxes all their lives and they deserve the system to come through for them when they need it." Meaning, I suppose, for the old anthem to cue up and a triple-decker geriatric facility to be built in their hometown. But as Canada's social programs continue to balloon, with the current crop of elderly people as the chief beneficiaries, I wonder: is this really the answer? Have the geriatric in this country really paid their fair share of
taxes?

I'm young and I say no. I'm the one who's going to finance these facilities. Me and my small cohort are going to fund this much larger cohort's days in the Manse or the Wood. Furthermore, I'm sure that the system, so much maligned, isn't going to function in the same way when I'm old and will have paid my fare share of taxes. The system will have reached a crisis, and on that day we'll recognize that the system is not our keeper from cradle to grave. We'll have priorities, we'll pay for what's right and reasonable, but we won't expect a cheque for everything that "impacts our health." We'll understand that Medicare can only do so much,
should only do so much.

When we get old, is it our right for Medicare to care for us? Or is it the responsibility of our loved ones to do so? Is it right for us to receive a $1200/day bill when we as family members refuse to provide that same care ourselves? Is it right when the system offers us a long-term care bed but we refuse, on the principle that we deserve to have our loved ones conveniently cared for in our backyard?

The issue isn't simple. Most people don't really think Medicare should do everything. Yet those people who would be shipped to distant facilities have families that would find it difficult to make a several-hour commute. That is, of course, if they even have a car. I'm not heartless, but I'm also not naive enough to know that there are people out there who are merely holding out for a better facility in town. I also know that there are a large number of people who want to
dump their relatives and have Medicare pick up the tab. This isn't always true—some people definitely need the care, and some have no one else to provide it. But my experience of this issue isn't merely academic.

I've had a patient come to me, saying, "Doctor. You've got to talk to the hospital. They're going to start charging me for my husband's care. I can't take him home, and I can't afford it."

"Why can't you take him home?"

"Oh, Doctor. He needs his puffers and he's confused sometimes."

He needs his puffers.

I said that I wouldn't be calling the hospital. I told her that it was a matter between her doctor and the hospital and her MP. She reluctantly agreed to a transfer to a facility about an hour from her home. She felt wronged and resentful. She told me that she had been a taxpayer all her life.

Me too, I thought. I felt that the system had done the right thing. A bed had been found. Not in her backyard, but a bed had been found. And that bed wasn't permanent—as soon as another bed opened up locally, he would be transferred. Through it all, he would get his puffers.

The fees are high, I admit. They garner a lot of attention, and I think the point would be better made by a token fee, say, of $100. It's the principle of the fee that's important, the idea that care is not free—as much as you want to trumpet Gramps' taxpayer status—and that there are costs for your refusal to work within the system.

Who needs the hospital bed more, a man convalescing from a heart attack or someone with Alzheimers who wraps his peas in Kleenex and hides them under his bed? Some would say this is ageism. I say it is pragmatism. The bed is expensive: how are we going to spend that money? I admit it's traumatic to send one's Grandfather to Etobicoke when he's from Kingston, both for family and patient. But no more traumatic for the poor ICU bloke who couldn't crack the bed blockade and was booted to Toronto.

Maybe it's just me, but I think we should have to pay for the care of our aging parents. Maybe we shouldn't have the system take them off our hands, at great expense to us in the end. Maybe we should send the message that a bed costs a lot of money and this is how much. But what's really interesting is that this message is causing such an outcry.

Didn't everyone already know that this is an expensive problem? Or is actually charging someone too overt an act? Much better to bury it in a tax bill that only partially covers the real cost. That way, as taxpayers, we're all entitled to the moon.