October 21, 2010
The Saskatchewan Roughriders became embroiled in a rather dumb controversy this week over magnetic resonance imaging scans (MRIs; a MRI machine is pictured above) for injured players Rob Bagg and Luca Congi. Bagg and Congi received MRIs more quickly than they would have if they weren't football players, and some have seized on this as a chance to argue about the importance of universal health care and absolute equality or if everyone should have the option to pay for quicker service. Both sides of this debate are missing the point.
Yes, athletes receive special medical treatment. This isn't really news. Most professional athletes receive more specialized care than the average Joe, and most teams tend to have an extensive medical staff for good reason, as there are so many severe injuries in sports. Yet, every once in a while, someone jumps on a particular instance of this and tries to use it to make a political point. A similarly stupid controversy was stirred up around the Calgary Flames' H1N1 shots last year, and that at least had a bit of a point to it. as it was questionable whether those players (not in the main risk groups for H1N1) should receive publicly-distributed shots before those who might be at more risk. MRI scans are much less of a debate, as there's no question that both Bagg and Congi required them to properly analyze their knee injuries.
Both sides attempting to make political hay out of this have key flaws in their arguments. Those that would argue that the same waiting queue should apply to every single MRI patient and that no one should be able to go around the system miss that some MRIs are more urgent than others. Football players' MRIs aren't the most urgent ones out there, as they're not usually life-threatening, but they directly relate to their ability to work, so they're certainly up there with the typical Workers' Compensation case. If these folks won the argument, professional sports as we know them might disappear; it likely just wouldn't be possible to provide athletes with the specialized and urgent care they needed through a one-size-fits-all health care system.
Those who would argue that average citizens should have the same ability to pay for off-hours MRIs might have more of a point, but they miss the key element here; this isn't an economic or political issue, but rather an urgency issue. A system that bases the urgency of your treatment entirely on how much money you have has just as many fairness problems as one that doles out MRIs solely on how long you wait in line. This doesn't even need to be a political issue or a debate about the ideal health system, though; it's just an ongoing issue specific to professional sports that doesn't necessarily apply to health care as a whole.
Here are the key details from The National Post's story on the subject:
"The team uses an average of about six MRIs a year, and they are either scheduled where there have been cancellations, or after regular hours, which stretch from 6:30 a.m. to 11 p.m. weekdays and until 3 p.m. weekends, Mr. Carney said.
The extra money, meanwhile, allows the system to fund more scans after hours that can be offered to patients on the waiting list. Emergency cases get MRIs immediately and other patients queue for two days to three months depending on the urgency, he said.
Workers' Compensation patients are treated under a similar system, with about 250 obtaining speeded-up MRIs a year, Mr. Carney said."
There are a few crucial things to notice there. First, the Roughriders are not jumping into the regular queue. Their MRIs are conducted in the early-morning hours and weekends when MRIs would not normally be performed. You could argue that MRI machines should be run around the clock to serve the general public more quickly, but that would take a considerable amount of funding; I've worked with nuclear magnetic resonance devices that operate along similar principles before, and they're highly complex machines that require trained and experienced staff.
Second, it's not like the Roughriders are taking advantage of the public system; in fact, they're giving it a boost by paying triple the going rate for their off-hours MRIs. That extra funding can be used to provide off-hours MRIs for patients in the regular system. Third, MRIs are not conducted on a first-come, first-served basis; they're done on an urgency basis, so it isn't like the principle of offering some people MRIs before others is completely foreign to the system. Finally, the Riders aren't the only group using this kind of system; Workers' Compensation patients receive similar treatment, and they're using far more MRIs per year (250 vs. six).
The Workers' Compensation comparison is apropos in more ways than one. For professional athletes, their sport is their job and their way of earning a living. Their physical health is absolutely essential to their continued ability to draw a paycheque; it's not like they can switch from a floor job to a desk job thanks to a bad leg. Football players in particular also work in what's likely one of the most dangerous environments in North America; beyond the risk of concussions and the long-term physical and mental issues those can create, they're also extremely vulnerable to knee, shoulder, back and nerve injuries that have the potential to paralyze them.
The dangers of their workplace environment necessitate that football players receive excellent and prompt medical care. I think most would probably agree that in an ideal world, that kind of care would be immediately available to everyone regardless of their job or their ability to pay. We don't live in an ideal world, however, so we have to prioritize. The Riders' situation, the Workers' Compensation one and the general approach of prioritizing urgent MRIs are all attempts to come up with the best solution possible for an imperfect world, one that offers care for everyone but prioritizes the most time-sensitive care.
Since it's clear that Bagg and Congi needed MRI scans, there are a few options the Riders could have pursued for their treatment. They could have followed the standard health system plan, which probably would have seen them waiting around for months. They could have sent the players to a private clinic in the province, or if one wasn't available, flown them to the U.S. for treatment. Or, they could go with the deal they have, which allows their players to receive MRI scans through the public system more quickly than normal, but only at times when the MRI machines are not normally in use (cancellations or during extended hours) and at a premium price that helps pay for others' treatment. The latter seems the most reasonable to me; instead of taking an end-run around the existing system, it's working within it and working to improve it for others. To me, that's a good thing.