In health circles there is a popular theory circulating that goes something like this: Governments are letting the medicare system collapse to pave the way for their private-sector buddies to fill the void and cash in.
As conspiracy theories go, it’s catchy, and almost believable.
Except for one thing: The premise means that governments actually have a plan. If only!
What we are seeing play out is not a nefarious plan, but the opposite: No plan at all. A total absence of vision.
After years of malignant neglect, there are many glaring problems: 6.5 million Canadians without a family doctor, overflowing emergency rooms, lengthening wait times for surgery, inadequate home care and long-term care options for an aging population, not to mention a sickness care system disconnected from the social safety net.
Many of these problems are structural and administrative in nature, but above and beyond that, they are political. And nothing is worse than politicians fiddling incessantly with structure. Witness Alberta, with its dizzying merry-go-round of centralizing and decentralizing that has achieved what, exactly?
We don’t lack the money or ability to fix the health system’s problems, we lack imagination and will.
By micromanaging the health system, offering up knee-jerk responses to every little problem that crops up and makes itself known in a newspaper headline, our political leaders have left the system largely rudderless.
Are private businesses looking to cash in on this chaos? Of course they are. That’s what entrepreneurs do: Look for opportunities.
Two of the most controversial (read: high-profile) moves have come from Maple, which offers virtual care, and from Shoppers Drug Mart, which is aggressively rolling out primary care clinics in its stores. (Both are owned at least in part by Loblaw.)
What these private businesses are doing is offering health consumers something the medicare system doesn’t anymore: Access and convenience.
The response has been telling, with swift calls to shut down these initiatives because they violate the principles of the Canada Health Act by charging user fees for “medically necessary” care.
If we don’t like this incursion by private business into health care, the sensible response would be for the public system to offer the same level of convenience rather than condemn Canadians to a lack of health care access in the name of medicare purity.
Or, better yet, the public and private systems could work together. At least three provinces have hired Maple to provide virtual care without user fees. (A reminder that the large majority of services are delivered privately in our publicly-funded health system.)
Instead of trying to stymie Shoppers expanding primary care clinics, governments should instead push for them to offer more extensive, longitudinal care.
If we’re going to ensure that every Canadian has a primary care provider – and that must be a priority – then having doctors’ offices in retail outlets that people already frequent is as good a place as any. About 90 per cent of Canadians live within 10 kilometres of a Shoppers Drug Mart.
But working with private, for-profit businesses doesn’t mean giving them free rein. The role of government is to ensure there are guardrails.
We don’t need virtual care and primary care farms that churn patients through lucrative consults but offer little value or improvement to their health. There needs to be accountability, something that is sorely lacking in our health system today.
We also can’t pretend that every single health service can be provided at no cost by a publicly funded insurance scheme.
Canadians already spend in excess of $100-billion annually purchasing health care services privately. (That’s 30 per cent of the $344-billion spent last year.)
But we have to be clear on what is, and what isn’t covered. We have to articulate the limits of medicare.
As the system continues to crumble, consumers will vote with their wallets. But that could create equity issues.
As the push to reform medicare ramps up, we need to not lose sight of its overarching goal: No Canadian should be denied essential care because of an inability to pay.
It is a noble sentiment, and a fundamental Canadian value.
But that defining characteristic of medicare will be lost if we continue to allow the delivery of care to degrade to the point where change is driven by civil unrest rather than by an urgent, yet thoughtful, re-imagining.