The emergency entrance at Mount Sinai Hospital in Toronto on Feb 14. 6.5 million Canadians have no family doctor, emergency rooms that are not actually closed are overcrowded, and wait times for critical surgeries and procedures are excruciatingly long.Fred Lum/The Globe and Mail
A half-century after Canada adopted medicare, the promise that no one would ever again go without medically necessary health care seems like a quaint notion from the past. Today, 6.5 million Canadians have no family doctor, emergency rooms that are not actually closed are overcrowded, and wait times for critical surgeries and procedures are excruciatingly long.
Something has changed. Something has gone wrong. But what hasn’t changed – what has in fact become fossilized – is the debate about what can be done.
The ossified wisdom is that 1) hallway medicine, delayed knee replacements and lack of access to a general practitioner may be lousy but it’s still better than letting “American-style” health care creep into Canada, and 2) that throwing money at the problem will take care of it.
These notions persist because there is zero accountability in a health care system in which responsibility winds through the federal government, 10 provinces and three territories, and then scatters even more, like light diffusing to the point of nothingness, through provincial agencies, hospital administrators and associations representing nurses, doctors and staff.
There are simply no consequences for the system’s manifest failures.
The only known way of reserving a spot in the pillory is to question the government monopoly on delivering and paying for health care. Do that and you will be labelled as a fifth columnist for medicare’s mortal enemy: America’s hideously expensive private health-care system, with all its inequities.
Better, then, to toe the line, tinker around the edges and pump more tax dollars into a system that is one of the most expensive per capita among its peers, while also being one of the worst performing. You will never lose your job by maintaining the failed status quo with adequate piety, even if you ought to.
An unhealthy debate
This is part of a series on our health-care system, and the challenges in diagnosing and fixing its problems, as explored in The Globe’s Secret Canada project.
Broken promises: The ‘universal’ model is anything but
Data: Lack of clarity is unacceptable
Lessons from abroad: Health care, Australian-style
Lessons from the past: Jane Philpott’s prescription for change
Justice: Defining the duty of care
This week, we have been proposing cures for Canada’s disordered health care debate.
We’ve called for up-to-date standardized data across the system. We’ve said it’s time to amend the Canada Health Act to explicitly include timely access to health care as a duty, and called for clarity on when and how private insurance is permitted. We’ve said it’s time to stop comparing Canadian health care to that in the U.S., as if that’s the only alternative. And we’ve pushed for more innovation and braver ideas for reform.
Now we want accountability.
On data, it’s not good enough that the Canadian Institute for Health Information has to rely on the inconsistent goodwill of the provinces to collect data on key indicators.
Yes, the provinces and territories have agreed to provide data in exchange for more federal funding, but the fact it is not a legal obligation is a serious flaw in the system. The data is not meant to be for the benefit of Ottawa; it is meant to inform Canadians about the state of their health care system, and to empower them.
From that flows the need for a reform of the Canada Health Act making timely access to care a pillar of the law, so that the provinces are obliged to work toward it, and have to set real goals and timelines for achieving them.
Finally, the country needs to hold to account politicians who moralize about the wickedness of moving even an inch away from a failing government monopoly on health care.
There are simply too many countries that have different approaches to universal health care, and which regularly outperform Canada in the most important metric of all – equality of access to care regardless of income – for doomsayers to dominate the debate.
Other countries provide universal care without such a monopoly. We are not saying that their models are an automatic fix; we are saying the problem is that, in Canada, we can’t consider the fix without blowing a fuse.
That close-mindedness does not make for a healthy debate, and it could do real harm. If Canadians conclude that medicare can’t be resuscitated, they may be inclined to let it die. We need to start talking about health care in an adult fashion now, before the damage becomes irreversible.