Canada’s health-care sys­tem needs shor­ing up

The Labradorian - - EDITORIAL - Dr. Charles Shaver Ot­tawa

De­spite record eco­nomic growth, the fall eco­nomic state­ment pre­dicts a deficit of $19.9 billion — dou­ble that promised in the Lib­eral elec­tion cam­paign. The Fraser In­sti­tute re­ported that from 2015-2019, the per per­son fed­eral debt will in­crease by five per cent per year.

Mean­while New­found­land and Labrador will have a deficit of $778 mil­lion for 2017-18 and a to­tal debt of $ 15.2 billion — the high­est per capita debt of any prov­ince.

A health min­is­ters’ con­fer­ence oc­curred in Ed­mon­ton on Oct. 19-20. The agenda in­cluded Indige­nous health, fed­eral sup­port for the fea­si­bil­ity of a na­tional phar­ma­care pro­gram, opi­oids, med­i­cal as­sis­tance in dy­ing, bulk pur­chase of ex­pen­sive equip­ment and mar­i­juana le­gal­iza­tion.

Inad­e­quately dis­cussed was en­sur­ing the fi­nan­cial sus­tain­abil­ity of health care. Sev­eral is­sues im­pact­ing pa­tients and health pro­fes­sion­als should have been added thanks to re­cent Lib­eral mis­man­age­ment of tax re­form pro­pos­als and immigration and in­flex­i­bil­ity re­gard­ing en­force­ment of parts of the Canada Health Act (CHA).

Ac­cord­ing to Candice Mal­colm (Ot­tawa Sun, Sept. 30), 32,000 il­le­gal mi­grants have en­tered Canada so far this year. Wel­fare ben­e­fits are $20,000 an­nu­ally, so the to­tal is $640 mil­lion per year. Ot­tawa is fast­track­ing work per­mit ap­provals. So­cial sup­ports re­main the re­spon­si­bil­ity of the prov­inces and ter­ri­to­ries.

Also con­sider that 280,000 Sal­vado­rans plus oth­ers from Cen­tral Amer­ica and Africa face pos­si­ble de­por­ta­tion from the U.S. in the next few months. If many at­tempt to come to Canada, what will be the cost to tax­pay­ers un­til they find em­ploy­ment?

It ap­pears that cer­tain prov­inces may bear a dis­pro­por­tion­ate in­crease in their costs for sup­port­ing these mi­grants, leav­ing a lesser amount in their bud­gets avail­able for health care. Fi­nance Min­is­ter Bill Morneau’s tar­get­ing of small busi­nesses is coun­ter­pro­duc­tive. It is they that might pro­vide jobs for many new im­mi­grants to Canada, so that they do not re­main a per­ma­nent bur­den on tax­pay­ers.

If Morneau’s ini­tial pro­pos­als are min­i­mally changed, some older physi­cians may re­tire pre­ma­turely, and some younger, mo­bile ones may leave for the United States. Physi­cians re­main­ing in prac­tice will be pres­sur­ing their pro­vin­cial and ter­ri­to­rial gov­ern­ments for ad­di­tional funds to com­pen­sate them for the loss of the fi­nan­cial ben­e­fits of in­cor­po­ra­tion.

Sev­eral months ago, premiers of the prov­inces and ter­ri­to­ries re­luc­tantly agreed to ac­cept a cut in the an­nual in­crease in fed­eral trans­fers from six per cent to 3.5 per cent (plus some tar­geted fund­ing). Sadly, Ot­tawa has “dou­bled down” and re­mained in­flex­i­ble on en­forc­ing cer­tain parts of the CHA, and in so do­ing is pre­clud­ing prov­inces from per­mit­ting a lim­ited amount of pri­va­ti­za­tion that could make the health­care sys­tem more fi­nan­cially sus­tain­able.

In the man­date let­ter to Health Min­is­ter Ginette Petit­pas Tay­lor from Justin Trudeau, she is re­quired to “pro­mote and de­fend the Canada Health Act to make ab­so­lutely clear that ex­tra-billing and user fees are il­le­gal.”

All of this will ex­ac­er­bate the health fund­ing short­fall for most prov­inces. This will make it more dif­fi­cult to re­tain physi­cians and other health pro­fes­sion­als in New­found­land and Labrador. New sources of rev­enue for health care must be found.

Clearly it is time to start hav­ing a dis­cus­sion about amend­ing the CHA, beginning with per­mit­ting med­i­cal tourism. This would pro­vide em­ploy­ment for the hun­dreds of re­cent Cana­dian or­tho­pe­dic graduates un­able to ob­tain OR time and hospi­tal priv­i­leges, to nurses, and other health pro­fes­sion­als. It would pro­vide badly needed ex­tra rev­enue to hos­pi­tals and min­istries of health.

As the fed­eral gov­ern­ment seems blind to the fis­cal re­al­ity of the prov­inces, health min­is­ters should set up a com­mit­tee to study how most coun­tries in Europe — with much shorter wait times than here — are able to suc­cess­fully blend a pub­lic and pri­vate health-care sys­tem.

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