Prescriptions for Canada’s failing health-care system

Matters of Life and Death: Public Health Issues in Canada

By Andre Picard

Douglas & McIntyre Canadians love to fret and argue about health care. Perhaps second only to our perennial angst about national identity, disputes about health care often number among our top national obsessions.

We have a lot to argue about, and our arguments are too often conducted in 100 per cent factfree zones.

If ill-informed health policy debates are part of the problem, this new book from journalist Andre Picard is an important part of the solution. Matters of Life and Death distils Picard’s 30 years of experience covering the health policy beat into a bracing dose of fact and analysis. And his elegant voice as a prose stylist is the spoonful of sugar that makes even his more alarming and discouraging passages go down smoothly.

According to the right-wing Fraser Institute in a March 2017 paper, “health-care spending by provincial governments has increased by 116 per cent since 2001 and is projected to keep growing over the next 15 years. In fact, by 2031, health-care spending is projected to consume 42.6 per cent of all provincial program spending (on average).” This important new book should be required reading for voters across the country.

Picard has been paying attention to Canadian health-care arrangements for decades now, and he has a lot to tell us about what he has learned. He pulls no punches, telling his readers early on that every developed country but the United States (which he frankly calls “morally bankrupt and economically inept,”) has universal health care that is “better, fairer and cheaper than ours.”

He calls our pride at having a better system than the American system a hollow victory, and he writes with searing anger about the injustices and inefficiencies that haunt health-care delivery in Canada.

He is particularly (and in my view appropriately) outraged by the Canadian system’s failures to provide adequate care for indigenous people, children, the addicted, the elderly, the mentally ill and the disabled.

In each of these instances he documents the reasons for his outrage by drawing upon a lifetime of wide-ranging journalism and his readings in medical journals and scientific papers, with all of this sometimes difficult material rendered accessible to lay readers by his lucid and straightforward prose.

While Picard is highly critical of the current state of Canadian health care, he does not segue from those problems to a call to unleash the power of the market by privatizing large swaths of our system.

He argues for some experimentation with mixed systems involving more market-based medical insurance than many observers would endorse, but no one should mistake this book for a pro-privatization screed.

For example, he advocates including prescription drugs in the benefits available to all under medicare and dramatically expanding medicare coverage for dental work, policy changes that would horrify the ideological champions of privatization.

This is a remarkable and useful book, richly provided with anecdotes, facts and statistics and often providing thoughtful suggestions for the big picture reforms that the author believes would improve Canadian health service.