Conversation about Medicare needed
We need to have a grown-up conversation about the future of Medicare.
During the past few years, that’s become a familiar refrain and it’s raised mostly by doctors and other professionals working inside Canada’s creaky and uneven health-care systems. But very few national or provincial political leaders have shown much interest in such a potentially-divisive and politically-risky discussion.
Medicare is a national program delivered by the provinces and territories with all the attendant differences and inequities that entails. So, the required conversation is complicated by the confluence of national and provincial issues.
The federal government kicks in health payments to the provinces - $38.6 billion this year – and, in return, the provinces must deliver on the essential elements of the much-revered Canada Health Act.
Medicare – universal medical coverage – has been around for more than 50 years, and the Canada Health Act is showing its age at 35. Governments have tinkered, but incremental change seems to have left primary care and elements of acute – hospital – care stressed-tothe-max, or nearly so, right across the country.
Long-term care for the elderly and infirm, and mental health services are generally inadequate and grossly unequal between provinces and, while Medicare is supposed to cover medically-necessary treatment, gaping holes persist, like coverage for prescription drugs.
The chair of Canadian Doctors for Medicare, Dr. Danyaal Raza told The Medical Post recently that Canada’s public health-care system was designed for a time when medicine looked very different than it does now when more people are living longer, often with chronic conditions.
Policy makers have responded to the high-priced problem of over-crowded hospitals and costly institutional care by trying to shift more elements of healthcare into the community through initiatives like home care.
But in order to keep people out of hospital emergency rooms and better manage demand for in-patient beds, a robust and accessible primary care system is essential.
On that front, Canada seems to be falling behind. The 2017 Commonwealth Fund Survey compared health care here with 10 similar countries and found that Canada ranks last or almost last on a number of indicators related to access to primary care.
The survey, also reported in The Medical Post, found that when needed, 43 per cent of Canadians were able to get a same- or next-day appointments with their family doctor or other primary care provider. That was the worst result among the 11 nations surveyed.
Two in every five Canadians who visited hospital emergency departments reported they did so for a complaint that could have been treated by a primary care provider, putting Canada near the bottom on that measure, too.
Access to primary care is clearly a national problem, but it falls to provinces to find solutions or suffer the political consequences. To further complicate matters, access has suffered across Canada despite increased enrollments in Canadian medical schools, resulting in more family doctors per capita today than Canada had 10, 20 or 30 years ago.
Total health spending in Canada in 2018 is expected to be $253.5 billion, which works out to $6,839 for every Canadian, and represents 11.3 per cent of the national gross domestic product (GDP). That level of spending places Canada in the middle of the pack among nations with national health insurance.
Canada can, and likely will, continue to stumble along with a national Medicare plan Canadians claim to cherish, while Ottawa and the provinces administer various remedies intended to treat the symptoms of a system under stress.
The problem with systems under stress is that eventually they tend to fail, or the stress reaches crisis proportions. At that point, drastic measures are generally required to salvage them, and options are limited.
Before that happens, Canadians in every province and territory should be invited into a conversation about what they can reasonably expect from their health-care system, what they need and want from the system and whether they’re prepared to pay for the difference.
A national conversation, conducted by every province and territory, diminishes the political risk to any government or party and, who knows, a national consensus may emerge.