HEALING HEALTH CARE
CANADA’S DISASTROUS HEALTH-CARE SYSTEM IS IN URGENT NEED OF REFORM
WE ARE NOT CLOSE TO GETTING A GRIP ON THESE PROBLEMS
— CONRAD BLACK
There is an unmistakably Canadian complacency that enshrouds and swaddles our national health-care system and insulates it from a critical examination even though leaders of the Canadian Medical Association have declared the system to be on the verge of collapse. Almost everyone who has any acquaintance with Canadian health-care is aware that waiting times imposed even for critical treatments are frequently intolerable, and that allowance for specialized treatment is in fact rationed health care, since only comparatively well-to-do people can afford continuing specialist care beyond the minimal allowance under our health care plans. Since doctors are not generally available, overwhelming pressure is placed on emergency services in principal urban hospitals and most people who arrive in such facilities do not belong there.
We don’t have remotely enough strategic managers in the health-care system; we have a poor physician fee schedule, we had a terrible pandemic response despite the fact that a number of governments have been re-elected on the basis of their performance in a crisis. There is appalling waste in many areas, such as with the federal government pay contract with IBM; far too much resources are squandered on top-heavy administration, lawyers, and commissions. According to a Fraser Institute study of 28 high income countries with universal health care systems, Canada ranked sixth in highest total spending as a percentage of GDP, at 10.8 per cent and tenth in health-care expenditures per capita at US$5,370. However, when we adjust for age, Canada ranks second highest on spending as a percentage of GDP and eighth in health-care expenditure per capita.
We are 26 out of 28 in physicians per thousand population: 2.8, 14th out of 28 in nurses per thousand population: 10.4. Twenty fifth out of 28 in acute beds per thousand of population: 2. We are eighth in long term beds per thousand of population: 54.3, and 22nd in psychiatric beds per thousand: 0.4. We are 15th out of 28 in life expectancy at birth: 82.1, and 26th out of the 28 in our infant mortality performance at 4.4 per thousand, we are 20th in perinatal mortality at 5.7 deaths per thousand and by any measurement on treatable mortality diseases, Canada is in the bottom third and is at the very bottom on most indicators of timeliness of care. We have one of the most expensive health-care systems in the world with available health-care resources well below the average of the prosperous countries. And our largest and richest province, Ontario, is almost at the bottom of the Canadian provinces in many of these criteria.
We are not close to getting a grip on these problems. The 2018 and 2019 Devlin reports on Ontario health stated that one of the principal problems was that patients had trouble navigating the system because it is too complicated. This is bunk; the system just doesn’t do its job properly. Looked at realistically, we shut the economy down again in January 2022 for a virus that causes something resembling the common cold for about 80 per cent who contract it, with a 99 per cent survival rate for those under 65, and where up to 60 per cent of those who get the virus do not know they have it. We conspicuously failed to keep our elderly people safe from the coronavirus and our first plan in Ontario was to vaccinate all who worked in the homes for the elderly without vaccinating the longterm care residents themselves. We now know, as some of us warned at the time, that the whole shutdown program was a disaster.
The Canadian Medical Association calls for expanded team-based care, a national health human resource strategy to rebuild Canada’s health-care workforce, more comprehensive data collection across health-care systems, Pan-canadian licensing to make physicians more mobile, and scaling up virtual care and use of artificial intelligence in improving access to care. The most scandalous policy failing of all has been the morbid overemphasis on Medical Assistance In Dying, (MAID). Our health-care system has become so hideously expensive that we can’t afford to commit more public resources to it, and as an antidote it has now been repurposed to convince an ever more youthful definition of the elderly of the virtues of suicide, in defiance of the fundamental and traditional purpose of health care, and to moderate the expense of our public health-care services. This is a triumph of government incompetence and hypocrisy.
The greatest single problem of Canadian health care has been the psychological addiction of Canadians to believe they have a superior system to that of the United States. This addiction manifests itself not only in glazing over the shortcomings of our system but in exaggerating the failings of the Americans. Too many Canadians who have an opinion on the subject actually believe that in the United States an ambulance will not take you to hospital nor will a hospital admit you unless you can produce a credit card or a public or private sector health plan card that assures the hospital that it will be adequately compensated for providing the necessary services. This is a rank fabrication. The American system provides health care for everyone and admits all who need it to emergency treatment, but the approximately 20 per cent of people who either do not choose to subscribe to a health-care plan or are not automatically in a category covered by public plans, or who have inadequate coverage, receive a service that is inferior to what such a rich country should provide, and run a risk of unsustainable financial hardship in the event of a health care crisis. The other 80 per cent of Americans are much better medically cared for than all Canadians except those who can afford and choose to obtain health care in other countries, (usually the worldfamous clinics of the United States).
We have appreciably fewer doctors per capita than many comparatively underdeveloped countries, such as Cuba, and even North Korea. This is the country that discovered insulin and many other medical advances and has now no pharmacological industry of its own. We should give everyone the choice of remaining in existing provincial health-care systems or opting instead for a reduction of taxable income for defined essential medical expenses, at the same time that we substantially expand our medical schools and if necessary incentivize the recruitment of candidate doctors, to alleviate the insufficiency of available care and diminish the frequently life-threatening excessive delays in both diagnosis and treatment.
In the public health-care plans, there should be a modest user fee for all who can afford one, as Tommy Douglas believed there should have been. Anyone who has ever successfully administered any service could, just by reading existing summaries of comparative research into the principal health care systems of the advanced world, produce proposals that would endow Canada with one of the world’s best health-care systems. We have been hobbled by our totemistic protectionist view of what is a notoriously broken down health-care system and by the pandemic of political fear that any radical improvement of it will be unanswerably misrepresented by political and media opponents as an attempt to degrade the health care of economically disadvantaged people. No sane person advocates that and a health-care reform proposal could easily be formulated that made it impossible for it to be defamed and caricatured as robbing the most needy of essential health care.
We have to stop treating this subject as an untouchable sacred cow, and stop using gimcrack psychiatry as a substitute for desperately needed reform in what is probably the most important public policy area of all.
WE HAVE TO STOP TREATING (HEALTH-CARE REFORM)AS AN UNTOUCHABLE SACRED COW.