What do we want from health care?

I don’t know about you, but the recent debates about how the health-care system should be run have not excited me.

It isn’t because I do not know what a LHIN is, what a regional health authority would look like, what an accountable care organization would do, or what special powers a super agency would have.

It’s because I think there is a more important discussion to have first.

Before we start a conversation about the structure of the health-care system, we should first have a conversation about what we want it to do. Form should follow function. And the discussion on function is urgent.

In some parts of Ontario there are 20 years difference in lifespan between rich and poor. Indigenous populations have higher rates of illness and shorter lives. Survival rates for chronic illnesses and cancer are worse for racialized groups. More people will die from opioid overdoses than car accidents. And even with the promised increase in dollars, we would still have an underfunded system with no coherent strategy to deal with the largest cause of work absences — mental-health issues.

Add to these issues our aging population, advances in prevention and treatment, and the fact that 40 per cent of our tax dollars go to health, you can see why we need an open and transparent public conversation on what we want our government to provide, and what the priorities should be.

It’s easy to get distracted by the system in the United States. The fact that our health-care system is better for more people than theirs may be of comfort to some, but we should be doing better. In the last good assessment of 11 high-income health systems, the Canadian system came 10th — only the U.S. scored lower.

And within Canada, Ontario is not a big spender on health. Ontario has the fourth highest GDP per capita but is the second lowest spender on health per person.

People experience this every day. Perhaps we need to ask people if they are happy that 60 per cent of the population cannot see their family doctor the same day or next day, or that two-thirds of people who leave hospital are not followed up with promptly by their family doctor, or that one in six people are readmitted after hospital discharge.

Are they happy with the fact that if you require eye surgery and should be seen for an assessment within a month, you are more likely to be seen half a year later? There are lots of questions. We could also add other concerns of the patients I speak with. They are proud that we have better access to health care than south of the border, but are not so clear that we have access to the quality or speed of care.

They are concerned about wait times, they are troubled by what they see as better, quicker treatment for those with insurance and they are worried about private companies taking profit out of a system that needs all the money it can get.

They also feel they have little say in decisions about health-care priorities and that they are not given good information about what is going on. They feel voiceless.

Some would say that tinkering with who runs health when there are urgent needs that have not been addressed is like rearranging deck chairs on the Titanic.

We have some fundamental decisions that need to be made and should be part of a public discussion.

Some may worry that we are not ready for an adult discussion about health care. They worry that we will want everything without considering the cost. This could lead to ballooning health spending. Democracy can be inconvenient that way.

But we also do not want to be a province that knows the costs of everything and the value of nothing. And the comparative value of health care is best decided by the public.

Amature public debate would go a long way to finding the right balance.

We need to agree to a deal with government about what the health system should provide and once we have agreement on that, everyone should know what rights they have to health care.

This is the most urgent order of business.