I wrote this article for The Epoch Times and wanted to share it with you. Enjoy!
With a health care system in desperate need of innovation, every election candidate competes to avoid saying anything new.
Overall, 37% of Canadian voters rank health care as their top issue going into the election. But only 5.8% of voters say that health care will change their vote. That number would increase if candidates actually said something unique about health care.
But no one does.They all wrap themselves in the flag of medicare and pledge allegiance to our national icon.
Since health care won’t win more votes, it ends up as a the most important non-issue in every election. Voters learn nothing new and hear more of the same or nothing at all.
Health care is Canada’s third rail in politics: “If you touch it, you get electrocuted”. Candidates have everything to lose, when addressing health care. Their only gain lies in promising more of what got us here in the first place.
The Liberals promise more money and a family doctor for everyone.
The Conservatives promise increased federal health transfers and more technology.
The NDP promises to “tackle wait times and improve access to primary care”.
And the Greens promise family doctors with a focus on “social justice, equity, and cultural appropriateness”.
The People’s Party comes closest to offering something innovative. Maxime Bernier, party leader, suggests we tackle wait times by holding the provinces accountable for performance, as outlined in the Constitution. Not exactly radical.
Canadian Health Care Resists Change
Canadian health care is perfectly designed to resist change. The federal government exerts enormous control with its ‘spending power’.
The federal government uses conditional, take-it-or-leave-it Canada Health Transfer (CHT) Payments, which are guided by the Canada Health Act (CHA). The CHT payments totalled $38.6 billion dollars in 2018-19.
Desperate for cash, the provinces take the money and moan about boutique health programs and being “dictated to” by the federal government.
The provinces are supposed to be in charge of health care based on the constitution. But the feds feel pressured by voters, or motivated by hubris, to enforce health standards, build national unity, equalize funding between provinces, and achieve all sorts of other noble goals.
Economists have no qualms about calling the CHT just one part of the overall equalization program. The fact that the CHT funds patient care is really secondary to the important work of redistribution. The CHA/CHT deal ends up serving non-medical ends. It is a federal gift that keeps giving every four years during elections.
Going in Circles
We end up with chaos: each level of government promises more and takes responsibility for less. The feds blame the provinces for wait times and disorganization. The provinces blame the feds for underfunding.
The feds are fastidious to claw back CHT payments from any province that allows user fees or extra billing. But the feds completely ignore the other four principles of the Canada Health Act: portability, comprehensiveness, universality, and public administration. Only user fees matter to the federal government.
So, health care sits and spins. Like two people in a rowboat each trying to row in different directions, the federal and provincial governments each want to steer health care. Candidates of all parties use it to woo voters, but candidates avoid any real direction.
Promises Half Met
Over 30% of patients wait in pain for more than 6 months for a hip replacement. In some areas the waits are much longer:
In London Ontario, patients faced an average wait of 307 days for knees and 299 days for hips, in 2017, while waits hit 671 days for knees in Strathroy that same year. And we wonder why we so many patients are addicted to opiods?
What’s worse, some babies, teens, and adult patients die with treatable conditions just because we cannot find a hospital bed.
Socialized medicine was sold on the promise to provide care. Tommy Douglas, former Saskatchewan Premier who was voted most famous Canadian and father of medicare, promised government insurance against medical bankruptcy for medically necessary care.
In most cases, politicians have kept half the promise; medical bankruptcy is rare in Canada, although analysis suggests that even this data might be exaggerated for political reasons. Regardless, Canada has failed to deliver the most important part of the promise: timely patient care.
Elections provide the chance for voters to ask questions and demand specific answers. As the most important issue for voters this election, candidates should offer clear promises and concrete goals that go beyond hand waving about spending more money.
Canadians deserve better. Elections matter. If we do not hold politicians accountable, we end up with the health care system we deserve.
Photo credit: Hilltimes.com
Tommy Douglas also stressed that each person should be responsible for at least some of the cost of their care so as to prevent abuse of the system. That principal was thrown out the window when extra-billing was banned as another election promise give away. FREE MEDICARE Vote for ME. I cant remember which politician it was that made this fatal error. It is the abuse and overuse of the healthcare system and the lack of financial input directly to care that leaves the system a prisoner of politically based budgets.
Great point, Ernest. Agree, Douglas said that we can’t have voters looking at medicare as Santa Claus.
PE Trudeau was Prime Minister until June 1984. The CHA was passed in April ’84. John Turner took over from Trudeau and lost in a landslide to Mulroney that fall.
Trudeau had hoped to use the CHA as a wedge issue for the election. Alberta had instituted hospital user fees. Only 10% of MDs in Canada were doing balanced/extra billing to make up for government refusing to increase fees with inflation (docs called it balanced; media called it ‘extra’). In fact, the total amount of balanced/extra billing came to 1.3% of the total spending on MD fees under medicare. In no province did it exceed 3%. Accidental Logics, Carolyn Tuohy, p. 93. (Docs went on strike to protest the principle, not the payments they were losing…they weren’t losing any money, just freedom.) But hospital user fees and balanced/extra billing were the evils that Trudeau hoped the Conservatives and NDP would fight to protect, on principle.
But Trudeau’s plan backfired. No party dared to say anything against the CHA. It passed unanimously (if I recall correctly), and their petard collapsed.
Sorry for getting all excited about the history!
Thanks so much for posting a comment!
Cheers
I couldn’t agree more.
Excellent article.
I have sent most of my recent articles to Andrew Scheer, Marilyn Gladu, etc. but no one has publicly supported any of my suggestions.
Trudeau’s pharmacare proposals are extremely vague. A physician treating a UTI would not order “some Amoxil,” but would specify the number of milligrams, how often and the duration of treatment.
That is why it is very difficult for physicians to attempt to be politicians!
Charles Shaver
Ottawa
Thanks Charlie!
Smart to send your article to the candidates. It gives me chest pains just listening to some of the comments made during this election.
And thank YOU for all your advocacy. You must be close to 500 article published now?! Wow.
Sure appreciate you taking time to post a comment.
Not sure why the feds are talking about Healthcare and GPs for all as it’s not their wheelhouse. As far as I’m concerned, they’re involvement in health is to either enforce or amend the CHA, neither of which they are promising to do now. The CHA is not being upheld consistantly amongst all provinces and no ones got the cahones to remove the yolk of this act to facilitate some free market activity.
Back when balanced billing was not widely taken up, ohip benefits were still over 90% of oma fees. Now the multiplier is 2.2x and I would question how many docs today would give up over 50% of their income if they had the choice to “balance” their fees.
Great points, Rob.
I wondered the same. On top of that, I found it very odd to see some candidates attacking provincial Premiers while at the same time making all kinds of promises that the Premier has jurisdiction over. Any federal promise would require cooperation from the provinces. It’s just insane.
Also good point about the 2.2 modifier. I think docs were forced to trim in other ways: shorter visits, fewer services provided in the clinic (e.g., no more phlebotomy in rural clinics — can’t afford to offer it), and smaller/less-renovated clinics. All of this trimming impacts the patient experience. Unfortunately, docs get blamed for it.
Thanks so much for reading and posting!
Cheers
As long as Canadians are willing to wait for increasingly mediocre care,and docs are willing to provide services for increasingly less money,our irrational rationed system will continue its downward spiral.
Politicians won’t touch the ‘third rail’ for fear of being electrocuted and federal candidates can promise everything as they don’t have to deliver on a provincial program.
The OMA(and other provincial assoc.) has a moral obligation to both docs and patients to lobby for a parallel private system like everywhere else in the world(except North Korea).If the OMA is not willing to derand docs (release them from mandatory dues),then it should advocate for the significant number that are trapped in an unresponsive irrational rationed system and promote what all other docs IN THE WORLD have …. the CHOICE of working in a different(ie parallel private) system.Those docs that want to continue in the present system can do so …. or hybrid models whereby all must ‘donate’ some of their time to the public system.Why do Canadians cling to this false’god’ of universal ‘free’ healthcare when it is actually detrimental and puts us 30th in the OEDC world ??? THE EMPEROR IS NAKED !!!
Well said, Ram.
I like your call out to the medical associations. The CMA used to play a big role in that space 50 years ago. Now it seems embarrassed that it ever had anything to say in defence of physicians (just my impression).
I liked your comment about a false god. Many people have compared medicare to a national religion. I agree, but I think there might even be a more modern/popular description. Some people love to criticize the USA for any hint of American exceptionalism. But no one criticizes our own Canadian exceptionalism when it comes to health care. Many people feel not only empowered to brag about Canadian health care, they feel righteous doing it. That is blind faith in a national icon despite the irrationality and rationing inherent in the icon. I’ve been stewing on this for a few weeks…hoping it will mature into a more coherent opinion. Feel free to help/make suggestions.
Thanks again for reading and posting. Something has to give.
Cheers
HI Shawn,
The reason central planning does not work is that plans are not reality. Reality is so much more complex.
Doctors are ideally suited to make that argument. If it were necessary to make a plan showing in detail how every part of the human body functions, that would, as of now, be impossible. But even if that were possible, imagine a plan intended to monitor every cell and tell it what to do in changing circumstances. That is a whole different level of complexity, and is not only impossible for us, but perhaps even in principle.
And yet there are billions of us walking around.
And that is because There IS NO PLAN. Every cell is off on its own, doing its thing, with a minimum of feedback, mostly local, very, very little at the highest levels. And the whole thing works, because, well … because it just does. that’s all.
And if it ever does stop working, a particular organism just falls off the evolutionary tabletop.
Now human society, and commerce and industry are extraordinarily complex. The fact that socialism equals poverty simply results from the fact that nobody (or committee of somebodies), could ever make a working plan, let alone monitor it once in application. Planners are, in fact, intuitively aware of this. It makes them extraordinarily conservative. Our healthcare, then, is frozen in place, by a paralysis in the individual cells (if it is not mandatory it is forbidden) and by a terror of change at the top (the holy terror of unintended consequences when you fiddle with something nobody understands).
It is starting to look like ordinary people will soon have to buy their own health care (the wealthy already do by choice), just as though there were no public system, because that system (even if institutionally embalmed for eternity) will not be yielding the care that people want and need.
Yes, failed evolution, MAY lead to extinction. But failing to evolve (by shutting down individual initiative in obedience to the “plan” fantasy) is absolutely guaranteed to cause extinction.
As a last resort, a kind of “hard” medical Brexit (let’s say a “Mexit”) in Canada would indeed bring great sacrifice. But we have a great problem. And just as we were willing to sacrifice millions in the defeat of fascism, perhaps we should now, perfectly rationally, be ready to sacrifice for the defeat of stupidity.
Longer we wait. Steeper the price.
Best Regards,
Gordon Friesen, Montreal
http://www.euthanasiediscussion.net/
Wow, thoughtful comment, Gordon. Thanks. I like the analogy of planning to how the body functions. I also like your ‘Mexit’ analogy — the only quibble might be that I think we will always have a public offering, something like the post office. But forcing everyone to only use the post office is just nonsense. Cheers
Thanks Shawn.
My comparator with the USA is this :
Canadians infatuation with our health care ‘system’ is as irrational as Americans infatuation with guns.God help the politician that tries to take either away.
Exactly
The CHA resembles the Norwegian blue parrot of Monty Python fame…it serves everybody ( other than its purchaser ) to pretend that it is alive and well, it is praised for its plumage, it is nailed to its perch because it is so vigorous , it prefers to sleep on its back, resting because of its long flight from the Norwegian fiords….
🙂
Well a lot can be said on this subject. When my wife was in practice she would say on any given day 25% of patients who came to the office didn’t need to be there. My opinion much of the vote buying listing for medical services should be delisted and that money could be redirected to people who have more serious illnesses. This goes hand in hand with people taking more responsibility for themselves which is a problem across the board not just in health care. The mention of hip replacement caught personal attention from us, we just happened to catch a documentary on Netflix called The Bleeding Edge about medical devices. A segment by Dr. Steven Tower talks about cobalt/chromium toxicity from hip replacements. He had his hip replaced with cobalt and 18 months later her ripped apart his hotel room at a medical conference. Long and short of it, he suffered cobalt toxicity. He had hip revision with stainless still hip and his cognitive issues vanished. Now here’s the thing he said if it hadn’t happened to him he wouldn’t have believed it. There are far too many health care professionals including doctors and ex-pharma reps trying to sound the alarm for iatrogenic harms to simply write this off as conspiracy. A lot of “health care” should be re-examined and what is harming or not producing results should be tossed out the door and enjoy the cost saving from that as well. Finally, I heard about you through Dr. Albert Benhaim and his battles with the “politicos” which his book The Execution documents. Also Dr. Pamela Wible’s book Physician Suicide Letters states that the equivalent of a med school’s med student dies of suicide every year. What I’m trying to point is that as a whole the system and many doctors are vicious towards it’s doctors. I worked for years in a pretty macho male dominated construction industry and never did the rivalry on the job come close to how many doctors treat each other. This needs to change for the sake of doctors work place environment and for the benefit of patients because doctors who may suffer from suicide ideation and any other form of PTSD cannot give 100% to patients. Personally, any politician who would offer an opt out clause from socialized medicine would get this voter’s vote but I know that isn’t going to happen.
Thanks so much for this, Brian
I hadn’t heard about the hip toxicity thing. I will keep an eye out for articles on it. You make a great point about doctors. While most people do not, and probably should not, feel sorry for doctors, patients should know that they get the best service from people who feel supported in their work. It applies to everyone from the barista who gives you coffee in the morning to the orthopod who changes your hip the next day.
Thanks again! Cheers
Yes we do need a public option, as part of our overall safety net.
But we must also refuse one-size-fits-all.
We need extraordinary relief measures for extraordinary hardship, not artificial “equity”.
Because in the end, a poor man in a rich society lives a lot better than the aristocrats of a poor one.
Gordon Friesen, Montreal
http://www.euthanasiediscussion.net/