One of the grumpiest politicians I ever knew said, “This is not a tea party.”
Often, medical politics is war. Opponents do not enter to fight fair.
I forget this all the time. Stephen Skyvington does not. He works to make opponents bleed. He published, This May Hurt A Bit: Reinventing Canada’s Health Care System with Dundurn Press in February.
I wrote this about it:
“One part memoir, two parts jeremiad, This May Hurt a Bit demands a discussion on healthcare. Skyvington pokes, prods, and provokes until he gets the debate Canadians need.”
Stephen kindly offered an interview. I do not agree with everything he says, but I admire his courage and insight. As a longtime pundit, organizer, and provocateur, I thought you might enjoy his comments.
Skyvington on Medicare
Q. Predict the future: In ten years…
A. As I say in the book, by 2030 we’ll either have bankrupted the country, have turned every road into a toll road and every school into a private school, or we’ll have ended up with the very thing people (including myself and Dr. [Brian] Day) say they don’t want, namely, a U.S.-style, two-tier health care system.
As former Ontario premier Dalton McGuinty once said, “There’ll come a time when the only ministry we can afford is the ministry of health, and we still won’t be able to afford the ministry of health.”
Q. What is the #1 problem with Canada’s health care system?
A. Those in charge keep looking for ways to solve the “political” problem instead of the actual problem.
For instance, instead of figuring out how to build a comprehensive health care system in the early sixties, Justice Emmett Hall figured out how to keep people from going bankrupt and losing everything when they or a family member took ill. Hence, we ended up with an insurance scheme instead of a health care system.
Q. Canada leads the world in wait time studies. If data won’t encourage people to support change, what will?
A. We have to get our elected officials to stop lying to us. It’s that simple. In fact, I feel so strongly about this that I put that right at the very top of my top ten list.
Q. Give us your thoughts on the Politics (capital “P”) of medicine.
A. It really isn’t politics, or left vs. right.
What it all comes down to is this: those who work in our health care system, or have family members who’ve been hospitalized, or who may have suffered a life-altering event like I did a few years ago when I dropped dead, understand what a mess Canada’s health care system is.
Those who’ve had no exposure to it, either directly or through a family member, or who don’t work in the health care field, they all think we have the best system in the world.
Q. Health economists insist that nothing bad happens when we ration care. How do we reconcile this with hallway medicine and wait lists?
A. There’s a great anecdote that I’m especially fond off and which I include in the book.
A city planner was heard to say back in the sixties, after train after train was delayed because passengers kept knocking the sliding doors off their tracks, that Toronto’s new subway system would’ve worked perfectly if only there hadn’t been any passengers.
I suspect that’s sort of how the ministry of health’s many civil servants feel, that our health care system would be so much better off if only it didn’t have to deal with patients.
Q. How can we change when people are so grateful for what they have and unaware of what they should have received?
A. As Dr. Brian Day said when I interviewed him for the book, the one person who’d be most unhappy with how our current health care system is functioning would be none other than Tommy Douglas because, ironically enough, it’s the poorest of the poor who suffer when the only choice being offered is a one-tier public system.
Q. Is it possible to have a rational debate about health care in Canada?
A. I believe it is possible. But first we have to convince Canadians that there really is a problem, that our health care system is broken and unsustainable, and that the status quo is no longer an option. Only then will we be able to get on with the job of fixing it.
Skyvington media bio
“Stephen Skyvington is one of Canada’s pre-eminent political pundits and health care policy experts. His columns appear regularly in newspapers all across Canada. Stephen can also be heard on NEWSTALK 1010, along with Ted Woloshyn, every Saturday. Formerly the manager of government relations for the Ontario Medical Association, he is currently the president of PoliTrain Inc. Stephen’s book, This May Hurt A Bit: Reinventing Canada’s Health Care System was published by Dundurn Press in February 2019. He lives in Cobourg, Ontario.”
How to run an efficient health care system. Watch these short clips in order.
1. https://youtu.be/Eyf97LAjjcY
2. https://youtu.be/x-5zEb1oS9A
Thanks Gerry! I will check them out. I have asked Stephen to respond to all comments…hoping he will soon. Cheers
Those videos to Stephen’s Answer:
“A city planner was heard to say back in the sixties, after train after train was delayed because passengers kept knocking the sliding doors off their tracks, that Toronto’s new subway system would’ve worked perfectly if only there hadn’t been any passengers.”
The British sitcom Yes Minister has a nice sketch…”the empty hospital” , on U tube…a nice shiny NHS hospital, shiny floors, administration staff, lots of unionized employees …no doctors…no patients….it won the Florence Nightingale award for hygiene…I’m certain that our hospital administration would have loved working in such a doctor less and patient less hospital since both pstients and their doctors interfere in the smooth running of hospitals.
I note that Gerald put a link for it above ( a skill i’ve Never acquired)…Yes Minister nails politicians and the government bureaucracies / ministries which are riddled with Humphrey Applebys.
My mentor, Jim Cooper, had the newly-installed political staff of the David Peterson government sit down and watch select episodes of “Yes, Minister” in 1985 when the Liberals took over from the PC Party.
The staff laughed and said, “Why show us this? Surely, the bureaucracy can’t be that bad.”
Two weeks later, they discovered just how bang on this show was.
Oh Gerry… These were just fantastic! I need to put them into a stand alone blog. Simply brilliant. Thanks so much for posting them.
“Our seemingly eternal central planners will only do the right thing after having exhausted every other alternative” ( Not a Churchill quote).
There are so many more blind dead end alleys that our brilliant central planners can drive our health care system into…the alternatives to doing “the right thing” are innumerable…it is troubling that we could have been doing “ the right thing” a long time ago saving a lot of money….instead the tax payer’s monies have been and are still being squandered and flushed into the sewer.
Our Canadian health care boffins and their health care bureaucracy remind me of Lysenko and the People’s Commissariat for Agriculture…that bloated Soviet Ministry grew and grew even as agricultural productivity dropped and dropped, and morale amongst collective farmers plummeted…both are / were trapped in a doomed statist paradigm.
Those denying the veracity of the statist paradigm led them into the lunatic asylum or the Gulag or, in modern day Canada to be ostracized.
At the end of the day, it was the peasants’ minuscule private plots , on 4% of available arable land, that they tended to after finishing their shift of the collective farm ( that was running at 25% of Canadian farming productivity) , that put food on the Soviet table…private productivity was up to x 12 of that of the state…the produced 72% of the meat, 76% of the eggs and most of the potatoes.
The Soviets avoided starvation thanks to their unofficial hybrid system…with the collapse of the USSR collective and State Farm system ( they loved teams) agricultural productivity boomed and Russia is now a net exporter of agricultural produce.
One suspects that in doing the “ right thing” health care wise that there is a role , in Canada, for a private system within a hybrid system.
Andris, I love your comments! I just found (did not know it existed) an abridged copy of The Gulag Archipelago by Solzhenitsyn . Loving it. You might like “The Soviet Health Service” by Gordon Hyde, 1974, if you can find a copy. Stephen will respond more fully soon…I expect. Thanks again!
Your post reminded me of something in my book . . .
An Insurance Scheme, Not a System
When you go in search of a dictionary definition of the word “system,” you’ll find
• a regularly interacting or interdependent group of items forming a unified whole;
• an organized set of doctrines, ideas, or principles usually intended to explain the arrangement or working of a systematic whole;
• an organized or established procedure;
• harmonious arrangement or pattern; and
• an organized society or social situation regarded as stultifying or oppressive.
Of the five possibilities the dictionary offers up, it’s the last definition — “an organized society or social situation regarded as stultifying or oppressive” — that comes the closest to describing the health care system we currently have in our country. Now, I probably don’t have to spell this out for you but they’re undoubtedly alluding to a political system like they had in Soviet Russia, or like they have today in China, or Cuba — in other words, communism. Now
Physicians cannot be part of this debate as we will always be vilified for having a self interest …. as Dr B Day has been.The public generally believes that if doctors are making lots of money treating patients,they must be scamming the system (Toronto Star)….privately,people feel that doctors should make more than professional athletes(good luck).
The ‘system’ is doomed to continue to regress,I’m afraid.
The only hope is a parallel private system as in the UK,France,Germany etc,etc,etc ….
Good point, Ramunas. Those who know cannot speak. Having said that, anyone who has ever said something the public does not like has been vilified, no? I tend to think that we need to speak up more, not less. But I can see things from your perspective on this also. I agree with your final goal also. Thanks for posting! Stephen should reply soon…
Ramunas, after decades the Public is waking up to the narrative of blaming physicians for the failings of the health care system. You are relatively new to suffering the onslaught of attacks but I am not.
Dr. Brian Day has had the broad and principled shoulders to take the public vilification that the idealogues have thrown at him. He will be one of the catalysts for changing the Canadian Health Care System to something better and sustainable.
The disparaging of physicians is an example of the Logical Principle that I thought up a couple of years ago:
Ad hominem is the last refuge of a failed argument.
I was very proud of myself for having discovered this principle until I read that Socrates had said the same thing a couple of thousand years ago:
When the debate is lost, slander becomes the tool of the loser.
Dr. Brian Day is our side’s Tommy Douglas.
Hopefully, some day after he wins his B.C. charter challenge and wins again at the Supreme Court of Canada, Canadians will recognize the contribution Brian has made.
He will be remembered as The Father of our new and better health care system.
Physicians must be part of this debate for the following reason . . .
“Just because you do not take an interest in politics doesn’t mean politics won’t take an interest in you. ”
― Pericles
I like that line…the Ancient Greek Athenian term “ idiotes” referred to people who take no interest in the affairs of their city.
I entered pre-meds in 1966 and have watched the Canadian healthcare system develop since then. As I read “This May Hurt a Bit” by Stephen Skyvington I felt that he had got the story right. He even jogged my memory with details that I had not thought about for years. There is only one thing in the book that I disagree with and that is that saving healthcare money includes preventative care. Preventative care only delay the inevitable final illness, which is usually the most expensive. As well preventative care allows us to live longer and develop chronic diseases that need to be treated for a long time. Preventative care helps the individual live a better life but it does not save Society money.
Other than this point, I agree with pretty much everything in this book. In order to understand the history of Canadian Health care you should read Stephen Skyvington’s book.
Steve has been around real physicians for a long time. He was a driving force in the Coalition of Family Physicians. He knows our issues and patient issues well. I think he has been frustrated not only with government and its self congratulatory propaganda, but with doctors who talk a good fight but dont have the time or resources to fight the system when our representative body, the OMA, seemed more interested in being seen to cooperate with the MOH than representing the members or the patients we serve. Tommy Douglas would indeed be mortified if he saw what his creation had become.
Thank you, Ernest (and everyone else) for your kind words.
As I’m fond of saying, even a broken clock is right twice a day.
Here’s what in a political campaign is the “ballot question.”
It’s what we’re really voting on and my job as the guy running the campaign is to ensure my candidate’s name is the answer.
If you still believe Canada has the best health care system in the world, that it isn’t a bloody mess, and it’s not time we do something about it, then what can I say? Just close the book, ignore the evidence, and pretend everything is fine.
But what if I’m right?
There is a psychiatric condition called a “ folie a deux” in which a delusional belief is transmitted from one person to another…a married couple might have the psychotic spouse believing that Herr Hitler is living in the basement and wants his tea…the non psychotic spouse enters the delusion to preserve the relationship and takes the tea down to Herr Hitler, returning to say how much the Fuhrer enjoyed it….in this case , believing that the Canadian health care system is excellent, world class, it is a folie a plusieurs…more accurately a folie nationale.
In an insane world it is dangerous to be sane, since they appear to be insane by the majority.
Read this.
It will gladden your heart . . .
https://vancouversun.com/news/national/ian-mulgrew-provinces-medicare-expert-pummelled
Yes, Stephen, it gladdened by heart. 🙂
It would seem that Turnbull and his researcher/ proofreader were expressing their feelings on the topic as opposed to the facts concerning the topic…feelings are not facts.
Unfortunately the moderns ( the millennials?) are increasingly ignoring facts and pay homage to their feelings…the reality is that reality doesn’t give a hoot about feelings …that brick wall we are hurtling towards is not subjective.
Interesting thread. I am not a physician or involved in the medical system. As a voting/tax paying member of the Canadian public I can make a suggestion that at least from my point of view would improve the public system tremendously, an opt out clause. I don’t use it. I would however like to have my portion of taxes that funds the system rebated back to me to pay for the medical treatments that is serving my wife that we currently fund out of my wallet. Oh by the way, my wife was a practicing physician for 25 years here in Canada and the failure of the system treating her as a patient and as a professional is nothing short of a disgrace.
re: ” I don’t use it. I would however like to have my portion of taxes that funds the system rebated back to me.”
Brian, that will never happen. It is like saying that I don’t have kids in school, I have never had kids in school, I never will have kids in school, I myself never went to school, and so give me back that portion of my tax dollars that is being used for the education system. Or I never commit crimes and don’t want to fund the police. I don’t have a car so I don’t want to pay for roads.
It’s just a non-starter, Brian.
I sent my children to private school ( where they were taught the “three R’s” ) at my own expense even as I paid through my taxes for the local schools…which I didn’t resent…however I did my bit to decrease public system class size in those years , in theory increasing the quality of schooling for those remaining in those schools…so I would have appreciated a tax deduction/ credit to reflect my largesse.
Many pay twice for health care…one via taxes for the public system…the other for private coverage….when introduced in the UK the unions representing the working classes, were first in line to sign up….at present , the more that British the public National Hearth Service deteriorates the more the British are turning to the private system …there is, at present, a boom in private insurance sales.
Lucky Brits.
Canadians do not have that option ( as they don’t in either Communist Cuba or North Korea) …Canadians are forced to suffer even as the magnificence of its free Medicare is driven into their heads by relentless propaganda , many slipping to the USA and other countries as health tourists so paying twice…one for the undelivered treatment in Canada as they stand in line , paying a second time for the service abroad…with no tax deduction or credit….after all they stepped out of line allowing the patient to move up one spot in the line up, don’t you think that they deserve a recognition for their act?
I wasn’t saying it shouldn’t happen and maybe they deserve it too, Andris, but my point is that a tax credit is not going to happen in our current society; in fact, I don’t think it will ever happen.
I agree…it won’t happen.
Oh I know it’s not going to happen for several reasons. It’s one thing to pay out of pocket for services because time wait times are too long but when you pay out of pocket for medical services not even offered with in the system this is particularly frustrating.