Canadian Health Care Reform Needs a Rethink and a lot of Courage
There is no purity to be found in a state-run health care system that increasingly cannot meet the needs of the people it is supposed to serve. There are solutions if the problems can be understood clearly. Yet, health care reform in Canada has been going on for decades without relief from the main problems related to access and affordability. As a result, today in Canada we have a health system of rationed care.
It is time to earnestly seek out health care reform that will provide for the increasing health demands of a growing and aging population. Political decision-makers need to overcome their fear and find the courage to move forward from the failed status quo. And they need to listen to solutions beyond the usual entrenched unaccountable advisers and backroom lobbyists. Not only do physicians need to be properly funded, physicians should replace the lobbyists and health technocrats at the table to develop ways to meet the needs of Canadians.
Over the years governments have requested multiple commissions and hundreds of reports intended to address health care system shortcomings, both federally and provincially. Frequently, as was the case with the Drummond Report, the terms of reference are conveniently limited to provide solutions within the status quo framework. It is no wonder that Canadians are still stuck with limited access to timely care and yet paying significant taxes for care they cannot access, including an actual health tax in Ontario that has not improved care.
There is an entire industry feeding into the costly lobby and technocrat consultant layer that never manages to get to the crux of the problem. This layer manages to feed its own serving as a comfortable landing place for former government staffers. Whether this shows the ineptitude of ministries of health, the complexity of the problems in health care, or lack of understanding by the politicians at the helm, is up for discussion. Meanwhile, the lack of access to primary care and the relative shortage of providers, particularly family physicians, have become a worsening crisis.
More centralization, coordination, standardization of care, and even the creation of centres of excellence has not provided the relief necessary although these approaches have been touted for decades as the path forward to cost-effectiveness and efficiency finding. The political decision-makers seem content to continue to look to consultants, both paid and unpaid, and lobbyists for solutions instead of funding the providers to create the access and provide the care.
Currently, Canadians are stuck in a crisis response to declining health care access that almost always includes creation of a task force, a targeted allotment of funds, and related legislative change if deemed politically helpful. This approach tends to appease various interest groups but never has a lasting effect. But nobody should confuse this government action with tangible results. The fundamental problem persists of the mismatch between the volume of services required versus government’s capacity to fund those services.
In Ontario for example, the health care budget consumes almost half of the overall provincial budget at approximately 40 per cent leaving 60 per cent of the budget to fund all other services including education, and social services. Do Ontarians want more of the fiscal pie to be taken from other areas of need to fund more state-run health care with its vortex of bureaucrats and consultants?
The health care system is at a critical inflection point. Canada’s aging population means less productivity just when health care needs are greatest. The country’s stagnant or dropping GDP cannot meet the increasing health care needs of an aging, and growing population. Sustaining the current health care system by increasing taxes at a time when families are struggling with affordability would reflect politicians as being out of touch. Increasing taxes on high earners and businesses has the unintended consequence of driving down productivity and driving out some of the most innovative companies and workforce. This all speaks to the need for original thinking, not a regurgitation of old reform ideas with a twist.
There are calls from those who believe that a single payer state-run health care system is the most equitable option and can solve the crisis at hand if there was just more government funding or more efficiencies found. After decades of bureaucrats, consultants, and political brainstorming to find those efficiencies and identify the waste, the situation in health care access and affordability is getting worse, not better. When should we expect to arrive at this “no waste in state-run health care” utopia?
Meanwhile, costs are rising. According to the Financial Accountability Office (FAO) of Ontario’s May 31, 2023 report, “Ontario Health Sector: 2023 Budget Spending Plan Review”, spending growth by program areas over the eight-year period from 2019-2020 to 2027-28 will be led by long-term care (12.9 per cent average annual growth), community programs (includes home care, 5.7 per cent), Ontario public drug programs (5.2 per cent) and hospitals (4.5 per cent). Of note by the FAO is that health sector spending includes combined spending by the Ministries of Health and Long-Term Care. Also of note by the FAO is that the Ontario government previously requested an increase in federal funding so that health transfers would support 35 per cent of all annual provincial-territorial health spending. This has not been forthcoming to any substantial degree. What is a province to do?
Given the current realities, it is misguided for health ministers and the Canadian Medical Association to be looking to restrict privately funded virtual care when an estimated 6.5 million Canadians cannot access a family doctor. Solutions brought forward and created by physicians and other front-line providers who understand how they can improve access to care for the patients they serve need to be taken seriously -- without having to hire lobbyists at tens of thousands of dollars a month.
Similarly, creative programs that allow for improved access within the parameters of provincial and federal rules should not be shut down when interest groups become vocal in opposition. There are more solutions that need to be understood along with the barriers that are preventing them from being realized. Canada’s rationed system creates barriers to care instead of creating timely access to care for all. Even with ever increasing funding from multiple levels of government, demand for health care outpaces spending.
AbacusData recently looked at what are considered “third rail” policy issues in Canadian politics. With respect to health care reform, third rail issues are true barriers to care because they shut down debate without greater effort to find the middle ground or solutions involving compromise. They are considered too dangerous to touch politically. In “What Policy Ideas Attract and Repel Canadian Voters?” regarding the policy idea to “Allow people to pay to access most healthcare procedures”, a total of 49% of responses included “Definitely vote for” or “Might vote for” and 39% would “Never vote for” a political party that promised this. Even though this policy idea was grouped into the “Vote Loser” category, there were more respondents open to the concept than not.
A recent Leger survey reported August 8, 2024, “Canadian Healthcare”, showed the following:
-Compared to January 2023, there has been a significant 10-point increase in respondents saying the healthcare system in their province is poor
-A vast majority of Canadians (85%) are worried about the state of their province’s healthcare system
While Canadians are losing confidence in their healthcare system, an Ipsos poll from 2023 found:
-59% of respondents expressed support for the private delivery of publicly funded health services
-60% of respondents were in favour of private health care for those who can afford it
-85% of respondents said they believed “drastic changes” are needed in the health system to meet the needs of the community
This is a substantial shift in support of options for health care reform beyond the failing status quo – and this includes private care. It’s clear that Canadians are feeling the system is so severely challenged they are now open to considering tangible solutions that work well in better performing health care systems.
There are solutions that work in other jurisdictions which Canada could learn from if it is possible to move past the barriers created by bureaucratic inertia, lobbying inequities, and funding restrictions related to the need to ration care in a single payer, state-run system. And fear-don’t forget the fear. Politicians are afraid to ride the third rail and do what needs to be done.
In the last few months, SecondStreet.org has produced a simple-to-follow documentary, “Health Reform Now”, which provides worthy solutions to consider how to improve access to care in Canada. Although some of these concepts such as “Activity-Based Funding” and “Reimbursement for Surgery Abroad” have been considered for many years, the limiting factor is government’s ability to pay for the additional access to care. New to the discussion is the solution, “Choose to Use Public or Private.”
This discussion of reform options and related actions is long overdue. It is now urgent. The crisis in Canadian health care demands new approaches used successfully around the world with superior results to ours. In the past these reforms may have seemed too hard to implement but with our system at the breaking point it is past time for individual physicians to drive the necessary reform. Ineffective representative groups, entrenched consultants, and self-interested lobbyists should get out of the way….and politicians need to have the courage to do what needs to be done.
References
We’re getting lousy value for the taxes we pay in Canada”, Toronto Star, August 19, 2024
“Are Canadians getting enough value for their tax dollars? The emphatic answer is ‘no’.” Financial Post, August 6, 2024
https://financialpost.com/personal-finance/canadians-not-getting-enough-value-for-tax-dollars
“Taxes versus the Necessities of Life: The Canadian Consumer Tax Index 2024 edition”, The Fraser Institute, July 30, 2024
“Brett Belchetz: The Canadian Medical Association is the real threat to health care access”, National Post, August 12, 2024
“Privatization concerns sparked by potential new Alberta health-care prototype”, CBC News, August 19, 2024
https://www.cbc.ca/news/canada/calgary/alberta-airdrie-one-health-ahs-urgent-care-1.7297676
“What Policy Ideas Attract and Repel Canadian Voters? A look at the “Third Rails” of Canadian Politics”, Abacus Data, August 18, 2024
https://abacusdata.ca/policies-canadian-politics-attract-repell/
“Report: HealthCare in Canada”, Leger, August 6, 2024
https://leger360.com/canadian-healthcare/
“Majority of Canadians support private options for health care, poll shows”, Global News, Feb 6, 2023
https://globalnews.ca/news/9458260/health-care-private-options-majority-canadians-support-poll/
“Federal government flouted rules when awarding McKinsey contracts: AG report”, CBC, June 4 2024
https://ca.news.yahoo.com/federal-government-flouted-rules-awarding-142829574.html
“A Systematic review of the accessibility, acceptability, safety, efficiency, clinical effectiveness, and cost-effectiveness of private cataract and orthopedic surgery clinics”, Cambridge University Press, August 1, 2023
View related short videos:
Why politicians cannot deliver on health care reform
Physicians need to be heard on health care reform
Dr. Merrilee Fullerton’s book “A Physician in the Political Arena” can be read here.