Re: Medicare debate under a cone of silence, Toronto Star, June 30, 2008.

By Dr Nan Okun, Maternal Fetal Medicine Specialist, Mount Sinai Hospital

As a practicing physician and a recently elected board member of Canadian Doctors for Medicare I struggled immensely with Ms Hébert’s editorial on the current state of health care in Canada. Medicare debate under a cone of silence

A relative newcomer to the politics of health care, I, along with the women I care for in my practice have been recipients of the inexplicable volatility in political decision-making that has defined how I am able to deliver care. From the heady 1980’s when the sky was the limit, to current times when “balanced budget” supersedes patient needs, I have wondered why politicians in this relatively rich country have had such difficulty delivering on a publicly funded medicare program that Canadians have repeatedly said they value highly.

Ms Hébert states that the departing Ontario and Quebec health ministers “leave behind a system whose root problems have ultimately defeated their efforts.” I would argue that it is not the system that has the problems; rather the problem lies with those that administer it being influenced by factors other than the vast majority of citizens that support the program and elect the governments.

Contrary to her assertion that “no federal party has ever had the courage to do for medicare what Stephane Dion’s “green shift” is about to do for climate change”, was it not the federal governments of the 1950’s onward that successively crafted the development of the current universal coverage that Canadians have the privilege to participate in, culminating in the Canada Health Act of 1984? Perhaps it is the lack of courage on the part of current governments to uphold it in the face of seemingly overpowering corporate pressure to reduce taxes at all costs, resulting in our perceived inability to protect and care for all Canadians in a publicly funded, single payer scheme of health care.

There have been commissioned and widely researched plans that would go a long way toward ensuring the sustainable future of medicare (eg Romanow Report on the Future of Health Care in Canada), but those in government appear not to be listening. Therefore we really haven’t given these plans a chance “to deliver truly sustainable results” that Ms Hébert refers to. That is different than saying that the plans themselves have not delivered those results.

She is right about escalating relative spending on health care. As many health care analysts and economists have pointed out, when overall social spending is drastically reduced as it has been of late, the relative proportion spent on health care will appear to be out of control. It is a true shame that we “devote twice as much to health as to education” as Ms Hébert points out. But the shame is in the relative decrease in proportional spending on education. This speaks volumes about the value that our governments place on two basic commodities that should be provided to all citizens in such a developed country.

Finally, I would love Ms Hébert to clarify what she means by the “different medicare mix” that no party has “had the guts to make the case for”. If she means the introduction of private for profit funding then we should hear one convincing piece of evidence that such a system would benefit all Canadians, not just those able to pay.

If there is doubt about what Canadians think about publicly funded health care, check out the recently published Dominion Institute survey (www.101things.ca) on the 101 things that we think define being Canadian. Whether categorized according to general public, immigrant, educator or order of Canada recipient, universal health care is in the top six.

The political cone of silence is likely not an accident. It allows the behind-the-scenes steady erosion of the Canada Health Act, created “to carry out the primary objective of Canadian health care policy, which is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” (Canada Health Act Annual Report, 2006-2007)