Being enthusiastic about medical politics isn’t often easy, but I’m pleased to exchange the pen of cynicism for the pen of hope in writing about an election in Ontario. Dr. Jeffrey Turnbull is a candidate for Ontario nominee as Canadian Medical Association president. If elected, he would assume the presidency in 2010.
What makes Dr. Turnbull special? I’ve never met him, but he has impressed many, including the Ottawa Citizen which called him “renowned for developing novel solutions to difficult problems.” He has worked in places as diverse as the slums of Dhaka, the homeless shelters of Ottawa, and the dean’s offices at the university of Ottawa. He is a clinician, educator, advocate, researcher, and administrator. He has served at many levels of leadership in the medical establishment. He is supremely qualified to be the president of the CMA.
Dr. Turnbull is also a proponent of health care delivered in a comprehensive, publicly funded and administered system. While some call for the Canada Health Act to be “modernized,” Dr. Turnbull knows that this legislation, in its simplicity, allows for an array of services and solutions to health care needs as broad as this country. It merely requires that these services be delivered equitably, and that displeases those who want to profit by exploiting the demand for scarce personnel and resources.
The change we really need is in the imagination and will of physicians, administrators, and politicians. By devising innovative and inclusive approaches to health care, Dr. Turnbull has shown that he can provide leadership and vision so necessary at a time when Canadian medicine is plagued by opportunism and mercantilism.
Both leading candidates call for a national pharmaceutical care plan. On this, Canadian physicians may be approaching consensus.
Members of the Ontario Medical Association may vote in the election from January 15 through February 26.
Randall F. White, MD
Saturday, January 17, 2009
Wednesday, October 29, 2008
What does Brian Day say (or not) about privatized medical education?
In August, the Canadian Medical Association passed a resolution during its annual meeting in Montreal calling for “public-private partnerships to facilitate the expansion of medical school capacity.” According to Brian Day, an orthopaedic surgeon and immediate past president of the Canadian Medical Association, Canada has a single-payer problem in medical education and in payment for physician services, which he said means “splitting up a pie that’s not big enough” resulting in a “rationing of resources.” During a talk to the University of British Columbia Clinical Faculty Association in October, he emphasized that Canadian health care is underfunded, and he predicted that, consequent to the Chaoulli decision, all provinces will follow Quebec`s lead to allow private funding of medically necessary services.
According to Dr. Day, private funding is needed: “That’s the way we’re going to get better health care for more people and how we’re going to get better funding for medical education.” He gave examples of private funding for medical infrastructure in Vancouver: the Jack Bell Research Centre, the Pattison Pavilion of the Vancouver General Hospital, and the Gordon and Leslie Diamond Health Care Centre. “This is all private money going into ‘public health care,’” he said, but if he meant to illustrate how the profit motive can enhance health care, his examples failed him. All three of these buildings, which are part of the Vancouver General Hospital clinical, education, and research campus, were named for prominent BC philanthropists.
I join Dr. Day in applauding the generosity of these donors, and I hope that wealthy people will continue to enhance medical research and education in Canada through charitable giving. But donation is not the same as investing in health care funding and delivery in order to generate profit. Surely the distinction does not escape Day, so his confusion is puzzling. Furthermore, he mentioned none of the problems that commercial health care can bring, which Dr. Marcia Angell presents in a recent Canadian Medical Association Journal essay. You can read more about peer-reviewed research on the downside of privatization on the CDM Web site.
As the meeting drew to a close, Day pointed out that Canada has too few physicians. Given a physician density of 2.1/1000 compared with a mean of 3.1/1000 among OECD countries, few would argue that Canada should not train more doctors. Day then brought up the proposal of a new medical school situated in BC’s Fraser Valley and affiliated with Simon Fraser University. This is the best thing that could happen to the UBC clinical faculty, he said, because UBC has a monopoly. He suggested that clinical faculty, some of whom are unhappy about UBC’s unwillingness to bargain with them collectively, would be better off if another institution provided competition. When an audience member asked about the role of a public-private partnership in the venture, he said the medical school would likely be in Surrey, BC and added, “I know more than I can tell you.”
According to two members of the SFU Faculty of Health Sciences, the medical school they and their peers envision would promote primary care and community medicine. Brian Day is not known as a champion of these issues. He founded a private surgical clinic, and during his remarks, he said that once Canada eliminates wait lists, medical tourism can develop as a “big industry” to provide procedures for well-off foreigners. This would be a source of funding for domestic health care, but he didn`t go so far as to say it could also create profit for investors and clinic proprietors, such as himself. Before the meeting ended, Day and some supporters obtained a hasty vote, with as many abstentions and nays as yeas, in support of the concept of a second medical school in BC.
Do we need more medical graduates? Yes, and UBC has just expanded its entering medical class to 256 students. It’s unlikely that the province will support another medical school right away, given the establishment of campuses in Prince George, Victoria, and Kelowna. Private money may be necessary to open a second faculty of medicine, but private-school graduates would come away with high debt, and if Day’s vision of commercialized payment and delivery prevails, perhaps an indoctrination.
Randall F. White, MD
According to Dr. Day, private funding is needed: “That’s the way we’re going to get better health care for more people and how we’re going to get better funding for medical education.” He gave examples of private funding for medical infrastructure in Vancouver: the Jack Bell Research Centre, the Pattison Pavilion of the Vancouver General Hospital, and the Gordon and Leslie Diamond Health Care Centre. “This is all private money going into ‘public health care,’” he said, but if he meant to illustrate how the profit motive can enhance health care, his examples failed him. All three of these buildings, which are part of the Vancouver General Hospital clinical, education, and research campus, were named for prominent BC philanthropists.
I join Dr. Day in applauding the generosity of these donors, and I hope that wealthy people will continue to enhance medical research and education in Canada through charitable giving. But donation is not the same as investing in health care funding and delivery in order to generate profit. Surely the distinction does not escape Day, so his confusion is puzzling. Furthermore, he mentioned none of the problems that commercial health care can bring, which Dr. Marcia Angell presents in a recent Canadian Medical Association Journal essay. You can read more about peer-reviewed research on the downside of privatization on the CDM Web site.
As the meeting drew to a close, Day pointed out that Canada has too few physicians. Given a physician density of 2.1/1000 compared with a mean of 3.1/1000 among OECD countries, few would argue that Canada should not train more doctors. Day then brought up the proposal of a new medical school situated in BC’s Fraser Valley and affiliated with Simon Fraser University. This is the best thing that could happen to the UBC clinical faculty, he said, because UBC has a monopoly. He suggested that clinical faculty, some of whom are unhappy about UBC’s unwillingness to bargain with them collectively, would be better off if another institution provided competition. When an audience member asked about the role of a public-private partnership in the venture, he said the medical school would likely be in Surrey, BC and added, “I know more than I can tell you.”
According to two members of the SFU Faculty of Health Sciences, the medical school they and their peers envision would promote primary care and community medicine. Brian Day is not known as a champion of these issues. He founded a private surgical clinic, and during his remarks, he said that once Canada eliminates wait lists, medical tourism can develop as a “big industry” to provide procedures for well-off foreigners. This would be a source of funding for domestic health care, but he didn`t go so far as to say it could also create profit for investors and clinic proprietors, such as himself. Before the meeting ended, Day and some supporters obtained a hasty vote, with as many abstentions and nays as yeas, in support of the concept of a second medical school in BC.
Do we need more medical graduates? Yes, and UBC has just expanded its entering medical class to 256 students. It’s unlikely that the province will support another medical school right away, given the establishment of campuses in Prince George, Victoria, and Kelowna. Private money may be necessary to open a second faculty of medicine, but private-school graduates would come away with high debt, and if Day’s vision of commercialized payment and delivery prevails, perhaps an indoctrination.
Randall F. White, MD
Wednesday, October 1, 2008
More on Howard`s complaint and its significance
by Randall F. White
Melvin J. Howard wanted to build "the largest privately owned health center in Canada.” According to documents filed with Foreign Affairs and International Trade Canada, he incorporated Regent Hills Health Centre in January 2003 in the province of BC. The original plan involved purchase of 9.5 acres in Vancouver, and he had begun securing financing and undertaken negotiations with the Canadian firms DGBK Architects and Ledcor Construction, Ltd. The scheme involved a Delaware company which would raise funds by selling bonds through Ziegler Capital Markets, a U.S. investment bank specializing in health care financing, "exclusively to American citizens, funds and companies." The loan would have passed through TD Bank in Vancouver, but the money would have flowed from and to the United States.
The Regent Hills Health Centre intended to offer outpatient surgery, laser dentistry, diagnostic imaging, physical and occupational therapy, ambulatory and medical education programs. The 215,000 square-foot building would have housed 14 operating rooms and 110 beds. Nowhere in the documents is a mention of how many physicians and nurses would be needed, how they would be recruited, or any acknowledgment of the peculiarities of health care financing in British Columbia such as the Medical Services Plan.
Howard wanted to open Regent Hills in February 2007, but given the dates on the documents, his plans in Vancouver have been derailed for some time. In the NAFTA complaint, Howard alleges obstruction of permitting by "municipalities or city officials," and loss of deposits on contracts to purchase 5 separate land parcels. Documents suggest he may have shifted his plans to Surrey after Vancouver denied him permission. Furthermore, he mentions "community activist (sic) opposing the private surgical center."
All this indicates that Mr. Howard doesn't give up easily. He is angry, aggrieved, and perhaps grandiose. But according to Todd Grierson-Weiler, Canadian attorney who specializes in NAFTA arbitration, Howard’s submission is amateurish and has little chance of advancing. As for his threat to invoke the General Agreement on Trade in Services, according to Ellen Shaffer of the Center for Policy Analysis on Trade and Health, only the U.S. government could initiate this action against Canada. Unlike NAFTA, the World Trade Organization, which administers GATS, does not permit investor-initiated actions against member states.
So perhaps this is a tempest in a teapot, but dismissing the “NAFTA bogeyman,” as Grierson-Weiler does, fails to acknowledge the crucial lesson. U.S. corporations are not going to give folksy Canadian entrepreneurs a free run. If a market in health care develops in Canada, multinationals like Minneapolis-based United Health International will be at the ready, and for them, NAFTA will be an essential tool.
Melvin J. Howard wanted to build "the largest privately owned health center in Canada.” According to documents filed with Foreign Affairs and International Trade Canada, he incorporated Regent Hills Health Centre in January 2003 in the province of BC. The original plan involved purchase of 9.5 acres in Vancouver, and he had begun securing financing and undertaken negotiations with the Canadian firms DGBK Architects and Ledcor Construction, Ltd. The scheme involved a Delaware company which would raise funds by selling bonds through Ziegler Capital Markets, a U.S. investment bank specializing in health care financing, "exclusively to American citizens, funds and companies." The loan would have passed through TD Bank in Vancouver, but the money would have flowed from and to the United States.
The Regent Hills Health Centre intended to offer outpatient surgery, laser dentistry, diagnostic imaging, physical and occupational therapy, ambulatory and medical education programs. The 215,000 square-foot building would have housed 14 operating rooms and 110 beds. Nowhere in the documents is a mention of how many physicians and nurses would be needed, how they would be recruited, or any acknowledgment of the peculiarities of health care financing in British Columbia such as the Medical Services Plan.
Howard wanted to open Regent Hills in February 2007, but given the dates on the documents, his plans in Vancouver have been derailed for some time. In the NAFTA complaint, Howard alleges obstruction of permitting by "municipalities or city officials," and loss of deposits on contracts to purchase 5 separate land parcels. Documents suggest he may have shifted his plans to Surrey after Vancouver denied him permission. Furthermore, he mentions "community activist (sic) opposing the private surgical center."
All this indicates that Mr. Howard doesn't give up easily. He is angry, aggrieved, and perhaps grandiose. But according to Todd Grierson-Weiler, Canadian attorney who specializes in NAFTA arbitration, Howard’s submission is amateurish and has little chance of advancing. As for his threat to invoke the General Agreement on Trade in Services, according to Ellen Shaffer of the Center for Policy Analysis on Trade and Health, only the U.S. government could initiate this action against Canada. Unlike NAFTA, the World Trade Organization, which administers GATS, does not permit investor-initiated actions against member states.
So perhaps this is a tempest in a teapot, but dismissing the “NAFTA bogeyman,” as Grierson-Weiler does, fails to acknowledge the crucial lesson. U.S. corporations are not going to give folksy Canadian entrepreneurs a free run. If a market in health care develops in Canada, multinationals like Minneapolis-based United Health International will be at the ready, and for them, NAFTA will be an essential tool.
Wednesday, September 24, 2008
Melvin J. Howard’s determination vs Canada’s ambivalence
In their evident ambivalence about a publicly funded, semi-privately delivered health care system, Canadians and their politicians have given an opening to a manic businessman. Arizona health care entrepreneur Melvin J. Howard, who has alerted the world to his bipolar disorder on his Web site, is portraying himself as an underdog in the effort to establish commercial clinics in Canada. He vows to continue his fight “no matter what obstacles get in [my] way.”
In May 2008, Howard wrote on his blog that he would file an investor’s complaint under the North American Free Trade Agreement (NAFTA) because “municipalities or city officials can and have put up numerous roadblocks such as zoning and by law requirements” that prevented his company from establishing a clinic in British Columbia. He cites recent developments in Canada, such as the Supreme Court’s Chaoulli decision and legislation in Alberta, as evidence that the time is ripe for private health care investment in Canada. Who can blame him? The government of BC has all but cheered on the establishment of commercial clinics and for-profit surgical centres
Howard, however, is not content with using the leverage granted investors by NAFTA. In his September 20th blog posting, he wrote, “I am calling on the WTO [World Trade Organization] to wade in on our trade dispute with Canada. In arguing to keep health care off the table Canada claims to have exemptions on their public health care system. At the same time they demand the right to export their own health care services and not allowing any imports; is that sending a message of double standard? I think so.”
Howard is referring to the fact that Canada has included commercial health insurance in its commitment under the General Agreement on Trade in Services (GATS). Canadian multinational insurance corporations have access to foreign health care markets, but foreign insurers are excluded from insuring medically necessary services in Canada. He also points to the existing privatized aspects of the Canadian system including home care and long-term care, laboratory services, and dental care.
As some commentators have pointed out, including Luke Eric Peterson, who broke the story in Embassy newsweekly, Melvin J. Howard’s Centurion is not a huge U.S. health care corporation like Aetna or Tenet. But he’s surely not the only investor who has watched the hypocrisy and complacency unfolding in Canada. The result is murky and confused policy, which may be the intended effect. The province and the country are in the grip of politicians who believe that markets provide solutions; public administrators and governments are impediments, or at best, conduits for the flow of tax payer money to private enterprise.
Nearly every Canadian who advocates for more commercialization of health care also proclaims opposition to a U.S.-style system. U.S. entrepreneurs and investors backed by NAFTA and GATS, however, have no aim other than making money; why should they change their business to accommodate "Canadian values"? Canadians may not be able to have it both ways, and Melvin J. Howard seems to have a personal mission to teach Canada a lesson.
In May 2008, Howard wrote on his blog that he would file an investor’s complaint under the North American Free Trade Agreement (NAFTA) because “municipalities or city officials can and have put up numerous roadblocks such as zoning and by law requirements” that prevented his company from establishing a clinic in British Columbia. He cites recent developments in Canada, such as the Supreme Court’s Chaoulli decision and legislation in Alberta, as evidence that the time is ripe for private health care investment in Canada. Who can blame him? The government of BC has all but cheered on the establishment of commercial clinics and for-profit surgical centres
Howard, however, is not content with using the leverage granted investors by NAFTA. In his September 20th blog posting, he wrote, “I am calling on the WTO [World Trade Organization] to wade in on our trade dispute with Canada. In arguing to keep health care off the table Canada claims to have exemptions on their public health care system. At the same time they demand the right to export their own health care services and not allowing any imports; is that sending a message of double standard? I think so.”
Howard is referring to the fact that Canada has included commercial health insurance in its commitment under the General Agreement on Trade in Services (GATS). Canadian multinational insurance corporations have access to foreign health care markets, but foreign insurers are excluded from insuring medically necessary services in Canada. He also points to the existing privatized aspects of the Canadian system including home care and long-term care, laboratory services, and dental care.
As some commentators have pointed out, including Luke Eric Peterson, who broke the story in Embassy newsweekly, Melvin J. Howard’s Centurion is not a huge U.S. health care corporation like Aetna or Tenet. But he’s surely not the only investor who has watched the hypocrisy and complacency unfolding in Canada. The result is murky and confused policy, which may be the intended effect. The province and the country are in the grip of politicians who believe that markets provide solutions; public administrators and governments are impediments, or at best, conduits for the flow of tax payer money to private enterprise.
Nearly every Canadian who advocates for more commercialization of health care also proclaims opposition to a U.S.-style system. U.S. entrepreneurs and investors backed by NAFTA and GATS, however, have no aim other than making money; why should they change their business to accommodate "Canadian values"? Canadians may not be able to have it both ways, and Melvin J. Howard seems to have a personal mission to teach Canada a lesson.
Wednesday, September 3, 2008
Montreal, Canada's commercial health care capital
In an opinion editorial published in the Toronto Star on September 3 http://www.thestar.com/comment/article/489323, Dr Robert Ouellet, president of the Canadian Medical Association, advances the idea that Canada can develop a European-style health care system with a public-private blend. This fallacy is promoted by politicians and pundits who are enamored of markets as the solution to our problems. But Canada is not in Europe, does not have a European-style social welfare establishment, and is party to a trade treaty with the United States. Once health care becomes a commodity in Canada, U.S. corporations will demand entry under NAFTA and the future of our health care system will be out of our hands, despite Dr. Ouellet's soothing rhetoric.
While it's frustrating for physicians to face an unresponsive bureaucracy, Quebec provides a cautionary tale of what may happen when entrepreneurs take matters into their own hands. Quebec radiologists established imaging clinics independent of the health care system, albeit with the province’s knowledge. The government then let itself off the hook for certain outpatient diagnostic exams, and these medically necessary procedures were delisted (which is illegal under the Canada Health Act). Patients now must pay out of pocket for these tests, and many buy commercial insurance "just in case."
Because markets and investors demand constant growth, established commercial clinics and health insurance will seek to expand into other areas. Dr. Ouellet is a manifestation of this—he is using his influence as the president of the Canadian Medical Association to advocate for more commercialization of health care.
Meanwhile, weeks after neurosurgeon Dr. Phillippe Couillard resigned as the Quebec minister of health, Persistence Capital Partners announced that he had accepted a position as partner. The Montreal firm is, according to its August 18 press release, “Canada’s first private equity fund dedicated to investing in healthcare businesses.”
When publicly questioned about the implications of his hopping from operating room to provincial cabinet to private investment firm, Couillard said, "It's perfectly in line with what I've been advocating for years - a strong public system, well-funded and well-organized." http://www.canada.com/montrealgazette/news/story.html?id=160dd9e1-5407-427e-86e3-6c3d55788825 As his legacy to the well-funded, strong public system, Couillard handed health care investors a gift in Bill 33, which promotes outsourcing to private clinics as a solution to excessive surgical wait times.
Both of these doctors insist that their efforts to commodify medicine demonstrate their devotion to public health care. Some physicians find this disingenuous. Medecins Quebecois pour le regime public issued their response to health care commercialization in Quebec during the August 2008 annual meeting of the CMA in Montreal http://www.medecinspourlacces.ca/position10.php Quebec may be different, but when it comes to health care opportunism in Canada, it is unfortunately not unique.
Randall White, M.D. FRCPC
While it's frustrating for physicians to face an unresponsive bureaucracy, Quebec provides a cautionary tale of what may happen when entrepreneurs take matters into their own hands. Quebec radiologists established imaging clinics independent of the health care system, albeit with the province’s knowledge. The government then let itself off the hook for certain outpatient diagnostic exams, and these medically necessary procedures were delisted (which is illegal under the Canada Health Act). Patients now must pay out of pocket for these tests, and many buy commercial insurance "just in case."
Because markets and investors demand constant growth, established commercial clinics and health insurance will seek to expand into other areas. Dr. Ouellet is a manifestation of this—he is using his influence as the president of the Canadian Medical Association to advocate for more commercialization of health care.
Meanwhile, weeks after neurosurgeon Dr. Phillippe Couillard resigned as the Quebec minister of health, Persistence Capital Partners announced that he had accepted a position as partner. The Montreal firm is, according to its August 18 press release, “Canada’s first private equity fund dedicated to investing in healthcare businesses.”
When publicly questioned about the implications of his hopping from operating room to provincial cabinet to private investment firm, Couillard said, "It's perfectly in line with what I've been advocating for years - a strong public system, well-funded and well-organized." http://www.canada.com/montrealgazette/news/story.html?id=160dd9e1-5407-427e-86e3-6c3d55788825 As his legacy to the well-funded, strong public system, Couillard handed health care investors a gift in Bill 33, which promotes outsourcing to private clinics as a solution to excessive surgical wait times.
Both of these doctors insist that their efforts to commodify medicine demonstrate their devotion to public health care. Some physicians find this disingenuous. Medecins Quebecois pour le regime public issued their response to health care commercialization in Quebec during the August 2008 annual meeting of the CMA in Montreal http://www.medecinspourlacces.ca/position10.php Quebec may be different, but when it comes to health care opportunism in Canada, it is unfortunately not unique.
Randall White, M.D. FRCPC
Wednesday, August 20, 2008
Re: Betting your health on Canada's doctor lottery - National Post
Kelly McParland's August 7 editorial, "Betting your health on Canada's doctor lottery," suggests that doctors leave Canada because of the health care system. Undoubtedly some do, and some highly trained surgical specialists can earn significantly more in the United States. But what about U.S.-trained physicians who come to Canada because of the system? They exist and I am one of them.
According to the Canadian Institute for Health Information, more doctors returned to Canada than moved abroad in 2004, 2005 and 2006. Perhaps they were lured by low administrative costs, low malpractice insurance rates, and guaranteed payments. And if Canadian doctors think "government interference" is a problem in Canada, wait until they have to struggle with insurance companies for payment, have their patients' treatment dictated by insurance industry bureaucrats, or find they must treat patients for free. The U.S. is the only industrialized country that relies on charity care for a large proportion of its population. In Canada, I can treat all patients without having to worry about whether they have insurance coverage.
The assertion that all or even most U.S. physicians "practice the best medicine possible without government interference" is wrong. The U.S. government funds close to half of health care, and that money comes with many strings attached. The insurance industry has plenty of strings attached to the remainder of health care financing. I've been there, I know, and I'm glad I'm now in Canada.
Randall White, M.D., FRCPC
According to the Canadian Institute for Health Information, more doctors returned to Canada than moved abroad in 2004, 2005 and 2006. Perhaps they were lured by low administrative costs, low malpractice insurance rates, and guaranteed payments. And if Canadian doctors think "government interference" is a problem in Canada, wait until they have to struggle with insurance companies for payment, have their patients' treatment dictated by insurance industry bureaucrats, or find they must treat patients for free. The U.S. is the only industrialized country that relies on charity care for a large proportion of its population. In Canada, I can treat all patients without having to worry about whether they have insurance coverage.
The assertion that all or even most U.S. physicians "practice the best medicine possible without government interference" is wrong. The U.S. government funds close to half of health care, and that money comes with many strings attached. The insurance industry has plenty of strings attached to the remainder of health care financing. I've been there, I know, and I'm glad I'm now in Canada.
Randall White, M.D., FRCPC
Friday, July 4, 2008
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)
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