Beyond The Commons

 Beyond The Commons

Aaron Wherry covers all the goings-on in and around Parliament Hill. Follow Aaron on Twitter: @aaronwherry

Categories: Beyond The Commons, Capital Read

'A serious, adult discussion is called for'

by Aaron Wherry on Tuesday, October 19, 2010 12:34pm - 0 Comments

Brian Mulroney considers the future of health care (among other matters).

On health care, for instance, we need to strike a better balance between the intrinsic value of universal coverage for basic medical service and the capacity of Canadians to pay the necessary taxes to support the system. The OECD, not exactly known for radical analyses, recently concluded that, because our health-care system is not sustainable in its current form, some form of user fees and greater scope for competition within the system will be necessary.

The current federal-provincial funding formula ends in 2014. A serious, adult discussion is called for and I believe a blue ribbon panel of medical and financial experts could provide a sensible framework for the debate and for the decisions needed. Not surprisingly, the fundamental assumptions on which Justice Emmet Hall based his recommendations for medicare almost 50 years ago have changed and we need to adapt accordingly.

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  • Mike T.

    If Mr. Mulroney is correctly quoting said report, in that those were the only possibilities mentioned, then it was woefully narrow in exploring options.

    • YYZ

      I agree…for example, both more efficient delivery within a public context and higher taxes/different allocation of tax dollars should both be considered in any adult discussion.

  • Orson Bean

    Great. The first post aims to derail a serious adult discussion about health care.

    I love the irony.

  • Greg

    Whenever a conservative calls for an "adult" conversation, I lock up my daughter and hide my wallet.

    • Emily

      Exactly.

      • Orson Bean

        Yes, it's much preferable to have juvenile conversations about serious issues facing our country. Like the funding implosion facing our health care system as our population ages.

        Or, better yet, let's have no conversation at all, do nothing and just see what happens.

    • Jan

      Yes, everyone else should drop their partisanship and adopt privitization. Beware the health insurance lobby, it works in not very mysterious ways. Bernier is not the oracle.

    • WDM

      People west of Ontario do the same thing when the Liberals call for one.

  • dave

    I believe a blue ribbon panel of medical and financial experts could provide a sensible framework for the debate and for the decisions needed.

    Been here, done this. How many of Tobin's suggestions got implemented? I still don't see many multi-specialist walk in medical centres with computerized records and doctors on salary being cranked into production…

  • Out There

    That was my first thought too: will a "serious adult discussion" about health care be equivalent to "we can't afford to give everyone free medical care any more"?

    In any "serious adult discussion", a watch will have to be kept out for lobbyists for US-based health-care organizations, which would no doubt love to be able to expand into the Canadian market. No doubt, these lobbyists would advocate a US-style system, rather than other options that may be available.

    Also: forcing poorer Canadians to pay some of the freight would likely encourage them to postpone routine checkups and ignore the early stages of problems in order to save money. Which might lead to a greater strain on the system later on (since, presumably, no health-care system would allow the poor to die).

    What are the Europeans doing these days, or is that not affordable either?

    • Mike T.

      They don't want an American style system. They want to be paid by the government, not having to rely on people.

  • john g

    The World Health Organization no longer ranks the world's health care systems. Here were the last ones done in 2000.

    How about for starters, rather than falling back on the tired old "US Style Health Care" fearmongering that is unfailingly trotted out as part of every election campaign, we take a long hard look at modelling a health care delivery system against one of the top 5 from the list. At first glance, all seem to have some mixture of public and private, for-profit service providers, and allow the population to purchase their own insurance.

    • alfanerd

      "US Style Healthcare" is now Obamacare. And opposing anything Obama does is racist. So we should adopt US Style healthcare, unless we're a bunch of racist teabaggers.

      • MostlyCivil

        Congats, alfa. With that nonsense, you've joined emily and a few other ranters on my "don't bother" list.

        • alfanerd

          Thanks MC, I was actually joking (and thought it was pretty obvious), but Im glad I made the list anyways.

        • Emily

          I was wondering why I was so lucky, MostlyUncivil!

      • Jan

        Now you're just being childish, alf…

        • alfanerd

          It's a freaking joke. Do I really need to put :) and lol everywhere to show people Im joking?

          • Jan

            Please, if you wouldn't mind. For some reason it is not always clear. I usually think you must be joking only to find out you're dead serious.

          • alfanerd

            Alright I'll try. For the record though, if what Im saying is merely outrageous, Im usually dead serious. :)

  • MostlyCivil

    Yet as soon as any provincial government moves towards evidence-based decision making (like not funding BS procedures and useless tests), the oppositions cry "shame" and "You're cutting health care! OMG!". NDP, Liberal, Conservative. All have played both sides, and still do. Same with the professional associations and unions, the advocacy groups and the lawyers.

    Everybody says the system is unsustainable, But nobody wants to be the ones to make the channges. Sure, user fees are no big deal for most, except for the people that make most use of the system. Oh, and people for whom that $20 is grocery money. So, user fees for the users with money, and exemptions for the sick and poor. The user fees should just about pay for the user fee collection system.

    We need everybody onside, boys and girls. And Brian, when you make the suggestion about the Blue Ribbon Panel, be prepapred for them to tell the OECD to get stuffed.

    • Amateur Hour

      "Everybody says the system is unsustainable,"

      This is commonly repeated belief … not backed by "evidence-based decision making".

      The population that Canada's healthcare system is intended to serve is shifting faster than is the system: this is the problem. As we urbanize and age and move towards long-term management of chronic conditions (vs. the old days of acute care at a hospital), our system's infrastructure needs to become more flexible and adaptable.

      However, the "system" of universal coverage and public insurance has been proven, time and again, to be not only sustainable, but also cost-effective compared to other approaches.

  • Holly Stick

    "…Everybody says the system is unsustainable…" Just because many people say this over and over does not mean that it is true.

    It is sustainable if we choose to make it so.
    http://rustyidols.blogspot.com/2010/01/jeffrey-si…

    • Emily

      Yup, it depends on what we choose to spend our money on…and for Canadians, it's healthcare.

      • Orson Bean

        But the question is, if it keeps on getting more expensive, and keeps on eating up increasing percentages of our provincial budgets, will we be willing to either (1) accept and implement needed tax increases or other revenue-raising measures (e.g., user fees); or (2) cut other government programs and services in order to shift even more funding over to health care budgets?

        I'm not sure what the answer is there. And if the answer turns out to be "no" to both (1) and (2), then as far as I can see, enhanced use of private delivery, providers and insurers would seem to be the only remaining option. But maybe I've overlooked some other alternative — I'm trying to keep an open mind here.

        • Jenn_

          No, obviously at some point if things continue to get more and more expensive then not making that decision is making the decision to pass the cost along to our children. I think we should keep that in mind, that we ARE making a decision.

          I have a problem in that "first you break the system, then you scrap the system that doesn't work." In my opinion–supported by absolutely no fact-based scientific evidence–doctors (or at least the CMA) would like for-profit health care and they are largely in charge of health care. Why else would doctors be recruited from other countries to drive taxis here? Why have sucessive governments made clear the College of Physicians and Surgeons must increase the number of licensed foreign-trained doctors, with virtually no improvement? So I'd like to suggest Mulroney ensures the "Medical Experts" on the Blue Ribbon Panel encompasses technicians, nurses, pharmacists, administrators and others, as well as just doctors.

    • Jan

      This has always been Gordon Campbell's mantra – because he favours privitization.

  • Horatio

    But on the flip side of that, isn't a public-only option now part of Liberal/NDP ideology? Every time some sort of private option is brought up, it's labelled as "American-style" health care. I don't think many Canadians want that. Some, most of whom are probably Conservatives, might want that system. But I think we all know that some sort of public option is never going away, not anytime in the foreseeable future anyway.

    Can't we have an adult discussion where we look at a some sort of hybrid public/private system. We can even call it European-style, if that helps the sell job.

    • Emily

      I assume so. The NDP because they think they started it, and at least during Allen Rock's day for the Libs since he said other countries warned him about a dual system, and wish they'd never started it.

      I have no idea what their current thinking is on it, but I wouldn't be surprised if it's the same.

    • Orson Bean

      Well, that's the thing. Many Canadians have this insane neurosis about the United States, and it inhibits rational discussion about health care. Meanwhile, most of our other G7/G20/OECD peers have some mixture of public and private delivery and administration, and yet nobody is labelling places like Scandinavia or Switzerland US-style neocon dystopias. Usually, NDPers and left-leaning Liberals point to Scandinavian countries as places we should emulate. Yet when it comes to health care, they don't even want to consider anything but our status quo — which, last time I checked, earns us an impressive 28th place out of 30 OECD countries surveyed in health care systems.

      • Emily

        Insane neurosis? When we can clearly see the ongoing disaster the US is?

        Why would anyone want to emulate that? In anything?

        • tedbetts

          The problem is that if the issue gets framed as US healthcare vs Canadian healthcare, Canadians lose. Our healthcare system loses.

          If we looked at the rest of the western world, we would see better healthcare systems and realize that the US "system" is not an inevitability and not the only option.

          Canada has never had single tier healthcare. Ever. That is what is juvenile about the "conversation" we have/don't have. Currently more than a third of our healthcare is private. I've heard that before but I think it lowballs the reality as I'm not sure to what extent it includes things like pharma and eyeglasses. The number does include dentristry. These are all run in a private care system with private insurance coverage (or not).

          Far better to look across the ocean at how these are handled better than the disaster that the US is and the disaster Canada risks soon becoming.

          • Emily

            I agree. US v Canadian is a sure-fire loser in any discussion. But there are lots of healthcare systems in the world. Grab the best one and run with it, I say.

            Of course other countries had a baby boom too, so why we think this is uniquely our problem I don't know.

          • Reverend_Blair

            The thing is that due to both geography and economic ties, US healthcare lobbyists have a lot of influence…including through a possible Chapter 11 NAFTA suit…than those promoting systems from other countries have.

            If we're not careful, we could actually end up with something worse than the US system. How about US costs with Canadian wait times and third-world recovery outcomes?

  • James Connors

    I'm pretty sure that the private interest in health care in Canada is mainly based on the concept; there is money in there somewhere we just have to find it.

    If I was certain it would drive down the price of aspirin I would support the effort. Call me cynical if you wish; when a Canadian's good health is driven by, ahem, market forces I begin to conclude the market and I may not agree on every jot and tittle.

  • brooster2

    "The current federal-provincial funding formula ends in 2014. A serious, adult discussion is called for and I believe a blue ribbon panel of medical and financial experts could provide a sensible framework for the debate and for the decisions needed."

    Great…how Canadian…another Royal Commission. Isn't the final report Roy Romanow's 2001 Royal Commission on the Future of Health Care moldering on shelves everywhere?

  • Stewart_Smith

    This will have to be short. (I find it very tiring to stay within an adult persona) The issue which Mulroney is raising has virtually nothing to do with the details of user pay or publicly funded systems. The need for health care is pervasive and the costs of health care enormous. Whether you pay out of pocket or through taxes, our current models for delivery of health care are too expensive, i.e. it is our ratio of health care costs to GDP which is the issue. As a result, the first order of business must be to change health care delivery. Here I am no expert, but reducing the use doctors for minor health issues must be one component. Likely another has to be a re-evaluation of the extraordinary costs associated with end-of-life treatments (the philosophers here might get to work on the thorny aspects of that issue).

    In any case, neither the Canadian nor US payment systems provide incentives for reducing health cares costs. Frankly I doubt if the European systems are much better, so I guess we are screwed.

    • alfanerd

      I agree. On that point, CBC's the Current had a good piece on (I believe it was yesterday morning) on a pay-for-performance program in BC, where hospitals dont get a fixed budget for the year, but receive $ when they perform a procedure. This means that, instead of being a cost, the patient is a source of revenue. The program has apparently lots of success and the BC gov is looking to expand it.

      Broadly speaking though, private healthcare is inevitably coming to Canada, I believe, and the baby boomers will be the one to demand it. While the boomers were happy to have public healthcare for their parent's generation, they've always wanted only the best for themselves and I dont expect them to allow for * their * healthcare to be only public.

  • Olivier

    Two-tier! Two-tier!

  • DianeG

    Sigh. There are other options that would be better than increasing private health care. In Ontario, we have gone through numerous and expensive 'revamps' when provincial goernments changed. There were silos, then no silos, CCAC's which were meant to be one-stop access, LINS etc. etc.

    What could help? More nurse practitioners, staffing 24 hour clinics & community clinics, salaries or a different fee structure for doctors, better home care (people can stay at home even with very serious chronic illness if the right help is given by trained personnel CONSISTENLY AND FOLLOW-UP) hospice care, health promotion. These are all practical unglamorous things and they would make a big difference.

    Also, I'm rather fed up with hearing that the cost of end-of-life care will be enormous. It does not have to be so.

  • Guest

    "A serious, adult discussion is called for and I believe a blue ribbon panel of medical and financial experts could provide a sensible framework for the debate and for the decisions needed."

    Sure, let's "frame" the debate so that we can support whatever foregone conclusion we were looking for.

    I'd suggest instead that we create a panel of ordinary every-day Canadians who have either been the recipients of severe medical errors (as have three members of my family within the last two years) or who suffer from poorly managed chronic illness. You'll find that THOSE people will have a high degree of frustration at the ineptness and waste of our current medical system that rewards providers of patient visits and procedures and punishes those who would promote health, and disease prevention.

    • Guest

      Sorry, hit 'submit' too soon. Those patients, who would much prefer a little bit of assistance to avoid disease and medical error, rather than a great amount of assistance to inadequately treat it after the fact, would astound you with the cost savings and health-care delivery reform they would propose and champion. Unlike those "medical and financial experts" who have no built-in interest in the well-being of either patients or currently healthy Canadians. For instance, just ask an MS sufferer just whose welfare the MS Society (comprised of those self-same "experts") is looking out for.

  • Bill

    Possibly his good friends from Big Pharma? After all, when in power, he certainly tended to their well-being (i.e. extended patent protection)!

  • Emily

    I like Brian Mulroney.

    I voted for Brian Mulroney twice.

    I am especially pleased about free trade.

    But….this is just another back-door attempt to privatize the Canadian health care system.

    Whenever we are called upon to have a 'serious adult discussion', it usually involves privatizing something.

    Canadians can have whatever they damn well please with their tax money, since it is theirs after all. Whatever they want, they can have….as long as we can afford to pay for it.

    And we have repeatedly opted for a healthcare system. Over everything else….including fighterplanes.

    So perhaps it's the fighterplanes we should be have a 'serious adult discussion' about.

  • Claudia Lemire

    Emily, I am starting to believe you are Kim Campbell : )

  • Emily

    LOL Nah, she had tanks. I regard them as park ornaments.

  • Claudia Lemire

    Hahaha…

  • Emily

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