Everybody knows Canada’s health care system cannot survive in its present form. It’s not a question of ideology, it’s a question of grade-school level arithmetic.
According to the Euro-Canada Health Consumer Index (2010), which compares health care delivery in 34 countries, Canada spends more per capita than all but three countries (Norway, Switzerland and Luxembourg), yet ranks 25th in peformance. “Canadians are paying for a world-class healthcare system,” the report comments, “but for a variety of reasons, they are not getting one.”
In a report just released for the CD Howe Institute, former Bank of Canada Governor David Dodge and co-author Richard Dion say that Canada is suffering from “chronic health-care spending disease.” They note:
- The share of national income devoted to healthcare has doubled in the USA since 1975, and has gone up by 60% in the UK. In Canada, it has increased by 70%.
- The growth of real per capita expenditures on healthcare has far exceeded the growth of personal income per capita
- Rising healthcare costs could mean that “the overall budgetary position of provincial governments could deteriorate significantly over the next decades.”
Money, money, money…but results?
Back to the Euro-Canada Health Consumer Index:
- Canada ranks lower than all but 4 out of 35 countries on “Patient Rights and Information”
- Canada is tied with Iceland for dead last on “Wait Times for Treatment”
- Canada is in the middle of the pack – beating 14 countries – on “Outcomes”
- Canada is just below the middle of the pack – beating 12 countries – on “Range and reach of services”
- Canada got just 63 out of 150 available points on “Availability of pharmaceuticals” – only three countries did worse
- Canada’s overall score, 594 out of a possible 1,000, gave it a ranking of 25th out of the 35. By contrast, the #1 country, the Netherlands, scored 857.
Given the high costs and the less-than-stellar results, it’s no surprise that, according to most polls, Canadians rank health care as the top election issue.
Cue the monkeys.
Healthcare is the last topic the politicians appear to be interested in. Oh, sure, there’s some appropriately cuddly verbiage in the party platforms – about the same level as “your call is important to us.”
Here – if you can stand the pain – is what passes for healthcare policy:
The Conservatives remind us that they are “committed to a universal public health care system and the Canada Health Act” but they also note that they’re committed to “the right of provinces to deliver health care within their jurisdictions.” They point out that they’ve “implemented the 10-year federal-provincial Health Accord…to assist the provinces and territories in strengthening health care services for Canadians.” They also “worked collaboratively with the provinces and territories to “develop a Patient Wait Times Guarantee for essential medical treatments.” While there has been “progress in reducing wait times for radiation/oncology treatments and cataract and bypass surgeries” it remains true that “more work is needed to reduce wait times for other treatments and diagnostic procedures.” But don’t worry! “We will continue to work collaboratively with the provinces and territories to renew the Health Accord and to continue to reduce wait times.”
If a private business used the word “guarantee” and then didn’t deliver, it could be charged with misleading advertising or even fraud. But hey, it’s the thought that counts…right?
And as to any specifics of how this “collaboration” will operate, and specifically what it will achieve (never mind when, and at what cost), not a peep.
The Liberals at least acknowledge that “Canadians are becoming more concerned about the sustainability of the system and the quality of services we are getting for taxpayers’ dollars.” And they do zero in on some specific issues – more support for family caregivers; promotion of better health, sports and active living; a brain health strategy to cope with Alzheimer’s. But on system-wide issues, it’s the same generalizations as the Conservatives: “Pan-Canadian collaboration on quality improvement, innovation and best practices.”
Well, sure. Who can object to “collaboration” and “best practices”? But as to specifics of what will be accomplished, and by when, and for how much dough…well, check with the Conservatives’ copywriter.
Just like the Tories, the NDP will “negotiate a new ten-year health accord with the provinces and territories in 2014.” (Like they wouldn’t? That’s when the current deal runs out.) They will “work with” provinces and territories to “promote a clear commitment to the single-payer system, make progress on primary care, take appropriate steps to replace fee-for-service delivery, take first steps to reduce the costs of prescription medicines and extend coverage to out-of-hospital services like home care and long term care.”
There’s so much Mom and apple pie here, I’ve highlighted all the weasel words. But how, precisely, are they going to accomplish this? What will it cost? When will it happen? Will anyone get fired if it doesn’t?
The bottom line is that all three major political parties are running away from health care as if it were, if you’ll pardon the express, the plague.
It’s understandable, in a way. They’re caught in an unsustainable model, and trapped by restrictions largely of their own making. It was always possible to have government-pay co-exist with private pay (jusk ask all those European countries who trounced Canada in the rankings); there was never any reason to volunteer the idea of “no two tier” as if it were some immutable national value (especially since we already have more than two tiers – i.e., pharmaceuticals, dentistry, physiotherapy, chiropractic, psychological services, etc., etc., etc.) But, no. They had to overreach and make it impossible for themselves to get out of the box without sounding like traitors.
So while everyone else in the country is starting to think realistically about health care – not that there still isn’t plenty of debate about what to do – the major parties and their leaders are terrified to step up. It’s become a game of “You go first.” But nobody will. So it reverts to “my meaningless platitudes can beat your meaningless platitudes.”
Will it ever change?
Not, I fear, until the money really does start to run out.