In the U.S., the Center for Patient Protection recently reviewed the data top hospital rating organizations provide about hospital safety performance. They cover the smallest community hospitals right up to the biggest teaching facilities, in a format where access to the information is quick and user-friendly. You won't find similar information anywhere in Canada.
Cities have to spend this money, taken from local taxpayers, because Canada's medicare system is the only universal, public health care system among developed countries that does not include universal coverage of prescription drugs. It is not wrong for cities to care for their employees. But leaving these costs to the cities makes about as much sense as requiring every homeowner to maintain the roads and infrastructure surrounding their property. Here's why.
I had a vision of cultivating a practice where patients felt heard and cared for, and where I could provide full-spectrum family medicine care, including obstetrical care. My practice embraced the principles of patient-centered collaborative care. It employed the latest in 21st-century technology. I loved my work and my patients. But after five years of constant fighting with multiple private insurance companies in order to get paid, I ultimately made the heart-wrenching decision to close my practice down. The emotional stress was too great.
The dismal record of for-profit hospitals illustrates the problem with running hospitals as businesses. The for-profits have higher death rates and employ fewer clinical personnel like nurses than their non-profit counterparts. But care at for-profits actually costs more, and they spend much more on the bureaucracy, a reflection of the high cost of implementing shrewd financial strategies. Canadian hospital administrators don't have to play financial games to assure their survival.
Employers want their drug plans to be as competitive as those offered by other employers. So what happens when the norm is to cover all new drugs at any cost, even if the drugs do not provide additional therapeutic value? Well, the end result is that everyone buys "generous" plans instead of increasing employee compensation. Everyone we spoke with agrees about the need to educate employees and employers alike. And in fact, everyone agrees (even insurers) that exorbitant drug costs are a big issue for Canadians.
While policy should be evidence-informed rather than belief-based, the complexity of health-system change makes it difficult to draw a straight line from one evidence-based improvement to health-system change as a whole. Improving the quality and quantity of evidence-based decision-making is perhaps the greatest challenge in systematically devising policies for bending the cost curve.
The Liberal government of New Brunswick appears to be stepping back from the brink of mandatory prescription drug insurance. And so they should. The drug plan chosen by the Conservatives was designed on a false premise: that the private sector can better manage things than government can. In many sectors, that might be true. But not in health care.
Most Canadians probably don't realize that health care in Canada is quietly undergoing a major transformation in funding that could significantly impact patients. Three provinces -- Quebec, Ontario and British Columbia -- are implementing a new funding model for hospitals and other provinces are watching with interest.
Rather than placing a tax on health needs -- as income-based drug plans do -- Ontario should consider a more positive road to universal pharmacare. Specifically, it should consider tax financing a universal drug benefit program that would give non-seniors the same coverage elderly residents enjoy today.
Last fall when I visited Canada, I met a Toronto doctor named Gary Bloch who has developed a poverty tool for medical practitioners. Bloch's idea was to zoom in on the social determinants of health -- food, housing, transportation -- all poverty markers linked to bad health and poor health outcomes.
Yes, we do ration healthcare in America. It's just that those affected the most are those who have the least income. In America, we have become oddly blasé about income inequality and its consequences, increasingly willing to let those without simply do without. But the mere hint that a needs -- or evidence-based -- process might be used to allocate scarce or high-priced healthcare raises an outcry from those accustomed to getting what they want, when they want it.
Beyond Quebec, despite the endorsement of the public health and policy community, a Health in All Policies approach has not found the political will necessary for meaningful change. But the past year offers signs of hope, with governments in Canada from across the political spectrum beginning to see the potential.
What would you think if your doctor handed you a prescription that recommended filing your tax returns or applying for food or income benefit programs instead of the usual medicines for high blood pressure or diabetes? You'd probably say the physician was nuts. Tax refunds? Food? What do they have to do with making you healthier?
Put simply, the aging of Canada's population has resulted in large and growing unfunded liabilities. The funding shortfall is estimated at $792.3 billion for the CPP, $494.4 billion for OAS, and $894.7 billion for medicare. Together the unfunded liabilities in Canada's public pensions and health care programs total $2.2 trillion or $134,841 for each income taxpayer. These unfunded program obligations make up more than half of total government liabilities. And their sheer size calls into question the structure of taxing current workers to provide benefits for retirees. Ultimately, to maintain current levels of spending in the future, taxes will have to increase or benefits for other programs will have to be cut -- or both.
A recent testimony before a U.S. Senate subcommittee by Dr. Danielle Martin, former head of the Canadian Doctors for Medicare, has given Canadians the chance to indulge in what may be a favourite pastime -- criticizing the American health care system. While the American health care system has some important shortcomings, the same holds true for Canada's. Inordinately long wait times, medical resource shortages, and ballooning healthcare costs have become defining characteristics of healthcare in our country -- and denigrating the American approach will not fix those problems.
That a considerable number of Canadians traveled and paid to escape the well-known failings of the Canadian health-care system speaks volumes about how well the system is working for them. It leaves open the question of just how many more Canadians might choose medical tourism outside Canada if given the opportunity.
One irony of Canadian life is that the most economically free province in the country, Alberta, often has government policy that is the most hostile to private health care. Another irony, this time right across Canada, is that one can spend any amount of money on a basic necessity of life such as food.
Our country needs a pharmaceuticals strategy that's more than just low-cost drug coverage. Unfortunately, when the Harper government -- which has consistently treated collaboration with the provinces and territories as both obscene and objectionable -- came to power, it walked away from a national pharmaceuticals strategy. As a result, instead of being eight years in on making prescription drugs more accessible, and safer, millions in our country -- as many as one-in-ten Canadians -- cannot afford the medication they need.
For decades, the advertising industry has successfully associated cigarette smoking, (and a multitude of other products,) with "freedom," and other abstractions. People not only "buy" the messages, but they buy the products as well. Similar Psy-Ops strategies are being employed in Canada under the Harper reign.
When Canada's premiers meet for the annual Council of the Federation this week, the future of health care is a critical item on the agenda. The role of a premier is to stand up to federal government bullying on behalf of all Canadians. We are asking them to send a strong message to the Harper Conservative Government: Get back to the table and get back on board to support public health care for all in Canada.