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.
Waiting is a defining characteristic of Canadian health care. Canadians wait, often interminably, for access to health care services. Canada's wait times are among the longest in the developed world. And, contrary to popular belief, Canada's terrible wait times are not the result of insufficient health care spending. In 2009 (the most recent year for which comparable statistics are available), Canada's health care system ranked as the developed world's most expensive universal-access system. The solution to Canada's waiting time woes is sensible health policy reform that would employ private competition in the delivery of universally accessible hospital and surgical services .
Every year, provincial health care systems across Canada dutifully reduce the volume of services they provide in preparation for the summer vacation season. This planned-for reduction has the inevitable effect of lengthening waiting times for Canadians over the summer months (and during Christmas holidays). The added twist this year is the slowdowns might be extended in a bid to reduce expenditures.
We would wager citizens of every country think health care could be improved. However, we would also bet a plane ticket to someone's favourite summer getaway that Canadians will find countries with universal health care, such as Australia, Japan, or favourite tourist destinations in Europe, have far better health care than we do. That's because their citizens and their governments have no hang-ups about the three boogeymen of upfront fees, "private" insurance, and private delivery. They are also nations with progressive, sensible health care practices that could help improve Canada's health care system.
Immediately after Pope Francis became the leader of the world's 1.2-billion Catholics this week, he prayed for guidance. And it's little wonder. He is the newly elected CEO of the Vatican. The United States, despite a currency mantra of "In God We Trust," has also been forced to undergo serious soul-searching following its 2008 fiscal catastrophe.
Policy planners and health-policy experts can build their models and do their studies, but patients want high-quality service now, they want it free and they want it effective. They pay their taxes for a health-care system that is among the most expensive in the world. They are not getting enough value for money. Why not?
Many Canadians have developed an insidious culture of self-satisfaction that comes with being told repetitively by politicians and media that we have "the best health care system in the world." We have somehow taken this patent lie as a slice of authentic Canadiana. It makes us feel good, safe and comfortable. But you don't have a "comprehensive and universal" system if it takes two years to get a hip replaced, or eight months to get an MRI after a hard knock to the head. How can we keep a straight face and call our system a caring and "universal" one if many have no where to go?
Back in ancient times I was health minister in B.C. Much has changed. No one had heard of AIDS in 1979-80. Organ transplants were rare. MRIs were just gleams in inventors' eyes. One thing has however remained the same -- the debate over private medicine. In those days doctors were demanding the right of "balance billing," a euphemism for padding their bills. Now the doctors are mad at Vancouver's Dr. Brian Day for operating his own form of balance billing by running a clinic outside the Medical Services Plan. At this writing, Day is challenging the government to go to court and get an injunction against his clinic.
Does our belief in, and desire to have, a public universal health care system conflict with our human and individual right to have timely access to the care we need if the system is not responsive? That is the question that will soon be before the courts. Dr. Brian Day, former president of the Canadian Medical Association, is forcing the issue. He is now CEO of a private, for-profit hospital in Vancouver. We aren't supposed to have those in Canada, but we do. Everywhere. Why? Because there is a huge market demand for timely and quality health care that is not being met by the public system.
Medicare and the CHA have reached mythical proportions in Canada. It is an untouchable "sacred trust." Those that dare question it -- much less talk of reform -- are virtually branded enemies of the state. I experienced this first hand last year when as a candidate in the general election I had the temerity to point out a simple fact: Canada does not have the "best healthcare system in the world," as all politicians have told us for years. In fact, that is a cruel deception. And CHA is nothing more than a hollow and toothless statement of intention and principles, has been the most untouchable of scared cows of Canadian politics since 1984. All three national parties kneel at its altar.
The Canadian Medical Association's 145th annual meeting is taking place this week. The mantra of the meeting is health equity, and Sir Michael Marmot, the white knight of social determinants, undoubtedly provides the human and scholarly element the issue of inequality deserves. There may be no better person to articulate Canada's barriers to better health outcomes.
We need leaders who will rise to the challenge of protecting and improving medicare, not shirk their responsibilities. Prime Minister Harper, you are needed back at the table for a 2014 Health Accord. Canadians have real expectations of you, not just to cut cheques -- and increasingly smaller cheques at that -- but to lead Canada on health care. Your absence will hurt the health of Canadians.