08/24/2012 07:58 EDT | Updated 10/23/2012 05:12 EDT

Let's Stop Deluding Ourselves And Fix Medicare Now

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?


If there are certain essential covenants intrinsic to being Canadian, one of them surely is an acutely ingrained sense of responsibility for those among us that are more vulnerable and need help. I don't think that the core human values that are so fundamental to who we are as a people have changed recently. For the most part, our governments have mirrored our values.

That is how our publicly funded health care system began. Like many significant policy innovations throughout Canada's history, the concept of universal access and comprehensive health care coverage originated from the provinces, not Ottawa. The impetus came from Tommy Douglas, Premier of Saskatchewan, who in 1947 led the first jurisdiction in the country to introduce its own public plan. British Columbia and Alberta followed suit. It was only then that Ottawa felt some pressure to get involved when it provided financing to the provinces for hospital construction, training and public health.

Eventually, Ottawa did come on board, and once it did, became the glue for a coordinated and collaborative national effort. In 1957, the government led by the great jurist and public servant, Prime Minister Louis St. Laurent, stitched together a national approach to public health care. In 1960, John Diefenbaker struck the Royal Commission on Health Services presided by Justice Emmett Hall. The Hall Report recommended that Ottawa develop agreements with the provinces to help them create and fund a system of medical insurance. The Liberal government of Lester B. Pearson gets most of the credit for the passage of the Medical Care Act -- what we today know as Medicare -- but all parties played extremely important roles, and the House of Commons passed Medicare legislation in 1966 by a vote of 177 to two. In 1984, in the dying days of the Trudeau government, the Canada Health Act (CHA) won the support of a large majority of parliamentarians. It was in those years that the overpowering mythology of Medicare and the CHA began to cement itself deep in the Canadian consciousness.

The peculiarly iconic and largely misunderstood Canada Health Act is a total of 13 pages long (in English and French). It is a statement of principles, intentions and aspirations on policy; but primarily it is a framework for federal financial contributions to provincial insurance systems. When one cuts through it all, it isn't much more than that. The CHA is also non-binding on the provinces. That is because health care is under their exclusive jurisdiction. Ottawa, however, has the option to hold back health transfer payments if the CHA is not respected. Despite some heated rhetoric and chest thumping over the years -- typically around election time -- that has never happened.

In the almost 30 years since it was enacted, the CHA is proving to be a significant obstacle to change. Why? Because the now gargantuan Medicare legend has engulfed all in its path, making talk of improvement and meaningful reform tantamount to treason. This week, in the comment section on this site and as a Liberal candidate for office last year, I have personally been called "un-Canadian" and worse for the mortal sin of encouraging an informed conversation on the health care policy choices we face.

The other impediment to change is the parochial nature of provincial politicians who jealously guard their jurisdictional turf. They say that they are not paid to think about the wellbeing, effectiveness and unity of the country as a whole. That is a sad commentary on them as political leaders because they are all Canadian, and with that privilege comes some important responsibilities.

Aggravating matters is the simplistic health policy ethos -- which fits like a glove with small-minded provincialists -- of the Stephen Harper government which essentially says: This is a provincial matter and is therefore none of Ottawa's business.

But the biggest hurdle of them all -- by a country mile -- is us.

We have developed a mindset of numbing self-satisfaction on Medicare and Canada's public health care system. This is constantly reinforced by pandering politicians telling us that we have "the best health care system in the world." We have taken this patent lie as a slice of authentic Canadiana. Believing this nonsense somehow makes us feel good. We've bought into the ridiculous notion that Medicare is a large part of what makes Canadian culture "unique and special." It makes us feel good, safe, comfortable and even morally superior, especially compared to the United States.

Besides being an utterly irresponsible fabrication, it is a dangerous illusion.

As I have written elsewhere -- and as the facts and evidence confirm -- we are far from the "best." In no small measure our persistent delusion breeds policy paralysis in Canada. If we all think we're so terrific, why change? Or if it's all the other guy's fault, why do I have to change what I do?

This is a paralysis made possible by the iconic and untouchable mythology of Medicare itself.

Federal and provincial politicians feel compelled to swear their everlasting faithfulness to the Canada Health Act, even if they know that doing so is nothing more than a political rite of passage. As a logical, albeit perverse consequence, politicians dare not touch health care. They know that if they do, it's a political death sentence.

There's no one more at fault for that inexcusable reality than us. We actually penalize aspirants for public office who dare to have the integrity and intelligence to ask hard questions and try to engage us in a fact-based conversation. Our sorely misplaced self-righteousness and ignorance on the reality and truth about health care is the biggest obstacle by far to positive change.

That is why, increasingly, our political culture only attracts the professional photo-op artist, the walking talking point and sound bite, or the killer smile, to stand for public office. People who are serious, genuine, substantial and dedicated to the public good don't run. What's the incentive for them to do so? These people have no tolerance for the superficial trained monkey environment that has become our House of Commons and provincial legislatures.

Yet if we citizens took the time to inform ourselves, we would learn that all reasonable analysis and objective evidence points to an unavoidable and inexorable conclusion: Our system is in trouble and it desperately needs our attention. Only we can compel our political leadership to engage and be straight with us. That too might be a pipe dream. Our perceptions of the state of health care are increasingly divorced from the reality of bureaucracy gone wild, narrow and entrenched vested interests, financial constraints and a complex operating environment.

We rarely take the time to appreciate the staggering complexity of delivering on the bumper sticker promise -- "Medicare is a Sacred Trust!" -- that is now profoundly ingrained in our national psyche. It is so embedded, in fact, that we are deceiving ourselves into thinking that everything is just fine, and would be even better if only we could spend more money. So, we take the easy way out and settle on numbing and meaningless platitudes from those superficial vote-hungry politicians. These are people that tell us the nice things we want to hear, not the difficult things we need to know.

Who's fault is that? We cannot credibly blame politicians for this state of affairs. We're the ones who demand simple, digestible and happy messages from smiling and perky politicians who insist we call them by their first names and make us feel like we're their best friends and they care so much.

In the meantime, while our collective heads are in the sand, the pressures on our system, the people within it, and on government's capacity to deal with it mount daily. Bed shortages, inconsistent access to medication, exceedingly long wait times, and an overall powerlessness to execute smart management is corroding trust in the system.

Canadian health care "system" is not really a system at all, and it's certainly not "national." It is 14 jealously guarded independent provincial and territorial jurisdictions that do their own thing. Despite these facts, Medicare ideologues persist with rhetoric that tugs at the very essence of our notion of national identity. Some of them have a vested financial interest in the status quo and others are cynical politicians who don't have the guts and smarts to tell people they represent the simple truth. Rigid ideology, dogma, and fear of change are enemies of progress.

You don't have a "comprehensive and universal" system if it takes two years to get a hip replaced, or a knee fixed, or if it takes eight months to get an MRI to assess whether you have sustained long-term damage after a hard knock to the head. How can we keep a straight face and call our system a caring and "universal" one if the mentally ill have no place to go, or drug addicts end up in an urban ghetto cesspool in downtown Vancouver where they are given a nice chat and clean needles to kill themselves with?

Or how about our growing aging population? After paying taxes all their lives, working hard, raising families, and in many cases serving our country, they can't get any decent and dignified palliative care or afford their medicines. And let's not talk about the shortage of family doctors. In 2008, Statistics Canada reported that an estimated 4.1 million, or 12.4 per cent, of Canadians aged 12 or older are without a family doctor. My mother didn't have one, and she died prematurely in front of my sister, brothers and me because of it.

Timely access to comprehensive public health care is supposed to a central tenet of Canadian citizenship. The truth is that it is not. It is a myth.

Citizens and residents of Canada are supposed to have the same level of access and services regardless of where they live and regardless of income. The truth is that we don't.

We are not supposed to have two-tiered health care in Canada. The truth is we do.

People are not supposed to suffer or die in Canada waiting for proper care. The truth is they do.

The Charter of Rights and Freedoms offers guaranteed constitutional protection for our basic human rights. If a government does not fulfill its promise to provide quality health care when we need it, why shouldn't we be able to access it elsewhere? When it comes to our health care, the most very basic of human needs, must we sacrifice our health and that of our loved ones because the service we need and pay for isn't available? Is it not sensible to assume that in a free society like ours if the government cannot or will not provide a valuable and needed service, we can turn to someone who can and will?

Somehow, we've lost sight of the basics of health care. It comes down to this: When people need health care services, they should get it. Period.

We've forgotten that fellow citizens are suffering -- and in many cases dying needlessly -- because we cannot seem to manage to suspend our partisan ideology and prejudices to fix a problem.

Unless we reform our system, systemic breakdown is not only a real possibility; it is inevitable. We can already see the cracks and strains. What we are witnessing today is deliberate and willful neglect on a systemic level. If we do not deal with it today, the next generation will have no choice but to make even tougher decisions tomorrow. And chances are that those will be necessarily radical.

We do not need another Royal Commission, another study, or another inquiry. And it's not as if we don't have talent, brains, insight and experience to devote to this vexing problem. They are all over the place, including governments, people who work daily in the health care world, academics, entrepreneurs, numerous and well respected think tanks, and the Canadian Medical Association, to name just a few.

Medicare needs pragmatic solutions that will strengthen access, quality, service and long-term viability. Our focus must be on only one question: What do we need to do to have a system that delivers the highest quality health care to all Canadians that need it in the most productive and cost effective fashion?

We suffer from an abdication of leadership, jurisdictional paralysis, a highly fragmented vision, arcane organizational, management and policies and wildly perverse incentives. All credible research and exhaustive analysis have said the same thing: Without a significantly improved performance of the system that we have given iconic status to, the pain to our people and our economic prospects will be real and debilitating.

The noble and terribly important idea of a cohesive nation was a fundamental tenet that underpinned the Canada Health Act and Medicare. Both are the product of a wide and deep national consensus. All political parties can rightly and proudly take credit in the caring and just society that we have strived to be. Fixing and strengthening health care for the 21st century is now our task.

This is not a partisan issue, and it should not be an ideological issue. But if we are to make any progress whatsoever, we must take off our blinders. Our shared priority as a society should be to strengthen the ties that bind and protect us. Don't we still agree that one of the values that differentiate Canada from many is that we choose to take care of those who are the most vulnerable and at risk?

So, I call on Prime Minister Stephen Harper to convene a First Ministers Conference where the one and only agenda item is the future of the Canadian health care system.

This would be the first time in six years in office that Harper would have convened such a gathering. I understand his reluctance. Premiers have used these meetings for nothing more than to bash Ottawa and demand more, more, and more. But he must get past that for the national good. Federal leadership has been missing and it is desperately needed now. As Pierre Trudeau, Brian Mulroney and Jean Chretien demonstrated, if effective, a prime minister's bully pulpit can be a very powerful tool to appeal directly to the common sense and decency of the Canadian people. A prime minister can and must be the national agenda-setter on matters that have an impact upon all of us, jurisdictional niceties notwithstanding.

That is what national leadership is for. If Stephen Harper either doesn't understand, or refuses to assume his duty to Canadians, what possible good is he to Canada and Canadians?

At least three days should be set aside in mid 2013 for this meeting. In preparation for it, federal, provincial and territorial officials and ministers must get to work immediately. Relevant stakeholders must be consulted and roped into a broad consultative process. And Stephen Harper should travel to every corner of Canada to visit hospitals, clinics, treatment centres. He also shouldn't forget to visit these facilities on Indian Reserves. That is solely federal responsibility, and if he has an ounce of humanity in him -- which I know he does -- he will weep. A clear set of objectives should be established before going into the meetings and an measurable action plan coming out. And this cannot be a one-off. It must be a sustained national project, not a political and public relations exercise to "fix Medicare for a generation." This will take patience. This will take time. And above all, this will take strong and visionary political leadership.

Federal and provincial parliamentarians of every stripe should be engaged in a national effort. If they can refrain from the temptation of scoring a cheap shot at an opponents expense and find their inner statesman for the national interest and common good, progress can be made toward building a national consensus and plan for reform. Without that consensus, we will remain stuck, and that cannot be a reasonable option for our Canada.

Canadians built our health system, and we did it together. The time has now come to fix it together. That's the only way we can protect and fortify the foundation Tommy Douglas and Louis St. Laurent first created for us, and that we carelessly take for granted each and every day.