03/01/2013 05:36 EST | Updated 05/01/2013 05:12 EDT

Chronic Condition: An Excerpt on Why Canada's Health-Care System Needs to Be Dragged Into the 21st Century

Jeffrey Simpson

The Huffington Post Canada is delighted to once again be partnering with the Writers' Trust of Canada Shaughnessy Cohen Prize for Political Writing. In the weeks leading up to the March 6 announcement of this year's prize winner, we are publishing excerpts from each of the five finalists. The authors have personally chosen the portions they'd like to share, and each excerpt begins with a brief explanation of why that particular passage was chosen.

A note from author Jeffrey Simpson:

I wrote Chronic Condition because I was unhappy with the non-debate about health-care in Canada. Politicians, knowing how devoted Canadians were and are to their health-care system, were unwilling to talk seriously about it. Election campaigns were bidding wars among parties promising to spend more than the others. Steadily but stealthily, we were putting more money into health-care at the expense of spending on other government programs, and the politicians were afraid to talk about that shift. I was also aware that if you do not benchmark a program, you don't know where you are, which in turn allows all sorts of mythologies and errors to creep into the public's mind; as in Canada has the best health-care system in the world, whereas in fact, according to all the international evidence I could find, we have a middle-of-the-road performer, nothing better, despite being among the world's biggest spenders for health. Since we weren't having an informed debate about health-care as it is, as opposed to myths about it, I thought maybe a serious, balanced book could inch us towards a better understanding of where we are and where we need to go. All authors have their conceits; that was mine.

When it comes to health-care, we are left with choices, hard ones today, harder ones tomorrow - the ones citizens would prefer not to hear about. Polling data repeatedly show that people do not want to pay higher taxes, and certainly do not want to pay from their own pockets to access the system, as with user fees. The Quebec government proposed user fees tied to income, with no fees at all for low-income citizens. The government withdrew the idea after the finance minister said that the "Quebec political culture" was not ready for this initiative. He could have been speaking about all of Canada.

Citizens do not favour the public system dropping any services, although a few provinces have done this to save money. Nor, of course, does the public want less money spent on other programs. No new taxes. No fees or private payments. No fewer services - indeed, more if possible. No cuts elsewhere. All the painful options - the ones politicians are reluctant to outline - have been pushed off the table. Politicians are left to resolve health-care dilemmas by pursuing the easiest one to articulate and the hardest one to achieve - the dream of efficiency gains.

Chronic Condition tries to look at choices and options. It is not designed to trash medicare. Medicare has been, and remains, an important Canadian national accomplishment. Just as the railway was a ribbon of steel that linked Canada in the nineteenth century, medicare might be thought of as a bond that has linked modern Canada. It has improved the health of Canadians and therefore the life of many citizens. Although my book is not about medicine per se, the medical achievements inside the system are often wonderful. When Canadians do gain access to the system, hey report high levels of satisfaction.

Medicare's foundation is equity, the notion that we are all better off when the risks of illness are shared, because no one knows where those risks will fall. That there should be a publicly financed system, available to all regardless of income or illness or chance, is a cornerstone of most liberal democracies, including Canada.

Chronic Condition is about the choices surrounding health care in Canada. To understand those choices better, it asks three questions. How did Canada get this system? How is the system working when measured against actual health care before medicare? Medicare's evolution is a gripping story full of controversy and critical turning points. Nothing was preordained. The history of how we got this unique system, therefore, is worth remembering for its own sake. History also reminds us that today's controversies have antecedents that contribute to making reforms difficult.

How the system works is what concerns most Canadians. History might be interesting or instructive. 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?

Necessary changes will be hard, but we cannot even consider them without a serious conversation, which is difficult in a world of blogs and Twitter and the generalized decline in quality media coverage of important public matters, the partisan rhetoric, federal-provincial finger pointing, interest-group assertions and political fears around a subject that Canadians say they care passionately about but are not eager to debate. There are no easy answers, and simple solutions to complex problems are invariably wrong. But we must ask hard questions, because the status quo should not endure.

From Chronic Condition: Why Canada's Health-Care System Needs to Be Dragged into The 21st Century. Copyright © Jeffrey Simpson, 2012. Reprinted by permission of Penguin Group (Canada), A Division of Pearson Canada Inc.

Jeffrey Simpson is currently shortlisted for the Shaughnessy Cohen Prize for Political Writing. The winner will be announced in Ottawa at the Politics and the Pen Gala on March 6.

2012 Shaughnessy Cohen Prize for Political Writing Finalists