02/09/2012 07:47 EST | Updated 04/10/2012 05:12 EDT

An Alternative Vision for Taking Care of Gram and Grandpa

The real importance of the Health Accords, which the Government has dodged responsibility for, was not to keep the provinces happy but to keep Canadians healthy. National cooperation, with or without the feds as the uber-paymaster and shot-caller, is needed to produce the political spine to get this done.


The federal government's latest bombshell: "Here's $40 billion in federal funds -- take it or leave it -- we're not discussing any Health Accords,'" left the provincial premiers pushing a rope.

Dusting themselves off, the Government's Plan B was to brandish a couple of committees to study practice protocols and tinker with managing the supply of doctors and nurses. If this was what the Health Accords were going to be about, it's just as well we saved months of political posturing.

The feds' hands-off approach means that we are relying on the provinces to set national standards of care, resolve structural inefficiencies, and get health care spending under control -- all without any immediate accountability. At least the feds could have demanded this much accountability for our billions of tax dollars.

The real importance of the Health Accords was not to keep the provinces happy but to keep Canadians healthy by fundamentally redirecting the country's health care resources to that end and not being held captive by what had been done in the past, or whose ox would have to be gored. National cooperation, with or without the feds as the uber-paymaster and shot-caller, is needed to produce the political spine to get this done.

So here's an alternate vision.

National Pharmacare: Too many people are not taking needed drugs or cutting back because they can't afford them. Provincial treasuries just can't cope with the eye-popping costs of the newer drugs so the funding approval process is slowed to a near stop.

Almost in desperation, the larger provinces have demanded price concessions from drug manufacturers and outlawed retail rebates from generic manufacturers. The prospect of financial ruin has steeled their political resolve. Imagine if all the provinces and the federal government acted in concert to demand fair drug pricing across the country and with bulk buying agreements, an independent drug review process and other systemic savings, and began the conversation about first dollar basic drug coverage for all Canadians.

Make Aging at Home a Reality: Canadians want to stay in their own homes as long as possible even if they have medical challenges but they can't do that alone -- the public system needs to reorient itself to make that hope a reality. The current Health Accords identified post-acute homes as the next essential service and put serious federal money behind it.

But much more is needed and frankly resides in the provincial jurisdiction -- stable funding and mandatory standards of home care, income support for caregivers -- especially those providing heavy care -- geriatric care, assisted living services at home and in affordable housing, and quality end of life care.

Redirecting existing resources is another avenue. The Virtual Ward project assigns a care manager to follow a discharged patient, which can pay off not only in preventing costly readmissions but also in stabilizing the person at home and possibly sidestepping a nursing home altogether.

A system of integrated continuing care done right -- at a fraction of the cost of institutional care -- can divert billions of dollars of demand from the formal healthcare system. A real opportunity for premiers shouldering intractable deficits.

Age-Friendly Healthcare: Canadians are living longer, healthier lives, but from the doomsday predictions that the aging population is going to bankrupt the healthcare system, you'd think that longevity was a curse. The evidence that healthcare costs are actually driven by the escalating price of new treatments and greater demand from everyone is pre-empted by the stereotypical image of granny languishing in a nursing home.

When the system fails its older patients and leaves them in acute beds because another government department has failed to provide enough home care or long term care beds, the finger is pointed at the "bed-blockers," not the dysfunctional system that keeps them there.

Is it any wonder that older patients suspect that they are not being given the best of care or all the options? They are more likely to face the challenges of chronic illness but also have to worry that the system treats them unfairly.

Luckily, this generation of seniors is more demanding and willing to accept innovative solutions. Addressing the issues that resonate with them will also improve the system for everyone else. The growing political clout of older Canadians should help politicians face down the sacred cows blocking innovation now.

That there will be no political confab is no excuse for inaction. Canadians certainly deserve more than a couple of committees.