Too bad there’s none on offer

Susan MartinukWhen the Premiers were first called to a sit-down lunch to talk about health care with Prime Minister Trudeau, there was plenty of talk about the potential for systemic change, innovation and accountability. It seemed that Canadians and their leaders were finally on the same page in recognizing that health care, as it is, is largely broken and money alone isn’t going to fix it.

But the meeting has come and gone, and there were no new ideas and no talk of change. The Prime Minister offered the premiers a big wad of cash over a two-hour luncheon, and the key message was take it or leave it.

Trudeau’s offer of $196.1 billion sounds like a major investment, but it isn’t. The premiers asked the federal government to increase its share of health spending from 22 per cent to 35 per cent (the equivalent of $28 billion per year). Given Trudeau’s rampant spending spree over the past seven years, that was never going to happen – but little did the provinces expect the offer to be less than a one per cent increase in federal funding.

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The $196.1 billion is an overwhelming figure which, once dissected, is little more than smoke and mirrors. The money covers a 10-year period, which means that the provinces shouldn’t bother asking Ottawa for more health care money each year. It includes just $46.2 of new money, which, over 10 years, leaves just $4.6 billion in new spending each year to be divided amongst the 10 provinces and two territories.

Of the $46.2 billion in new spending, $2 billion was earmarked for urgent needs in children’s hospitals and Emergency departments, $17.3 billion to provide a funding boost over the next decade, $1.7 billion to top up salaries over five years, and $25 billion over 10 years to be negotiated with each province independently after it submits a specific health-care delivery plan for the money. Apparently, these plans will be necessary (and sufficient) to check the accountability box on the federal budget sheet.

No wonder the premiers were underwhelmed and offered reporters comments such as “disappointed” (Manitoba); it’s “a starting point, a down payment” (Ontario), and “insufficient” (Quebec).

Billions of dollars are always a substantial investment, but, in this case, it suggests a shocking lack of leadership and vision when it seems Canadians are looking for wholesale changes that will ensure timely care.

An Ipsos poll that came out just before the premiers’ meeting showed that Canadians’ attitudes to health care are shifting rapidly. A full 85 per cent of Canadians now believe that “drastic changes” are needed to the health-care system, with six in 10 (59 per cent) supporting the private delivery of publicly-funded health services. The same number (60 per cent) say that those who can afford private care should be able to access it.

Finally, one-third of Canadians (32 per cent) would go to the United States and personally pay to receive routine health care, while 29 per cent would do so to receive urgent or emergency care.

The numbers represent a changing perspective on health care, and that means politicians must start listening. For 60 years, Canadians have pinned their health care hopes on the symbolic and non-tangible principle that universal health care will take care of our medical needs. We may have to wait a bit longer for care than those in other countries, but universal access to health care works and it is the Canadian way.

But a two-year pandemic and a rapidly aging population are chipping away at that ideal. Canadians are finally waking up to the fact that this underlying principle is not enough to provide access (let alone timely access) to medical care.

According to a recent report, more than 1.2 million Canadians were on wait lists for various surgeries and procedures. More than one in five Canadians cannot find a family doctor. Access to non-emergent mental health care takes years, and the media routinely cover deaths related to wait lists for care and/or overwhelmed emergency departments.

There is limited access to diagnostic medical technology (CT, MRI and PET scans) even though their use is routine in other developed, wealthy nations. We need doctors, nurses and other health-care workers. We are far behind other countries in terms of transitioning to electronic records and the use of virtual care for remote areas.

Yes, the system needs money. But it also needs leadership. Trudeau seems content to let others deal with a broken system, with the Conservative party offering little at a time when the appetite for change runs deep. The NDP’s proposed Pharmacare will only create more pressure on an overburdened system.

Health care desperately needs creative leadership, and the job remains open to anyone with an innovative spirit. Apply within. Please.

Susan Martinuk is a Senior Fellow with the Frontier Centre for Public Policy and author of Patients at Risk: Exposing Canada’s Health-care Crisis.

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