Contributing Writer

Canadian healthcare is "floundering" and the federal government isn't doing much to rescue it. That assessment by Chris Simpson, the new president of the Canadian Medical Association (Ottawa) has set off a debate about the federal government's role in Medicare and sparked new calls for a national strategy on seniors' healthcare. "Our healthcare system provides excellent care – when you can get it," Simpson told the Medical Device Daily. The challenge: "how we can transform Canada's healthcare system into one that isn't next to last in the Commonwealth Fund rankings."

According to the Commonwealth Fund only the U.S.'s healthcare system ranks worse than Canada's on nearly every measure of quality and access. At the top of the heap: Britain, Switzerland and Sweden. Simpson placed much of the blame for Canada's poor showing on Prime Minister Stephen Harper's repeated refusals to sit down with the provinces to discuss ways of delivering timelier, cost effective, quality healthcare.

"(W)hen we look at high-performing European health care systems we see that having an engaged national government, setting targets, objectives and strategies is a key common factor to building those successful systems. These systems don't get good by accident; it takes work on all levels."

By stressing instead the province's role delivering Canadian healthcare services, the federal government is abrogating other responsibilities it has for healthcare, Simpson said. Such as helping to coordinate efforts across the provinces for consistent application of medicare principles. Or unifying the often fragmented interests and points of view that populate the current Canadian healthcare system.

Two men who seldom agree on anything – former CMA president Brian Day and healthcare analyst Michael Rachlis – told MDD they agree Canadian healthcare today is not what was envisioned when Medicare was first introduced in 1966. "Medicare was always intended as a stepping stone towards actually having a delivery system capable of providing high quality, reliable, equitable healthcare and that was not the delivery system we inherited," said Rachlis. "Absolutely," said Day. "We don't have the excellent healthcare system that some people have been led to believe we do."

Beyond this Day and Rachlis part company with Simpson and with each other. Day has long argued for a hybridized version of medicare in which private health clinics take some of the burden off publically funded hospitals by treating and billing patients who can afford it. Canada's provincial governments, he added, see healthcare systems in France, Belgium, Germany and Austria "that are working better than ours and should be able to develop a model of healthcare based on those principles."

Rachlis, by contrast, thinks Canadians must be on guard to prevent further in-roads into public healthcare by private clinics such as the one Day operates in Vancouver.

The debate really heated up, however, when Doctors Day and Rachlis were asked if Ottawa should penalize provinces that allow such clinics to operate, by reducing federal transfer payments for hospitals and medical programming. Far from supporting penalties, Dr. Day wants Ottawa's "interference" in health care to end altogether by abolishing the federal ministry of health. "I think we could save a lot of money. What do we need a federal ministry of health for when we don't have a federal ministry of education?

"Day's contention that the federal government is intrusive in any way is completely false," Dr. Rachlis countered. "The only G string of decency for the federal government in its health policy is its declaration that patients should not be charged for (medical) services." That policy may not be well enforced, he added, "but it's all we have." Rachlis accused Day, who speaks widely on healthcare reform, of knowing "virtually nothing about healthcare." Canadian healthcare "can be fixed," he said, "without his shenanigans."

Another sticky issue: seniors care. Unwilling to forcefully address Canada's rapidly aging population since the last election, Stephen Harper's Tories won't likely make any promises until compelled to in next year's election. Canadians might not let them wait that long, however. According to a CMA commissioned poll, 78% of Canadians above age 45 worry they will not have access to necessary health services, while 81% fret about the quality of the care they will receive as seniors.

"There is nothing in the Canada Health Act that would preclude our nation from taking strategic action to make our healthcare system better," said Simpson. "What we need to do is coordinate our efforts under a national seniors strategy to address the impact of the aging population across Canada."

Perennially nervous about talking to reporters, the federal health minister sent an e-mail outlining chronic care and home care programs for seniors and her efforts to work with "non-government partners to develop tools to raise awareness among seniors . . . and to influence policy and practice." No word on what might influence Ottawa to kick start a national senior's healthcare strategy. Monika Dutt, chair of Canadian Doctors for Medicare (Toronto), told MDD that Canada needs a federal plan to address seniors' healthcare and rising healthcare costs.

"We're coming to an election which . . . would be a perfect opportunity for the federal government to say we want to play a strong role in healthcare, we want to address seniors care in a comprehensive way."

Rachlis heaped scorn on that idea as one based "on received wisdom about Canada's health system. Healthcare costs are not wildly out of control. The aging population won't break the bank." Most of our system's problems, he said, are due to "antiquated processes of care" and "reflect the failure to make substantial changes in models of care" in the past four decades.

"People believe that my fellow baby boomers and I will really deep-six Medicare as we get older. They say the only alternatives are to hack services, go private, or do both, and that we need an "adult conversation" about who gets tossed out of the life raft."

The real conversation, he said, should take place between Ottawa and the provinces by convening a first minister's meeting, something that likely won't happen until after the election. Rachlis is betting the Tories will be turfed and that Liberals will form a majority government. The result will likely be a federal government "slightly more involved in social policy." //