Social Policy in Ontario

Five controversial lessons to cure health care from Jane Philpott

Posted on December 4, 2024 in Health Debates

Source: PolicyAlternatives.ca — Authors: Steven Staples

PolicyAlternatives.ca – CCPA Monitor, pp.50-51
Fall 2024.   Steven Staples

HEALTH FOR ALL: A PRESCRIPTION FOR A HEALTHIER CANADA.  DR. JANE PHILPOTT.  McClelland and Stewart, 2024

Dr. Jane Philpott’s Health for All: A Doctor’s prescription for a healthier Canada is exactly what the nation needs right now, but not everyone is going to like her proposals to save Medicare.

From her unique vantage point in medicine and politics, she blames successive governments for “several decades of denial, complacency, and neglect” for the poor state of health care in this country. Her prescription to bring health systems back from the brink are evidence-based, delivered in a clear-eyed compassionate manner, but are sure to rankle those on all sides of the debate.

Health for All is three books in one, intertwining stories that are personal, professional, and political. In a deeply moving recounting that beckoned tears as a parent myself, Philpott shares her pursuit of public medicine, which was sparked by the loss of her older brother to childhood illness, and then propelled from the tragic death of her toddler daughter to an unforgiving infection while she and her family were working in West Africa—24 years later to the day of her brother’s passing.

Jane Philpott earned a unique perspective on our health care system. Growing up in a Presbyterian family instilled in her a moral compass based on faith and service. Her journey wound its way through family medicine, development work, advocacy in Canada with many non-profit groups, to serving as Canada’s health minister and, most recently, academia at Queens University.

In my 30 years working on federal policy issues, I have met plenty of politicians of all stripes. I can tell you that Jane Philpott is among those who place their calling working for social change in social movements above all else, pursuing electoral politics as a means to that end. “Nothing drives me forward more than the realization that the world is far from equitable—and the belief it could be fairer,” she writes.

A chance meeting with former Prime Minister Paul Martin convinced her to engage in electoral politics. She was swept into government in the Liberal wave of 2015.

Philpott joined the Trudeau cabinet as the first physician health Reuters 51 minister in 2015 and later led other departments. Her record includes several key policy successes, including welcoming Syrian refugees, harm reduction, physician-assisted dying, Indigenous health and welfare, immigration support.

Sadly, her rise and fall in politics is worthy of a Shakespearean tragedy. The Library of Parliament counts 1,463 days she served as a member of parliament—a remarkable period demarked by a dramatic election, her appointment to a succession of three cabinet positions, ending in a humiliating public dismissal by her own Liberal party colleagues in 2019.

Fortunately for people in Canada, her faith and professional commitment to health equity have not allowed her to become discouraged in the least.

In fact, she has generously shared her experience and advice with me numerous times since I began working on health policy with the Canadian Health Coalition three years ago, and we have shared a platform on two occasions to champion universal public health care.

Her goal in writing Health for All is to ensure “every person living in Canada has access to a primary care home, in the same way that every child has access to a public school.” But she acknowledges that it will require a transformation that challenges current thinking, practices and interests.

Five recommendations to improve primary care access from Jane Philpott

1. The federal government has a role in public health care, despite complaints from the provinces. The premiers of Canada’s 13 provinces and territories are as quick to complain about federal interference in their jurisdiction for health care as they are to demand more money through the Canada Health Transfer (CHT) without conditions attached.

Philpott is adamant the federal government has the authority and the duty to act. In addition to the federal and provincial government, municipalities and Indigenous governments have a role to play too: “Ideally, all orders of government would work together.”

2. Don’t change the Canada Health Act, pass complementary legislation focused on access to primary care instead. I’ve heard many public health care activists argue that the 40-year-old Canada Health Act needs to be changed to include a plethora of issues, including mental health, long-term care, and even systemic racism. But others, including the Canadian Health Coalition, fear that opening the Act risks weakening the federal law that governs federal health transfers to provinces.

Philpott agrees that while the Canada Health Act has largely withstood the test of time, it has not evolved with the changing health care ecosystem. She proposes a new sister act: the Canada Primary Care Act. The federal government would link a separate transfer for primary care and establish the overall goal: universal, authentic access to primary care.

3. Phase out fee-for-service payments and put doctors on salary. Evidence in other countries demonstrates that patients in Canada would be better served by primary care homes, where a team of health care professionals works together. Every patient would be assigned a family doctor or nurse practitioner and have access to other specialists as needed.

Implementing this model will require doctors giving-up the prevalent fee-for-service model, where doctors bill the province for their services and pay out of their pocket to rent commercial office space, hire staff, buy equipment, etc. like they are running a small business. In its place, doctors will be paid by salary or by the shift.

4. Indigenous governments should be able to exercise their authority over health care. As the first Minister for Indigenous Services, Philpott recounts learning from the Grand Chief of the Assembly of Manitoba Chiefs how hospitals placed “birth alerts” on Indigenous expectant mothers. On average, an Indigenous child was taken from their mother every single day and placed into the child welfare system in the province. The child apprehensions were conducted with little empathy for the mother, who could be labelled as a risk simply because she was poor.

In response, working with community leaders, she drafted Bill C-92 which made it clear that Indigenous governments could exert their jurisdiction in relation to child and family services. The bill passed into law in 2019, and she argues that Indigenous governments should have the same authority over health care.

5. Address the social determinants of health by providing primary care for everyone—including refugees. Jane Philpott was appalled by former Prime Minister Stephen Harper’s efforts to eliminate access to health care for refugees, “which seems not only cruel but unwise from a public health and public policy perspective.” Among her first acts as health minister was to reverse the cuts and provide additional coverage to refugees. The right to care for the most vulnerable groups must be a top priority, writes Philpott. Clearly, Jane Philpott has not given up hope that our elected representatives can do what is required to save public health care. With provincial elections and a federal election on the horizon, her book provides a path forward.

M Steven Staples is the national director of policy and advocacy for the Canadian Health Coalition.

https://www.policyalternatives.ca/wp-content/uploads/2024/11/CCPA-Monitor-Fall-2024-WEB.pdf

Tags: featured, Health, ideology, Indigenous, jurisdiction, mental Health, participation

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