Health-care reform needs the discipline of deadlines

Posted on January 5, 2023 in Health Debates

Source: — Authors: – Opinion/Contributors
Jan. 4, 2023.   By Robin V. Sears, Contributing Columnist

Politicians, bureaucrats and medical professionals have played kick the can for far too long. They face no penalties for failure.

The Nature COP15 in Montreal last month hammered out an agreement with only hours to spare. Like the 2015 Climate COP in Paris and November’s in Sharm El Sheikh, each avoided humiliating failure minutes before a strict deadline.

Dennis McDermott, the giant of Canadian Labour who led both the autoworkers and then the CLC, used to say “Never forget that the best agreements are always at 11:59.” Negotiations among a set of 14 disputatious partners are dramatically more complicated than those between an union and an employer. Multiparty negotiations seeking agreement on a large goal, backed only by a fuzzy vision of big change have no end. Success requires clear deliverables and deadlines.

Politicians, bureaucrats and medical professionals have played kick the can for far too long. They face no penalties for failure. The script never changes: the provinces demand more money, the feds demand more financial oversight. After every failure, each side stages childish finger-pointing press conferences.

Fixed deadlines need be backstopped by consequences. Pollsters tell us that there are few political consequences for failing at health-care reform. It is not a ballot question. Perhaps the pandemic and its knock-on impacts on health care this winter may be finally turning voters’ anger into a serious political risk.

Health-care needs more money. But money without the certainty of reform merely sets up the next cycle of failure. Political pressure might force each participant into agreeing to hard targets for improvement by set dates, before money is allowed to be on the agenda.

As an opening agenda, they could agree on three achievable reforms. Perhaps one might be breaking down the walls we have allowed the medical profession to build to prevent immigrants from practicing medicine. A two-year deadline might be needed to implement a nation-wide digital database, based on shared measurement standards and real-time data collection.

Harder still might be to finally breakdown the boundaries of specialist stovepipes, unwind the mess of unfair compensation differences and to elevate the role of nurses. But three years for an entire agenda should be the fixed deadline. Fully integrating virtual digital and one-on-one care is another priority. The list of necessary reforms is long. But a short agenda of priorities, clear targets and deadlines is the only path to success.

New technologies must be in the forefront or each reform — no more doctor’s illegible hand scratched prescriptions and the entire health care system could be told to finally junk their fax machines. Encrypted email or texts is what the entire world except the Japanese, doctors and hospitals have used for decades.

On Ottawa’s demand for greater fiscal oversight, often put by this prime minister in the patronizing tone of a distrustful parent to a child, has an easy solution. It is one he was offered almost two years ago and ignored. The provinces came close to agreement on third party evaluation of performance under former B.C. premier John Horgan’s leadership.

The Canadian Institute for Health Information (CIHI) exists, in part, for just such a task. A rolling 12-month evaluation on progress toward agreed targets could become a permanent feature of Canadian health care. Reporting each December would help frame the funding required before each government’s annual budget cycle.

With those new disciplines and boundaries in place, an adult conversation on revenue sharing might succeed. The consequences of failure would be difficult for any of the partners to avoid. An implicit threat if one participant consistently fails would be a cut in funding. Imagine heading into a 2025 federal election with the Trudeau government having failed its own progress report. Not, perhaps, the best campaign launch message.

In the battle for medicare in the ’60s and ’70s, Tommy Douglas would include one of a dozen stories he carried in his head about the victims of private medicine. He’d roll one out at the end of a stem-winding speech, to standing ovations. Today’s medical horror stories would no less enraging: death by delay, emergency wait times in days, surgical wait times in years. Canadian voters can force the players to get serious in making changes. It’s past time we did.

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