Social Policy in Ontario

Sometimes Canadian accomplishments have to get noticed in the U.S. to get noticed back home. Whether it’s a basketball team or a musician, we often proudly claim success at home once Canadians make the hit list south of the border.

This happened to Canadian medicare last month. A group of international health care experts were in Washington, D.C., testifying at a Senate hearingabout how the U.S. stacks up in terms of health care quality, cost and equity. The debate was lively, and the result was pretty clear. Our system’s focus on the principle that access to care should be based on need rather than ability to pay is in line with the best available evidence on how health care systems should be built.

From the groundswell of support and the media attention the Senate hearing garnered one can only draw one conclusion. Canadians still care about — in fact they are wildly proud of — medicare.

But as great as that is, being proud of our system because it delivers more than that of our neighbours shouldn’t leave us complacent.

As a family doctor, I am acutely aware of the problems in our system. I treat patients who experience significant complications of their chronic diseases because they don’t have insurance that covers prescription medications. I see others who wait months for elective surgery or to see a specialist. I grit my teeth as I watch people subjected to duplicate tests because our information systems aren’t designed to communicate with each other. We have a lot of work to do before we can rest on our laurels and claim a perfect health care system.

Those challenges do not stem from the fact that our insurance plans are public. On the contrary, working within a single-tier system helps us to better tackle the challenges shared by all industrialized nations, including rising costs, variations in quality, and waits for access. Experiments in other countries show us that more private money and more for-profit delivery of health care services would only make things worse.

So let’s get to work on real reforms that will actually improve the health of Canadians. In scanning the environment, I see three big ideas out there that could raise the bar for the health of Canadians in the next decade.

The first is to improve access to prescription medications. Public insurance, either provincial or national, should cover the 20 most effective medications for chronic disease for every single Canadian. If we purchased those 20 drugs in bulk for the whole country and bargained effectively on the price we pay, we could put this program in place without spending a single penny more of public money than we already spend.

The second big idea flows from a campaign called Choosing Wisely. It taps into the reality that today’s health care consumers are increasingly well prepared to have conversations about the risks of tests and treatments. Too many Canadians are harmed every year by inappropriate, wasteful and often harmful tests and prescriptions. Radiologists agree, for example, that 30 per cent of CT scans are unnecessary, and these scans involve radiation. And do we really need to be taking 80 per cent more drugs than we did 10 years ago? It’s time to challenge the belief that more is always better when it comes to health care, and start a conversation between patients and health care providers that is more honest about what good research tells us are the risks and benefits of our interventions.

Third, we need to acknowledge that health is about more than just health care. Rather than spending more and more at the repair shop, we need to attack the causes of ill health. Income is the most important predictor of health: the poorer you are, the more likely you are to have negative health outcomes. The Guaranteed Annual Income, a simple and powerful concept that is supported both by local and international evidence, could dramatically improve the health of all Canadians by reducing poverty.

Supporting medicare doesn’t mean claiming that our system is perfect. On the contrary, it means committing ourselves to working relentlessly to preserve and improve the quality and accessibility of services without relinquishing the fundamental principle of equity that we so rightly cherish. If we continue to do that, then we really will have something to be proud of, no matter which side of the debate — or the border — you’re on.

Danielle Martin is a family physician, Vice President Medical Affairs and Health System Solutions at Women’s College Hospital, and an Assistant Professor in medicine and health policy at the University of Toronto.

< http://www.thestar.com/opinion/commentary/2014/05/08/how_to_deliver_on_the_promise_of_medicare.html >