Make health care an election issue

Posted on August 27, 2015 in Health Delivery System – Full Comment
August 26, 2015.   Tasha Kheiriddin

When voters are asked what issue matters most, health care once again tops the list. Yet the issue remains on life support in the current federal election campaign. As with campaigns past, it has so far failed to become a ballot question, despite the fact that it’s one of the few common experiences we all share. So why is health care traditionally absent from the campaign trail?

There are two main reasons. First, there is the Constitution. It deems health care a provincial responsibility, essentially limiting the federal government’s role to that of a giant ATM machine. When provinces deliver good health care, they take the credit; when they are unable to do so, they blame Ottawa for not transferring them enough money. Promises not only come with a price tag, but siphon money from other priorities, all without delivering political payback.

The second reason is our proximity to the United States, which has served as the health-care bogeyman for over 50 years; the example of what Canada does not want to be: a place where people have to go Breaking Bad for cancer treatment. As a result, no party dares think outside the public monopoly box, or challenge the status quo. This reduces the debate to one of dollars and platitudes, which is about as appealing as hospital food.

But now, as the Canadian Medical Association (CMA) is warning, Canada is facing a grey tsunami, an aging population that threatens to swamp our health-care system and budgets. By 2036, 25 per cent of the Canadian population will be seniors and health care will eat up 62 per cent of public spending. Surely a crisis like that would open the door to a wider discussion of how to tackle health care, not only for this population, but all Canadians.
Like a tsunami, it still looks small while it’s on the horizon; only when it towers over you do you realize the full impact of the disaster
No such luck. One of the problems is that this crisis will take 20 years to fully hit us. Like a tsunami, it still looks small while it’s on the horizon; only when it towers over you do you realize the full impact of the disaster. It lacks the immediacy of a terrorist attack or oil-price shock. It’s also not part of a broader reform agenda, such as that undertaken by Sweden following its financial crisis of the 1990s, which led it to reform of its health-care system by introducing market mechanisms and a mix of public and private delivery.

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But it is an immediate disaster for the millions of medical professionals, families and individuals coping with the health-care demands of aging. Their voices are being drowned out by sniping over the minutiae of the Mike Duffy trial, or announcements of boutique tax breaks for teachers or service club members. Despite an alliance between the CMA, CARP, the Alzheimer’s society and others, health care remains on the back burner.

If providers, caregivers and seniors hope to get this health crisis more attention, they need to change how the debate is framed. It needs to be seen as a crisis of today, a crisis that moves votes, a crisis that politicians feel they need to address. They also need to advance cost-effective solutions at the front end, rather than plowing money into it at the back end. Prevention strategies, for example, could help ensure that the seniors of 2036 are healthier than those of 2015, thereby reducing budgetary strain. The middle aged middle class need to be reminded that they won’t stay young forever and that they need to prepare the system for what lies ahead.

Canada should look to the rest of the OECD, where countries from Australia to Switzerland feature mixed health-care delivery models
But advocates also need to tackle the big picture: this country’s resistance to market-based provisioning of health-care services. The Supreme Court’s decision in Chaouilli v. Quebec turned 10 this month, but has not resulted in the changes many were hoping for, in terms of significantly increasing choice in the health-care system. Forget the U.S. — Canada should look to the rest of the OECD, where countries from Australia to Switzerland feature mixed health-care delivery models, incorporating public and private institutions, and payers, including public and private insurance. Many of these countries also spend less per capita than Canada, while achieving superior outcomes.

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In other words, give the federal parties a chance to craft an original political solution, rather than simply throw more money at the problem. Just as the Canada Health Act served as a legacy piece for the Liberal government of 1984, new health-care legislation could become a hallmark of whatever government holds the reins after Oct. 19. More importantly, It could ensure that the health needs of the aged, and all Canadians, are met for generations to come.

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