Our health-care system is broken. More of the same won’t fix it

Posted on January 16, 2023 in Health Delivery System

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TheStar.com – Politics/Opinion
Jan. 13, 2023, By Martin Regg Cohn, Political Columnist

At a certain point, patients will lose patience with the political games, Martin Regg Cohn writes.

If you want a glaring example of how private, for-profit health care impacts our lives, consider how COVID-19 vaccines were delivered when most needed in mid-pandemic.

It wasn’t quite two-tier medicine, but people could pick a lane …

What was the cost of enriching profit-seeking chains like Shoppers and Rexall at the expense of panicky patients trying to protect their health? Turns out there was no charge to patients for the vaccination.

What was the drain on health-care workers from the existing system? Staff weren’t diverted from publicly funded clinics to for-profit pharmacies.

Like the expansion of flu shots to pharmacies nearly a decade ago, this was a win-win. Which is why Ontario is now expanding the number of ailments that pharmacists can diagnose and prescribe for.

The point of this parable is that our fidelity to medicare need not force us into rigidity. As the public debate heats up over the possible “privatization” of our so-called “public” health-care system, let’s not pretend we’ve never seen this before.

OHIP is a single-payer system (government) that has always relied heavily on private sector providers. If medicare is in crisis today, the prescription depends on the diagnosis.

If you listen to the provincial premiers, the system is starved of cash. Ottawa should hand over more money to resolve the problems, no questions asked.

If you heed nurses’ unions, low wages give rise to staff shortages. Boost the payroll and the burnout will fade away.

If you pay attention to patients, the system is straining. Our just-in-time delivery model failed to build extra capacity, forcing our most vulnerable Canadians into hallway medicine during predictable flu season surges and an unpredictable pandemic.

But the contradictions among critics are glaring: The system is broken, yet we dare not tinker with it — just do more of the same with more money.

In fact, Canadian medicare is more costly than ever, and more expensive than in other countries with universal health care, yet less responsive to patient needs. What’s the remedy?

We could just plow more money into a system that almost everyone acknowledges is well intended but badly managed. We could continue to rule out alternatives and adaptations, insisting that Canada now has the most highly evolved form of health-care delivery — ignoring the iterations and experiments in other universal systems abroad.

But medicare has long relied on private operators who take payment from the government — not the patient — to deliver those services. When you get that COVID-19 vaccine or flu shot at a private pharmacy, you don’t pay Shoppers — medicare does; when you see a physician, she or he is typically a private contractor, not a government employee; when you get blood tests at a private, for-profit lab, you don’t pay a penny — medicare does.

The NDP likes to say that no one should have to cough up their personal credit card for private treatment. Premier Doug Ford’s response has been to turn that line around — reassuring Ontarians they’ll only ever have to use their OHIP card, never their credit card, under his coming reforms.

All that said, our massive health-care system is nothing if not complex — and a flu shot is different from a surgical procedure. Beyond the philosophical arguments against private delivery, there is now a practical concern that a competing system could siphon off scarce nursing or other talent from existing hospitals, and leave patients disconnected from integrated care.

Those are legitimate concerns. The Ford government claims it will maintain safeguards against private poaching, but it has failed to persuade — or fully consult with — the major players and professionals in the system.

The College of Physicians and Surgeons, the arm’s-length regulator, warned this week that the government failed to follow up on previous warnings that “stand-alone surgical centres need to be connected to the hospital system.” If not, private clinics could “further tax our health human resources shortages.”

That’s a harbinger of yet another botched rollout by the Ford government. But even if today’s concerns about staff shortages are real, they won’t last forever — so why rely on that fear to rule out reforms when the time is right for innovation and experimentation?

For all his unreliability, Ford showed surprising flexibility this week when asked if he’d go along with federal demands for more data before handing over more money, saying he’s open to it. His fellow premiers keep insisting on increases while resisting any transparency, but Ford seemed to break away from the pack — notably his Quebec counterpart, François Legault, the former accountant who recoils at accountability for federal cash flow.

“There is only one taxpayer,” Ford likes to muse. Just as, in medicare, there is only a single payer.

At a certain point, patients will lose patience with the political games. And voters will tire of the ideological rigidity that conflates medicare’s commendable values with a system that doesn’t always deliver measurable value for money.


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