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A bold solution for an ailing healthcare system

A new book by veteran political journalist Jeffrey Simpson, Arts'71, LLD'05, stirs controversy when he tackles the hot-button subject of how to reform Canada’s healthcare system.

Healthcare spending in Canada, which eats up more than $200 billion in public and private money each year, is the country’s biggest public spending concern. It has been referred to as “the third rail of Canadian politics.” Concerns about it top public opinion polls, and while praise, prescriptions, and palliatives are bandied about in most election campaigns, the reality is that any politician or health-care official who tries to change the system or even have a candid debate on it, risks ­being electrocuted.

Such concerns don’t inhibit Jeffrey Simpson, Arts’71, LLD’05, The Globe and Mail’s veteran national affairs columnist. His new book, Chronic Condition, Why Canada’s Health-Care System Needs to be Dragged into the 21st Century (Allen Lane, $32), probes, prods, and prognosticates without fear or favour.

Jeffrey SimpsonVeteran Globe and Mail political columnist Jeffrey Simpson, Arts'71, LLD'05

Simpson, a dedicated policy wonk, has produced the facts, insights, and analysis needed to fuel a debate on how to ensure the future of the Canadian healthcare system we need but don’t have because people are either unaware or unwilling to examine the necessary trade-offs and alternatives. He is particularly incensed that politicians and bureaucrats alike seem afraid to be honest, having “hoodwinked people into believing future costs can somehow be paid for without affecting other government services or tax increases.”

Simpson has an explanation for a variety of concerns: long waiting lists; failure to meet deadlines for treating priority conditions; high drug prices; over-capacity and stressed hospitals; highly paid but ­under-utilized surgeons; and expensive, under-utilized operating rooms.

He finds much good in the Canadian healthcare system, but says it must be improved and adapted to the freight train of an aging population that’s hitting the system with expensive, increased demands as the tax base diminishes – an unsustainable situation unless Canada undertakes a policy revolution.

“Traditional medicare, as we define it, which is doctors and hospitals, has to be shaken out because it isn’t delivering the value for money by any international standard that I could find,” says Simpson. “So I say let’s be bold and get rid of shibboleths and ideology. Let’s do things that work.”

Simpson has written thousands of columns and magazine articles (many of them about healthcare) as well as seven previous books – including Discipline of Power, which won the 1980 Governor General’s award for non-fiction. So why this book at this time?

One might speculate that at age 63 ­Simpson approached this latest effort as his magnum opus, a twilight crie de coeur to wake up politicians, healthcare ­professionals, administrators, and the Canadian public. But that’s not Simpson. He’s much more prosaic about his approach. “I had been unhappy for many years about what I thought was the lack of intelligent ­discussion by political people and others about the whole healthcare phenomenon,” he explains.

“What’s the treatment? What’s the disease? A lot of the things we were trying were not adequate . . .”

It was apparent to him when he talked privately with many senior officials, especially those from the provinces, that their top concern was how to reduce the curve of rising healthcare costs. In the process, Simpson recognized things that he had not sufficiently thought through to his own satisfaction. “What’s the treatment? What’s the disease? A lot of the things we were trying were not adequate,” he says.

Simpson decided to write this book to clarify his own thinking, and to prompt a wider awareness and ­dialogue.He started with prodigious research – every commission and study undertaken since Tommy Douglas sowed the early seeds in the 1950s in Saskatchewan, followed by interviews with many of the principal healthcare players in the country, and hands-on observation, following around Dr. Jeff Turnbull, Meds’78, chief of staff at the Ottawa Hospital complex and the 2010-11 president of the Canadian Medical ­Association.Not to be overly influenced by the hotshots in one of the country’s largest teaching institutions, however, Simpson also spent time in the emergency department of the 80-bed South Shore Regional Hospital in Bridgewater, NS.

What he has written is arguably the most comprehensive tour d’horizon of the Canadian healthcare system available. Canadians frequently boast they have the world’s best healthcare system. It’s not true, but people believe it is because they are only looking south, comparing the Canadian healthcare system to the one in the United States.

Simpson points out that when compared to healthcare outcomes to such ­European nations as France, Germany, the U.K., Sweden, Denmark, and Norway, however, we are only in the middle of the pack.

We do have some of the world’s highest- paid doctors, with an average gross income a year of $390,000, and our specialists are the third-highest-paid in Organization for Economic Cooperation and Development countries. Canadian drug prices range ­between 10 and 30 per cent above those in Australia, France, Germany, the U.K., Sweden, and the Netherlands. Canada’s ratio of investment in pharmaceutical research to a percentage of drug sales is the lowest in the OECD, second only to Italy and dropping. We also have some of the longest wait times for medical treatment and hospital beds among the ­advanced western countries.

Simpson has had personal experience with wait times in Ontario. Unwilling to wait several months for an MRI at an ­Ottawa hospital, he went across the river to Quebec, wrote a cheque at a private clinic, and had the results in 48 hours.

Simpson starts from the premise that we must continue our common payer system of so-called “free” healthcare, which, like the railway in the 19th century, has become the icon that ties the country together and defines Canadians.

However, Simpson also hastens to point out that there are strengths to the Canadian healthcare system. They include talented, dedicated doctors, nurses, and related healthcare providers; challenged administrators doing their best in difficult circumstances; and world-leading researchers offering new treatments.

He does not claim to have found the ­silver bullet. “To every complicated problem there’s a simple solution that’s almost always wrong. There’s no one thing you can do that will make the system better,” he says.

But he describes with fact-studded clarity the strengths and weaknesses and a relentless upward cost curve that is starving other programs, especially education.

The simple solution – more money – without fundamental changes has been shown not to work. The $41-billion increase in federal transfer payments to the provinces begun by then-Prime Minister Paul Martin in 2004 was supposed to fix medicare for a generation. Instead, it has become “the biggest lost public policy bet of this generation.”

Simpson starts from the premise that we must continue our common payer system of so-called “free” healthcare, which, like the railway in the 19th century, has become the icon that ties the country together and defines Canadians.

That doesn’t mean he feels we can’t have more private delivery of government-paid service and more competition within hospitals utilizing activity-based funding. Surgical wait times would be dramatically reduced if surgeons had opportunities and were given incentives to use the many ­operating rooms that now sit vacant for as many as 16 hours of the day. His basket of proposals would shake up the three principal components of Canada’s system – doctors and nurses, hospitals, and pharmaceuticals – to make the system more competitive, efficient, and patient-friendly (“Make the money follow the patient, not the providers”) while restraining the cost curve.

Many surgical procedures could be done in specialized clinics outside of hospitals while as many as 90 per cent of the patients who clog emergency departments could be treated elsewhere.

Of pharmaceuticals, he says, “We have the worst of every world; we’ve got the highest drug prices, the lowest average investments in pharmaceutical research, high generic prices, and a patchwork of programs for seniors.”

Perhaps Simpson’s most innovative proposal calls for the creation of an insurance program to pay for seniors’ drugs, one modeled on the Canada Pension Plan (maybe combined with it) as a precursor to comprehensive pharmacare. Like the CPP, people would pay “a social-return contribution” during their earning years in the knowledge they will eventually get a benefit. It is sellable, he argues, because at least 85 per cent of the population will need prescription drugs by the time they are 65, and a universal insurance program would pay for them.

It would also be a way to get the federal government back into the healthcare system, create a common national formula, and increase the bargaining power to lower drug prices.

Simpson concludes that Canada’s healthcare system is not in crisis, per se, but rather it’s afflicted with debilitating chronic conditions. There are means of lessening some of medicare’s chronic conditions. “We can do so,” he says, “if we have the courage to talk about them, to banish foolish fears of sliding into a U.S. model, and to understand that there are two options that will ensure the deepening of chronic conditions: to do nothing or to spend more doing the same things.”

Queen's Alumni Review, 2012 Issue #3Queen's Alumni Review
2012 Issue #3
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