Monthly Archives: April 2017

A Vision of Healthcare in the 21st Century


(This is a condensed version of our Publication “Wanted: Leadership for Healthcare”, C.D. Howe Institute Verbatim, June 8, 2016)

Canada needs both ‘top-down’ and ‘bottom-up’ leadership to create a genuine system to meet our 21st century needs for health and healthcare services at a cost each province, territory and the country can afford. Governments need to step up to governing, of re-vamping the ‘delivery system’; doctors, nurses and other providers have to find better ways of working together.

Leaders would start afresh by envisioning a reinvented healthcare system. It would provide equitably the range of high-quality services needed to optimize the health of the population; its elements would be affordable, informed, and smoothly connected.

Their first step would be to create the new system’s apolitical governance, answerable ideally to the federal and provincial/territorial governments working together[1]. Second best, each Canadian province and territory would appoint separate bodies[2].

That governance would take step two, mandating adoption by all providers of a common information system capable of maintaining for every resident a health/medical record. It would include health status, records of every interaction with a healthcare provider, and measures of its outcome. The chosen EHR[3] should be the best then available as assessed by an expert sub-governance panel and capable of evolution over time. Many such EHRs exist internationally; strong leadership would be essential to avoid excellence being enemy of the good. Continue reading

Trump’s impulsive missile strikes against Syria have changed nothing and could ultimately prove counterproductive.


This op-ed first appeared in Policy Options on April 11, 2017.

On the evening of April 6, Trump took a break from hosting Chinese President Xi Jinping at the Mar-a-Lago residence to launch air strikes in Syria, targeting the Shayrat airbase. The strikes were punitive, ordered after US intelligence indicated that Bashar al-Assad had once again gassed his own people, killing more than 80 men, women and children. The US strikes were also futile, the knee-jerk reaction of a president who has not planned his next move, let alone thought through a strategy to end the Syrian conflict.

The night Trump called for those strikes, US allies, Canada included, were not consulted, they were notified. According to reports, Trump called Prime Minister Justin Trudeau one hour before the missiles were launched and asked for political support. This kind of bilateral, last-minute request is difficult to turn down, especially when one is familiar with Trump’s pressure tactics and unpredictable nature. Other close allies, like the UK, France and Germany, were quick to issue supportive statements. This show of support was misguided. Continue reading

Why is Transformation of Healthcare so Hard?


The need for change in healthcare has been obvious for years. Many studies have been conducted and recommendations made on what’s needed to meet optimally the needs of the population in the current and coming decades. But change itself has been very scarce.

One reason is that none of our 14 provincial/territorial/federal healthcare delivery ‘systems’ has a single governance; the place where the ‘buck stops’ with respect to what each does and does not accomplish and how well or poorly. It is only by default that Canadians hold their governments accountable for how well their hospitals, physicians, pharmacists, and other providers meet their changing needs for healthcare services. On the other hand that there are 14 ‘systems’ could be an advantage as it was when Saskatchewan’s pioneering introduction of Medicare was copied by other jurisdictions.

That there is no governance of healthcare’s delivery rests on David Naylor’s phrase “public payment for private practice”. Throughout Canada, healthcare services are provided in the main by private individuals, organizations and institutions that are answerable only to their owner/operators and/or their boards of directors. Our publicly funded healthcare systems are, in fact, healthcare insurance systems intended to remove, in part, the financial barrier between those in need of healthcare services and those who provide them.

Continue reading