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Time to Drag Canadian Health-care Into the 21st Century

Guest blog from Jeffrey Simpson

As the Globe and Mail’s national affairs columnist since 1984, Jeffrey Simpson has his finger on the pulse of Canada and the world. He is one of the few outstanding political writers who can express his opinions as well with the spoken word. His latest book, Hot Air: Meeting Canada’s Climate Change Challenge, Simpson outlines the few simple policies that Canada must adopt right away in order to significantly reduce greenhouse gas emissions over the next few decades. With clarity and detail, Simpson offers a highly credible solution with the same unique and thought-provoking insight found in his columns.

Why write a book about health care in Canada? Don’t politicians talk about it all the time? Haven’t we had endless studies and commissions about health care? Yes and yes. So why write Chronic Care, my book about health care.

Because not many people these days are talking sense about health care. Canadians are in love with Medicare, but they don’t realize it can’t continue as is. Nor do they know that, by international standards, this beloved system of ours is priced like a Cadillac but operates like a Chevrolet.

We spend in the top rank for health care among industrial countries; we get middling results. While this gap widens between spending and performance, we shovel so much extra money into health care that everything else suffers – education, social services, transport, environment.

Governments are so desperate for money for health care that most gambling revenues now go into it. Health care is hooked on gambling. Imagine that.

Politicians fear health care. They fear its appetite for more money. They fear the public’s attachment to it. Result: they don’t talk common sense. They make outlandish promises – “Save Medicare!” “Cut Wait Times in Half,” “Train a Thousand More Doctors!” They are scared of leveling with the people. And so there is no intelligent debate. Which is why I decided after watching this fluff to write Chronic Care.

I had been writing journalistically about health care for two decades. I had been invited to give dozens of speeches on the subject – ten of them across the country in 2010 by Great West Life. Just in the six months, I’ve spoken to the Canadian Orthopedics Association, the Queen’s University Faculty of Medicine, the McGill Faculty of Medicine, the Better Medicine Colaition, Deloitte Consulting, testing out ideas. In the months ahead, I’m at the Canadian Nursing Association conference and the Canadian College of Health Leaders.

I wasn’t satisfied that Canadians were being told what’s up about Medicare, so I decided to do the research, put it into an accessible book, explain the history of Medicare, indicate how it compares internationally, illustrate what it’s doing to public finances, debunk so half-baked ideas for reforming it, and suggest some big, but doable changes that might achieve the two most important objectives: improve quality and reduce the increase in health care expenses. I’d written six previous books, won all the country’s leading literary prizes, and figured: Why not health care? After all, there hasn’t been a good book about Canadian Medicare that people other than experts have written in decades. Why not me? Why not now?

Will everybody agree with my diagnosis and remedies? Absolutely not, because there are no easy answers, although people peddle them all the time. But I am convinced that if people are invited to address the real issues – not the ideological ones – we can actually improve the system. And we’d better as soon as possible because in 2100, the first of the Baby Boom generation began retiring. Starting now, the population will begin aging – and with aging come all sorts of new and complicated challenges for the health care world.

By the way, forget all comparisons between the Canadian and U.S. health-care systems. No leading personality in Canada wants U.S.-style medicine. Instead, the U.S. system has been used as a bogeyman to scare people away from even talking about changes to Medicare, in case it leads to the slippery slope of U.S.-style health care. As former Prime Minister Jean Chrétien used to quip: “Down there, they check your wallet before your pulse.” Scare tactic, pure and simple.

It’s was a lot of work doing Chronic Care, but it was fun, too. I spent a week in the Ottawa Hospital observing, visited emergency clinics, talked to scores of physicians and medical experts – and to politicians and officials too, although they were often reluctant to be quoted because the issues are so sensitive. There are recommendations that flow from those conversations about drug policy, how hospitals should be financed, how doctors should be paid, how Medicare should be reformed .

Chronic Care tackles a big subject, the one Canadians always put at the top of their list of public concerns. It explains what’s happening and what’s going to happen in a clear, accessible way, without resorting to slogans or easy answers. We’ll leave those to the politicians, thank you.