Healthcare needs ideas, not intransigence
Canada’s health ministers ended their meeting in British Columbia on Tuesday with the usual demands for money and better data-sharing. Missing from the conversation are ideas that can fix a broken system, one that lacked for innovation and political courage for decades before the pandemic drove the proverbial stake through its heart.
Healthcare reform has always represented the third rail of Canadian politics due to a toxic mix of public fear, political cowardice and private pressure. Mention for-profit healthcare, and many Canadians gird for battle. They do not want to choose between healthcare and bankruptcy. Medical pressure groups reinforce that message for their own benefit, and politicians are deathly afraid of doctors and public sector unions – especially when they connect with voters.
Thus, conversations around healthcare reform revolve around either the worship of socialized medicine divorced from its clogged ER reality, with offerings to the healthcare god measured in billions of dollars, or the worship of a dumbed-down version of corporate management courses, where the efficiency god is fed consultancy papers and arguments about whether making hospital food 3% more inedible will eliminate wait lists for cataract surgeries.
But most Canadian doctors run private businesses. They are not civil servants. They perform a service and bill the government, the same way a construction company bills the government for building a road or school. The only difference between a doctor’s office and other businesses is that doctors can only bill the government. In exchange for providing health services – and being well paid to do so – doctors get a deal no one else could dream of: they get to decide how many doctors there will be.
Reform starts by acknowledging reality and then defining our principles, as a country, and then the outcomes we want to see. The principle is simple: No Canadian should have to choose between bankruptcy and the healthcare they need. Healthcare should be free of charge at the point of delivery. The outcome is just as straightforward: Canadians need timely access to the care they require. They need access to innovative treatments. And our hospital capacity needs to be able to scale up in a time of crisis, as we have experienced in the past three years.
How do we get there? By being honest about the role businesses play in healthcare and expanding that role. By allowing private clinics to perform surgeries and other procedures. By increasing competition in the healthcare field, between clinics, and between clinics and hospitals. All while honouring the single payer principle.
Recent legislation introduced by the New Brunswick government starts down this road, expanding opportunities for private providers to offer joint replacements and other procedures stymied by long wait lists. A good start, but there’s no reason to restrict the reform: let internal markets decide whether a city needs one, seven, or zero private clinics. The government will only pay for services delivered, so facilities will be encouraged to find efficiencies because their business depends on it, not because a McKinsey consultant needs to fill in a graph on page 117 of their report.
Next, foreign-credential recognition must be part of negotiations with unions and professional associations. Canada must offer a quick and affordable path for foreign professionals to demonstrate their skills and rejoin their profession, within months, not years. In Ontario alone, in 2020, 13 thousand foreign doctors and six thousand nurses were denied entry to their profession. This at a time when so many positions are currently unfilled.
Next, bite the data bullet: invest the money to ensure health costs can be counted, allowing hospitals to compare the cost of a cataract surgery, the cost of a surgical gown, and to publicly share as much of that information as possible. That will support arguments for preventative care, help keep wage demands in line with reality, and give policy makers the evidence they need to make better decisions.
We are not “customers” of our healthcare system. Citizens are stakeholders and we have the right to know what the system spends, and how. We should expect competition and transparency not because it undermines public healthcare, but because without it our system cannot survive. How long will it take for Canada’s political parties to accept this reality, and how many Canadians must suffer and die because courage is the virtue in shortest supply?
Dominic Cardy is the Advisory Council chair of Centre Ice Canadians, a new political movement bringing citizens together for respectful conversations around shared values of personal and fiscal responsibility, collective action around national security and other evidence-based policy priorities, and an aggressive defense of democracy and the rule of law.