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The Case for a Health Care Czar

August 2nd, 2023

By Rick Peterson

Imagine for a minute that you’re working for a large services company that can’t keep up with the customers coming in the door.

You’re on the front lines, pulling 12-hour shifts, alternating days and night. You go home exhausted, mentally drained and physically a wreck. Your phone rings constantly with requests for you to pull extra shifts. You’re maxed out at $50 an hour – good money, for sure – but you’re wondering if it’s worth the toll on your body and your personal life.

Management can’t find enough people who want to work full-time with your company. So, they contract out to an agency for some part-time hires.

In the lunch room a few days later, you find out that the part-timers now working with you are making more money than you. The contracting agency charges your employer $140 per hour for each person they send to work with you. The agency gets a cut, but your co-worker is clearly way ahead of where you are, despite you both having similar education and work experience.

That’s not all. The contract workers get better shifts than you. More flexibility on days off. They get free parking in the company parking lot – you’ve been told none were available. They can book off whenever they want. You’ve been told you need another five years’ seniority before you can do that.

How well would that go over with you? Not well, for sure. No wonder some of your colleagues have quit, or have decided to work part-time, or are now working for those same agencies.

That’s the exact situation that’s facing our front-line nurses across Ontario and likely many parts of Canada these days, according to this recent report in The Globe and Mail showing that Ontario spending on private nurses is soaring.

Wheels falling off the public health care cart

The Ontario government reports that it spent $168 million on nursing agencies in the first three quarters of last year – three times more than the previous period.

“Our tax money is going to these corporations,” according to a quote in the Globe story from Erin Ariss, head of the Ontario Nurses Association. “This is for-profit care. This is more privatization.”

And, guess what? She’s right. This is indeed private sector health care. And it’s there because the wheels are falling off the public sector healthcare cart.

It all boils down to the question of the recruiting and retention of nurses. As Kelly Grant, the Globe health reporter wrote, this “is more evidence of how the pandemic-era staffing crisis in health care is hobbling Canada’s medical system.”

But wait, you’re thinking. This is a provincial issue. What does this have to do with federal politics and what we’re focusing on at Centre Ice Canadians?

The answer is this: better health care outcomes should be a federal issue.

As a taxpayer, I want my tax dollars spent wisely, no matter who is spending them.

So, if the federal government takes some of the federal share of my tax dollars and sends it to the provinces, I want the feds to be absolutely involved in making sure this is being spent wisely.

Yes, I want strings attached. Yes, I want federal oversight and provincial accountability for tax dollars. Yes, I want someone overseeing the provincial premiers who are squarely responsible for the current mess the system is in.

I want the provinces to present a plan to the feds on how they are going to do a better job. I want targets, deadlines, benchmarks and an ongoing scorecard in this area.

And here’s where the rubber really hits the road: I would like to see the feds appoint a private sector, all-powerful “Health Care Czar” to oversee, implement and crack the whip on reforms in this area. I would like to see a Prime Minister who has the courage to call out the premiers, insist on these outcomes, and designate someone who takes charge of making sure this happens. Governments change – putting in place a Health Care Czar with a 10-year mandate would provide stability and accountability.

We need much more efficient healthcare outcomes than we’re getting now. There is no issue more important than the sustainability of our healthcare system, and there is no more urgent time than now.

The pandemic has caused the cracks in our healthcare system to now become gaping holes, like the deep crevices in a mountain that swallow up lives and tax dollars. And we’re now seeing a wave of entrepreneurs who are trying to meet the needs of Canadians who are desperate to seek a family doctor, desperate to get access to our system and desperate to simply get the health care they deserve.

This includes the Marda Loop Medical Clinic in Calgary that has tried to connect Canadians to a doctor quicker through a $2,200 annual membership fee. The Alberta provincial government is shutting that down since this practice is illegal under the Canada Health Act.

Nurses vs. Uber drivers

Yet, the bigger question is this: why do more than 5 million Canadians today not have a family doctor? Why does the OECD rank Canada 26th in the world for the number of doctors per capita? Why does one of the richest countries in the world not be able to recruit, retrain and retain front-line nursing staff? Why is Canada’s richest province forking over hundreds of millions of doctors to private sector health care contractors? Why do entry-level nurses in Canada only make about $42,000 per year, while a good Uber driver will make $50K?

The blame here is squarely on the provincial governments, as you can read more about on another Globe and Mail piece published on Tuesday: What Taylor Swift has in common with your family doctor.

The article points out that provincial governments “own” the market for doctors in their provinces. Provincial premiers are ultimately responsible for the wreck that is our healthcare system.

Decades ago the provinces choked back med school enrolment to keep medical costs down. Enrolment flat-lined and then dropped. It’s increased relatively since then but is still far, far behind population growth. The limits on foreign-trained doctors – including Canadians who did the med school studies in the US, UK, Europe and Caribbean – have been way too low.

What’s the answer? It’s not rocket science: hire a flood of new foreign trained doctors and do it now. In 2021 it was reported there were 13,000 internationally trained physicians in Canada who weren’t working.

Here’s some simple math: the OECD says 2.8 medical doctors serve 1,000 Canadians. That’s about 357 patients per doctor. If we let in 13,000 foreign-trained family doctors and they each support 357 patients, you now have 4.6 million Canadians who now have access to a doctor.

Who would you want as Health Care Czar?

Don’t wait for the provincial premiers to do the math or get this fixed. Their track record is atrocious, and the take-up on any efforts to change things, if there were any, would be uneven across the country. That would put some Canadians at a disadvantage over others.

So, let’s tie federal healthcare transfers to success in hiring foreign doctors. If a province hits 80% of its target, it gets 80% of the funds normally earmarked for it. If it hits 20%, so be it.

And let’s get a federal Health Care Czar to crack the whip. It’s long overdue. Canadian taxpayers need someone advocating for their health care dollars. It’s not the premiers – so why not a Health Care Czar?

Let me know what you think of this, and any other ideas you might have for our healthcare policy platform.

And while you’re at it, any ideas on who would be a good Health Care Czar? My vote is for Tony Fell, a highly respected former investment banker and former chair of the University Health Network, and someone who’s clearly got a handle on the key issues, as you see in this op-ed: Let’s rethink Canada’s health care system .

Who do you like? Who would you nominate? I look forward to hearing back from you. Thank you.


Rick Peterson is founder and chair of Peterson Capital of Edmonton, a capital markets advisory firm with offices across Canada and in Europe. He’s co-founder and director of Centre Ice Canadians.

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