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Strengthening Canadian health care

Three distinct and unrelated groups made important public statements today about the Canadian health care system. All of them represent a meaningful effort at stimulating a thoughtful discussion. We finally seem poised to have a serious national conversation.

It comes not a moment too soon.

Today, the Canadian Medical Association launched a consultative campaign to transform Canada's health care system into a more efficient, patient-centered model. "Until now, governments have determined what kind of health care Canadians receive," CMA President Jeff Turnbull said. "This initiative is a unique opportunity for Canadians to let government know what they expect from their health care system." The CMA is asking Canadians to consider three questions:

-          The law underpinning our system - the Canada Health Act - dates back to the 1980s. It covers only doctor and hospital care. Do you think it should be broadened to include things like pharmacare and long-term care?


-          It is important for citizens to feel they are receiving good value for their health care. What would you consider good value?


-          Patients and their families play an important part in their health care. What do you think Canadians' responsibilities are, now and in the future, in regards to their health?

This morning, the Globe and Mail published an editorial by Michael Kirby, a former Liberal senator and chair of the Mental Health Commission of Canada, and former prime minister Brian Mulroney.  They call for “National adult discussion that will allow us to arrive at a common goal: finding new ways to increase funding to our system while preserving the fundamental principles Canadians cherish.”

And in speeches delivered today by senior members of the parliamentary caucus across the country, the Liberal Party of Canada today reaffirmed its unwavering commitment to the core tenets of the Canada Health Act and its steadfast resolve to defend and strengthen our health care system.

For the uninitiated, the Canada Health Act is a law of parliament that establishes the principles and criteria for health insurance plans that the provinces and territories must meet in order to receive full federal cash transfers in support of health. Delivery of health care – the hard part – is the exclusive jurisdiction of the provinces.

Many Canadians are concerned that our health care system is under siege by ideologically motivated free-market “purists” and fear that, given the opportunity, the system would be fully or partially privatized by them if given the chance. 

Others feel that the system is under severe financial stress. They argue that increasing cost and demographic pressures of an aging population must force a radical rethink of the system itself. Service is deteriorating. Access to world-class care not what it should be. Infrastructure and equipment is far from state-of-the-art. And wait times are unbearably long.

Both have valid points and worries that we should consider and take great care not to dismiss simply because we don’t like what we hear. A discussion based on facts and reason is called for and is the only sensible course to take to unpack the issue and build a consensus for action.

While our population is indeed aging, the evidence suggests that our aging population is not the biggest driver of health care costs – pharmaceuticals are. Drug costs are the fastest-growing area of health care expenditure, rising from just under ten percent of the total in 1985, to more than 16 percent of all health care costs last year. And most of these costs end up paid for by Canadian families or private insurers, not the public system. And here is an alarming figure: one in ten Canadians report not filling a prescription because they cannot afford to pay. If Canadian families are going broke to pay for medicine, we are surely losing the spirit of Medicare. Part of the 2004 health accord was the National Pharmaceuticals Strategy. This was a definitive step towards a national pharmacare program. But all our progress stopped in 2006. The provinces have been trying to move forward, but there has been a total absence of leadership at the federal level.

Medicare is a highly charged and deeply emotional issue that touches all of us.

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