Someone or something needs to control health care, set an agenda, perform long range strategic planning, monitor performance, make corrections, bring in new ideas, and eliminate old ones. That is a tall order in the context of a health care system that is perhaps our most complicated decision making environment; one that has such an immediate and direct impact on individual people.
We as members of society expect “someone” to make those decisions. That “someone” is generally government and in the end politicians. I now believe that the system is complex enough that it can’t and shouldn’t be left to the politicians to govern. It’s too complex. The inter-relationships are myriad. The demands are too great. The opportunity for political opportunism is too great. Policy decisions get made above the fold. The electoral cycle demands that no real work occur in the first year after an election and the last year before the next. The negotiations cycle with professional associations is unwieldy and not fleet enough to respond to new demands. In the end, although we expect politicians to guide, lead, and make bold decisions, the very nature of politics in our current environment means that they cannot.
We need bold decisions that may not be pleasant, will not make everyone happy or everyone the least unhappy, that might even fail and need change. This is not the business that I see politicians in with regards to health care. The best the provincial leaders could do was talk about an “innovation fund” – we don’t need more study, we need real, significant, game changing action; some of those actions would result in politicians and parties not being re-elected – for this simple reason, those actions cannot occur.
Who should run health care? We should have an agency that with government negotiates the public contribution to health care, sets long term strategic goals, devises structure and plan, isn’t politically aligned, and is, by lack of political master, is more able to manage the politics of health care. Something with the same kind of power as the Ontario Health System Restructuring Commission of the 1990s, which was able to operate above the political fray. Perhaps the Bank of Canada is useful model – an agency that works to set monetary policy for the country within parameters agreed to with government
It’s a big idea. It’s tough. It requires politicians to give up something that I think many feel they have to be in because it is so important to citizens. At the same time, I suspect that many would be happy not to own the “third rail” of health care. No one wants to be the party of record when the current system fails and yet they feel compelled by circumstance to fiddle.
This space is not for small ideas. It’s a place for us to talk, not about the possible but the necessary. We need this change.