If you regularly peruse the pages of Healthy Debate, you’re in the bubble; one could call you an ‘insider’. If you’ve heard of the Canadian Institute of Health Information or Health Quality Ontario, or if you scan the news for columns by André Picard, Kelly Grant or Tom Blackwell, then you are an insider. Do you ever tune into White Coat Black Art, did you watch the clip of Dr. Danielle Martin testifying at a US senate committee, or have you read Timothy Caufield’s The Cure for Everything? Insider.
When it comes to reforming health care, most insiders can speak passionately and at length to the inadequacies of our system. We’ll quote the experts, reference reports and all nod in agreement. Most Canadians do not participate in these discussions. The reasons for their lack of involvement and, more symptomatically, their inattention to health care during Canadian elections has been described elsewhere. Chief among those reasons is the belief that our system is the best in the world, particularly when in juxtaposition to US health care.
On their current track, provinces will spend more than 50% of total available revenues on health care by 2028, so how could we not have a system that performs exceptionally well? Unfortunately, it is well known among insiders that high price does not necessarily translate into high quality care, as clearly demonstrated by the recent Commonwealth Fund report showing Canada ranked in the bottom third of all five evaluated dimensions of health system performance (quality, access, efficiency, equity and healthy lives) compared to 10 industrialized countries.
We, the writers and readers of Healthy Debate, should strive to bring these conversations to the people outside the bubble.
Outsiders are numerous and, perhaps surprisingly, often include front-line health care providers. Those who are excellent at providing care and advocating for patients are often too busy to worry about the direction and structure of the system and how these are intrinsically linked to the care they provide. Anecdotally, but objectively, Canadian medical education curriculum pays minimal attention to health policy or reform, and we have no doubt that other clinical training programs are no different. So, if many of those within the system, who are to be the players of any major reform, are neither aware nor interested in the discussions, how can we expect the general public to be?
What can we do? There is an obvious but complicated need to substantially update clinical training curriculum to make the clinical workforce more aware and ensure reform is organic. More straightforward, let us insiders lose the jargon and focus on concisely and clearly defining tangible ground level issues that truly matter to Canadians. We need to reinforce the concept that even though Canadians culturally identify with our universal care, it does not mean our system is beyond reproach. We, collectively as insiders and outsiders, are voters and should be able to express to our leaders our demand for better value for dollar.
This is but one example from a long list that deserves attention from all Canadians: A universal pharmacare program or even guaranteed catastrophic drug coverage; inclusion of mental health therapy by psychologists and counsellors in provincial medicare programs; better integration across sectors; a committed emphasis on access to primary care; a national health human resource management strategy; quantifiable commitments to tackling the social determinants of health.
Our bubble is teeming with knowledge and opinions on these topics, but the walls are hard to penetrate. It’s preventing these discussions from reaching the average Canadian’s dinner table conversations.
The newly elected Ontario Minister of Health made a few remarks recently to the effect that Ontario has the best health care in the world, even though there is absolutely no evidence demonstrating this, so it’s no surprise that many point fingers at a lack of political leadership in health care reform.
However, democratically elected leaders in Canada are only accountable to us. We want our elected representatives to accept that there are many problems that plague our system and hear the many, sometimes diabolically different, solutions. First, though, we need all Canadians to start interacting with the bubble; we need health care discussion and debate to ebb and flow, floating among policy, research and, public space.