Friday, May 02, 2014

The Federal Government and Healthcare Reform

The future of health care may be the most important issue that Canada faces heading into the 2015 federal election year.  The 2003 First Ministers’ Accord on Health Care Renewal injected $36 billion in federal money into health spending and the 2004 10-Year Plan to Strengthen Health Care added a further $41 billion over that decade in order to, in then-Prime Minister Paul Martin’s words, have a “fix for a generation” that would “buy change”. On March 31 that Accord expired.
Unfortunately, all this  federal spending mostly did was to buy the avoidance of  change for about half a generation. Hardly a “fix”.   And by avoiding hard choices, progressives in the Liberal Party and the NDP have opened the door for Stephen Harper – a man who was once the President of the National Citizens Coalition (an organization founded by an insurance salesman who hated Tommy Douglas for getting in the way of profits)—to do things his way.  The really scary part is that Harper doesn’t have to commit political suicide to undermine medicare. As prime minister, all he has to do is cap funding (with reductions conveniently scheduled to commence after the next election), not enforce the Canada Health Act very vigorously, and let nature take its course.  
But if  throwing more money at the provinces won’t work, what should we do instead?  We need only go to the source: when he first implemented medicare, Tommy Douglas was against the fee-for-services approach as something that blunted the cost effectiveness and equity of the single-payer system. Half a century of experience with our healthcare system (not to mention the analysis of the world’s most reputable health economists and policy analysts) shows that Tommy was right.  We need a federal government that will use its spending power to accelerate  the creation of a strong primary care foundation that is more patient-centred, more focused on prevention and chronic care,  and less focused upon high-cost providers simply billing the government for their services. We need to stop using acute-care hospitals as long-term care facilities.    And we need a national drug strategy so that we can  use the power of the single-payer to lower drug prices.
That drug strategy could have been accomplished by now.  Every business person understands that the larger your bulk order, the greater your chance of lowering the price. Economists estimated in one study that for four major drugs the savings in Canada of a single national drug plan could be as high as 50 percent.  Premiers Lorne Calvert of Saskatchewan,  Ralph Klein of Alberta, and Gordon Campbell of British Columbia all  called for a national pharmacare program. But prime minister Martin was too busy, and  he dithered. As a consequence, the deal was killed in 2006 when we elected the Harper Conservative government.

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