Ideology is the problem, not the solution

Susan MartinukWhat’s wrong with Canada’s health-care system?

Dysfunctional systems, wait lists, not enough doctors, and not enough beds are just the obvious ‘starters’ in a long list of problems that are keeping Canadians from accessing medical care.

While tossing more money at the problem will provide temporary relief, it can’t fix the one defining issue preventing positive change in delivering health-care services – ideology. Canada’s health-care system is falling apart because it has been built on the mistaken idea that only government can pay for, and deliver, health-care (called single-payer universality) rather than on the more practical notion of actually providing timely medical care.

That’s why the federal government’s recent offer of $46.2 billion for health care over 10 years comes with strings attached: Expenditures must maintain medicare’s governing ideology of single-payer universality – the very concept that has constricted access to care and created years-long wait lists for surgery, scans and specialists.

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Ideology has been at the heart of medicare since its inception, and a little history will go a long way to understanding our collective foolishness in allowing this to persist.

From the mid-1940s to the early 1960s, Saskatchewan’s  Co-operative Commonwealth Federation (CCF) party (the precursor to today’s NDP), led by Tommy Douglas, won multiple elections by promising ever-growing coverage of medical care that culminated in full universality in 1962. Along the way, the CCF had assured voters that such reforms were sustainable: that party line/myth held true until 1964, when the CCF was finally ousted from power by the Liberals led by Ross Thatcher.

As related to me by Thatcher’s then-chief of staff, Thatcher’s priority was to figure out how to fund the medicare monster that he had inherited. He had a fresh team of accountants pour over the province’s financial books, but all they could conclude was that the money to fund medicare simply wasn’t there. In other words, the CCF had misled the Saskatchewan people by telling them the province could provide sustainable funding for universal medicare. Thatcher immediately fired the bureaucrats who had created the program and seemingly fudged the books.

Meanwhile, back in Ottawa, Prime Minister Lester B. Pearson was leading a minority government and looking for a wedge issue to gain total power in the next federal election. His top advisor, Tom Kent, offered universal medicare as the solution, calling it “the jewel in the record of achievement” that the government could use to win a majority government. (Tom Kent, A Public Purpose, page 365)

The uncertainty about when a federal election might be held added to the pressure to quickly create a national medicare plan to present to Canadians.

Pearson thought it best to base the national program on the Saskatchewan model, so the federal government hired none other than the same bureaucrats who had just been fired for incompetence by Premier Thatcher.

They tried – and failed – to once more develop realistic costs for a national medicare program. That was when one Saskatchewan bureaucrat came up with what Kent believed was a brilliant way to resolve the problem. In his 1988 book, Kent writes, “The government did not need to work out or legislate the details of a shared-cost program – it only needed to define, clearly, the principles of what it meant by medicare. Then it would contribute to the costs of any provincial program that satisfied those principles.” (Tom Kent, A Public Purpose, page 366)

That was how Canada’s beloved universal medicare program began – with the delivery of medical services founded and grounded in an intangible ideology rather than in more tangible concepts such as costs, sustainability, delivery, and common sense.

And here we are, almost 60 years later, still talking about making medicare work under the erroneous presumption that only our cash-strapped governments can deliver and pay for healthcare. Approximately three million Canadians sit on wait lists; six million are looking for primary care doctors; patients are waiting long hours for care in Emergency Departments; and cancer patients are dying awaiting treatment.

No strings should be attached to federal health transfers other than that they go towards health care. We should be emulating Europe’s successful hybrid/complementary health-care systems, where governments pay for most care, but both public and private sector professionals compete to provide care. Innovation and new delivery care models should be encouraged; patients who can afford private care should have it. Hospitals should be paid on activity-based funding that encourages more procedures rather than the current global funding that constricts care and the number of procedures.

Doing things the same way over and over and expecting a different result is what Einstein termed the definition of insanity. It’s time for Canadians to move past our collective insanity and realize that ideology is part of the problem, not the solution.

Susan Martinuk is a Senior Fellow at the Frontier Centre for Public Policy and author of Patients at Risk: Exposing Canada’s Health-care Crisis.

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