The Invisible Issue
when did we stop caring about health care?

Doug Thomson, CEO
Canadian Orthopaedic Association

As recently as last August, pollsters Angus-Reid predicted that the top three election issues (in ascending order) would be the economy, environment and, above all, health care. And yet, during the federal election any real discussion about Canada's health care system was all too conspicuous by its absence.

Was it that everybody took Paul Martin at his word, when he said he would fix health care "for a generation"? And while the ten-year escalator clause in the 2004 First Ministers Health Accord guarantees annual six-percent increases in federal health transfers to the provinces and territories, there has been no accompanying investment of political capital at the federal level for some time now. Pre-election, what unfortunately passed for national discussion on health care, amounted to mostly ideological pronouncements - based on biased research by the RCMP, as it turns out - about a supervised injection site in Vancouver: health care as a law-and-order issue.

And then there was the global financial meltdown in the middle of the election, which effectively focused voters' minds more on bankers than on doctors. That's too bad. This election - which one pundit has described as a "$300-million photocopy of the previous election" - could have been a terrific opportunity to engage Canadians in a proper discussion about the future direction of health care.

Dr. Robert Ouellet, new president of the Canadian Medical Association, tried to kick-start that debate in August. In a front-page interview with the Globe and Mail that appeared the day of his inauguration, Ouellet said his stance on privatization is part and parcel of his ongoing fight to improve access to care for his patients: "My whole career has been about resolving access issues."

It's no accident that two CMA presidents in a row are highly visible owners of private clinics and strong advocates of introducing private elements into Canada's public health care system. The message from Canada's doctors could hardly be clearer.

As to the outgoing CMA president, in his final speech COA member Dr. Brian Day said the Harper Conservative's Throne Speech in 2007 "almost completely ignored" health care, while the early election platforms from both the Liberals and the Conservatives omitted health care from their main talking points. Eventually, both parties imitated the NDP, by promising to hire more doctors and nurses - a promise that Dr. Day and the CMA worked very hard to extract from all political parties with a highly visible social-marketing campaign in Ottawa and the provincial capitals.

Two years ago, during a very partisan counter-campaign for the CMA presidency, Brian Day's numerous and vocal critics tried to paint him as the arch-fiend, destroyer of Canada's public health care system. Ultimately the scare tactics failed. And he remained true to his basic credo that the system should first serve the patient. And if that involves injecting fundamental business principles into the administration of health care, so be it. 

As he revealed in an interview for the December 2006 COA Bulletin: "If there's one thing I want to push as CMA president it's activity-based funding. This approach alone won't help aboriginal health or rural family practice or mental health or child health or any of those important priorities, but I think we have to recognize that the biggest expenditures in health care are related to hospital treatment - $40 billion a year in Canada. If we can deal with that problem, then we have moved ahead substantially."

And that will likely be Brian Day's lasting legacy as CMA President: convincing government to consider moving from block-funding to patient-centred activity-based funding. BC has already begun to introduce this model on a pilot-project basis. Quebec is gearing up to do the same. And activity-based funding is part of Alberta's top-to-bottom health care reforms. Can Ontario be far behind, as that province deals with deficits and a deepening recession in its manufacturing sector? That could prove to be the tipping point for the other provinces to adopt a similar funding model - a major breakthrough in the way health care is delivered in Canada. The fact that this new model is being discussed at all is primarily due to Dr. Day's leadership.

Although it's too soon to tell, the Prime Minister's selection of rookie MP Leona Aglukkaq from Nunavut as the new minister of health seems to indicate that the federal government might stick to a very narrow interpretation of its responsibilities, emphasizing First Nations health care and signalling a reluctance to engage in any debate on public and private delivery of care. Maybe the hope is that provinces will fill the policy vacuum. In any case, as Dr. Day said in his valedictory address to the CMA: "I am more than optimistic - in fact, I am absolutely confident - that the momentum for change has not only begun but is unstoppable." Amen.