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Medicare in Canada: the next 50 years


George Smitherman's Perspectives

by George Smitherman

The events unfolding in Ontario provide an opportunity to reflect on the work that Dalton McGuinty has led during his tenure as the province’s premier. In the politician’s search for “legacy” there’s no doubt that improvements in access at the primary-care level and reductions in wait times are two things likely to be mentioned repeatedly.

Looking back at what McGuinty inherited when the Liberals first came to office in 2003, I think it’s fair to say his government reversed a declining confidence in medicare. That’s not to be confused with saying everything in health gets two thumbs up from patients, but overall system performance on many measures has improved and accordingly contributed to McGuinty’s historic run, winning three successive elections.

What will be most interesting in the provincial Liberal leadership race will be to see if any candidate sees advantage in moving beyond the current consensus in Ontario health care. Pending decisions on the transfer of the Shouldice private hospital licence, and the campaign (which I strongly support) by the Registered Nurses Association of Ontario for the elimination of Community Care Access Centres (CCACs) are a couple of places where a real debate might actually emerge.

As Ontario Health Minister Deb Matthews contemplates jumping into the ring, the risk grows that a caretaker will be appointed and the decision-making capacity of the health ministry will be further restricted. Perhaps greater is the risk that a caretaker minister and a tired government will defer even more to the bureaucracy.

For the life of me I can’t understand why the government has allowed a debate to emerge about whether the Shouldice licence will be transferred. Outdated ideology and a reliance on the misnomer that the Canada Health Act forbids private delivery are clearly at play here. This is an agenda driven by workers, not patients.

It doesn’t do us any good to signal that privately delivered OHIP services are a priority for “repatriation.” Taken to its extreme, does that mean some Liberals would favour expropriation of such services? I have had blood drawn and chest X-rays completed in private settings that function as an integrated part of the healthcare system.

In the case of Shouldice, it enjoys an exemplary clinical reputation. It never caused the ministry any problem that I am aware of, and patients reported positively on their experience.  Hardly cause for disruption.

In fact, if we are to believe all of the talk about patient-centered health care and quality as key drivers, then isn’t Shouldice a model we should be prepared to celebrate, as we do the Kensington Eye Instituteperformance in the area of cataract surgery?

Cheaper, better, faster ought to be the motto for deciding the best service delivery model.

I strongly favour taking a comprehensive look at the wide range of services, tests and procedures currently being done in hospitals that could be done at the community level. I am agnostic about who should deliver the care, so long as quality is central to the mix. Cheaper, better, faster.

Hospitals are not only the most expensive operating environment we have in healthcare—the size of hospitals and the capital cost of reconstruction is a massive risk going forward. For example, I do not understand why so-called “satellite dialysis” more often that not takes place in a hospital. Where is the patient voice in all of this? Bad enough that I might need dialysis three times a week; please spare me from having to enter a hospital so frequently.

Shouldice should be held up as an example of how private delivery works just fine, not scapegoated simply because some have an ideological aversion to profit, or seek territorial advantages in terms of unionization.

For Liberals fighting against how a service is delivered isn’t nearly as critical as fighting to ensure that services are delivered on an equitable and timely basis. Liberal values should be offended by incursions of two-tier healthcare, not threatened by how services are going to be delivered, so long as quality is assured.

George Smitherman is a former Ontario Deputy Premier, Minister of Health and Long-Term Care and Minister of Energy and Infrastructure. He is now Chairman and Principal of G and G Global Solutions.





PV Mayer

Dr. Perry Mayer is the Medical Director of The Mayer Institute (TMI), a center of excellence in the treatment of the diabetic foot. He received his undergraduate degree from Queen’s University, Kingston and medical degree from the Royal College of Surgeons in Ireland.

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