OTTAWA — Pulling the health-care system out of its “downward spiral” won’t happen until politicians stop haggling over money and start a formal national discussion on lasting reforms, the president of the Canadian Medical Association urged Wednesday.
“What we’re seeing is the devolution of the discussion when you focus on money and not people,” Dr. Granger Avery said in an interview. “Governments, and quite rightly as custodians of our tax dollars, focus on what happens with the money. But we need to be thinking about what it is that our people need, how do we best help the people in front of us in a way that’s sustainable.
“It’s not about putting the money first, which is what seems to be happening.”
Granger proposes collaborations involving five groups — federal and provincial governments, medical professionals, health-care managers and administrators, universities, and Canadians, especially indigenous peoples — to devise “a different way of making decisions on health care.”
He said the difficulties of improving such a complex system, which is currently running flat out, are immense. “In my view, the only way to do it is to create a collaborative table of all of the five health-care partners.”
If you built a house 60 years ago and didn’t pay attention to its upkeep, you might expect it not to be working quite so well. That’s what we have with health care
His comments came as NDP Leader Tom Mulcair called Wednesday for a one-year extension of the annual six-per-cent Canada Health Transfer increase to the provinces to allow for, “a proper, open, deliberate serious conversation with the provinces and (to) stop trying to pretend that the federal government can dictate things to the provinces.”
With a crucial negotiating session between federal Health Minister Jane Philpott and her provincial and territorial counterparts scheduled for Oct. 18 in Toronto, the two sides appear headed for an impasse over a new multi-year agreement to start next year. The previous 10-year accord expired in 2014.
Instead of striking a new deal then, the former Conservative government unilaterally set the annual transfer increase at six per cent, with a reduction to about three per cent in 2017.
The Liberals, faced with new economic forecasts predicting weakened tax revenues over the next two years, are standing pat at three per cent, along with $3 billion in separate funding for provincial home-care programs. (The average cost for patient home care is $55 a day compared with about $1,000 for a hospital bed.)
The provinces have balked, demanding the annual hike be held at six per cent before entertaining Philpott’s conditional offer of short-term funding for home care and other “shared priorities,” including mental health services, technological innovation and access to prescription medications.
Both Philpott and Finance Minister Bill Morneau, speaking to reporters this week, remained firm on three per cent.
Avery said Wednesday, “maybe there is a good argument for holding over for a year. I don’t know how they will end up sawing that off, but let’s get past that, let’s get something that’ll keep provinces ticking over in their current state while we set in place that more robust process.”
He called Philpott’s conditional home-care funding offer “an important piece” of any long-term solution but, “how precisely they agree to do that and manage that objective and the money, that would be a matter for the provinces and the federal government.”
Avery stressed the health system has a number of “silos of excellence” including cancer treatment, cardiac care, stroke interventions and hip replacement.
“But the connectivity and the wait times to access those silos of excellence and the way that the specialties are connected, that all leaves a lot to be desired,” he said. “That’s what has prompted me to say we could do a lot better.
“If you built a house 60 years ago and didn’t pay attention to its upkeep, you might expect it not to be working quite so well. That’s what we have with health care broadly speaking.”
Research by the Commonwealth Fund ranked Canada’s overall health care 10th out of 11 western industrialized nations for efficiency, access and equity. Only the United States placed lower. The United Kingdom was ranked No. 1.
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The Canadian Medical Association’s five recommendations to the federal government for a new health accord:
• Support the innovation and transformation needed to address the health needs of the country’s aging population by delivering additional funding on an annual basis beginning in 2017-18 to the provinces and territories by means of a demographic top-up to the Canada Health Transfer.
• Deliver on the government’s commitment to increasing the availability of home care and palliative care by creating a new targeted home-care and palliative-care innovation fund.
• Include capital investment in continuing-care infrastructure, including retrofit and renovation, as part of its commitment to invest in social infrastructure.
• As a step toward comprehensive, universal prescription medication coverage, establish a new funding program for catastrophic coverage of prescription medication.
• Amend the Caregiver and Family Caregiver Tax Credits to make them refundable.
