Lessons learned from the pandemic about health care

When we pull together, we can quickly achieve results that have escaped us in the past.

image: Hartford Healthcare

Some liken to being at war but I prefer to compare the pandemic response to what happened when we created universal health care.

Governments have been reluctant to implement the universal coverage of drugs in the past, but in short order we have vaccines freely available for all Canadians.

It’s that easy. A universal pharmacare program could happen, too. All it takes is the will to carry it out.

Canada has the dubious distinction of being the only country in the world with universal health care that doesn’t include prescription drugs.

Canada has been stuck in a time warp since the inception of health care. When Tommy Douglas envisioned a healthcare system in 1947, it included hospitals and then later, doctor’s services.

Other countries have moved on. New Zealand’s publicly funded system goes beyond hospital and physician care to include long-term care, mental health, physical therapy and prescription drugs.

While we like to boast of our healthcare system compared to our neighbours to the south, in reality ours is just good enough. Canada is stuck in “paradigm freeze” — good enough to prevent any major change or improvement.

The pandemic can shake us from our stupor and awaken us to the fact that a universal pharmacy program is cheaper for all, not just in the bargaining power of negotiating drug prices but in reduced healthcare costs resulting from a healthier population.

Another lesson learned was how rapid we can achieve, essentially, a basic universal wage. The Canada Emergency Response Benefit (CERB) was distributed virtually overnight.

CERB has been replaced with other programs but with the political will to make it happen, Canada could have a basic universal wage.

A reduction in poverty through a basic income could improve health. The connection is deep, say Drs. Nadine Caron and Danielle Martin:

“But, perhaps surprisingly, the experiment [CERB] that may have had the biggest impact on health during COVID-19 didn’t take place in the healthcare system at all.” (The Walrus, Jan/Feb, 2021)

The connection between finances and health is well studied. Between 1993 and 2014 in Ontario, for example, residents of the poorest areas were more than twice as likely to die from a preventable cause as those living in the wealthier neighbourhoods.

Another lesson learned was from the fewer diagnostics done during the pandemic.

On the negative side, cancelled tests meant that diseases went undetected. The B.C. Cancer agency estimates that 250 British Columbians unknowingly had silent cancers go undiagnosed as their screening mammograms, colonoscopies, and pap smears were cancelled in just the first six weeks of the pandemic.

On the positive side, many tests routinely done may be unnecessary. If all those tests are so important, why aren’t they done uniformly across Canada? Chris Simpson, a cardiologist and former president of the Canadian Medical Association, wonders:

“Why do patients in one region get these tests and procedures at higher rates than other regions?”

The simple answer may be that, like prescriptions, doctors like to order tests so as to be seen to be doing something towards patient care. All those tests may not be the best use of resources.

Canadians can be proud for pulling together during this crisis. Let’s not forget what we can accomplish.

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The rocky relationship between CERB, EI and getting back to work

Back to school concerns compounded by back to work woes

While parents worry about sending their kids back to school in September, millions will be without work and without government assistance. The Canada Emergency Response Benefit (CERB) runs out in September. It provided   $500/week to pay the rent and buy groceries.

The future looks especially bleak for those previously employed in the service sector. They represent the largest sector -three out of every four jobs.  With isolation measures in place, many jobs in the food and tourist accommodation sectors are lost for a long time.

Without CERB, a cloud of debt hangs over the unemployed. Canadians owe $1.77 for every dollar available to spend as of June, 2020.

The holders of that debt face a problem as well. Banks were happy to see Canadians in debt as long as the credit cards, loans, and mortgages were paid off with profitable interest. But what do banks do when Canadians can no longer pay debt?

Canada’s Big Six banks face growing loan losses as government programs wind down, and loan-deferral and interest rate relief programs come to a halt. Banks have already set aside $11 billion for losses but that may not be enough.

CERB has kept the wolf from the door so far. Personal insolvencies are below average and credit payments have remained stable.

The government of Canada faces a big problem as well. You only have to look back at the Dirty Thirties to see what happens when there are no jobs and no government support. Men left their desperate families on dustbowl farms and wandered the countryside on trains trying to find any work and money to send back home to starving families.

As of Tuesday, Prime Minister Trudeau has prorogued Parliament to deal with the crisis, a move that sets up a confidence vote this fall that could trigger a 2020 election.

Here’s the problem that the Trudeau government faces.

As of last March all EI recipients were rolled into the CERB program and received $500 a month. The feds will discontinue the CERB program at the end of this month and move recipients back to EI or an “EI-like” transitional benefit. Just what will an EI-like program look like?

There are major holes in the move back to EI as it now stands, according to calculations done by David Macdonald, senior economist with the Canadian Centre for Policy Alternatives.

At the start of August there were 4.7 million people receiving the CERB. Because EI has no minimum, 811,000 of those would receive less on EI than they did on CERB; instead of $500 a week, they would receive only $312 on average.

And under current EI rules, 2.1 million of those receiving CERB will not be eligible; they will get nothing at all. In B.C., that’s 324,000 who were previously receiving $500/week who will now get nothing.

The clock is ticking as CERB runs out. I look forward to the Throne Speech on September 23 and the federal plan in which “no one will be left behind,” as Trudeau promised.

 

Emergence of Canada’s economy from a coma must be done carefully

Canada’s economy has been placed in an induced coma since it was infected with the novel coronavirus. Arousal from the coma must be done carefully to avoid a devastating setback.

The Dirty Thirties. Image: Canadian Encyclopedia

Keeping the comatose economy on life support has been expensive. We’ve blown the wad on the first wave of the pandemic to the tune of one-quarter trillion dollars. We can’t afford an expensive relapse.

Canada’s debt, manageable now, could lead to consequences worse than that of the Dirty Thirties if the recovery is not done right.

Royal Bank of Canada CEO Dave McKay puts it this way: “We can’t screw this up because we don’t have enough fiscal firepower. We can’t fail the re-entry. We don’t have enough money for a massive step back.”

Bringing the economy back to life is as much an art as a science; a little wakefulness here, a few stimulations there. Hurry up and wait to see what happens. The patient’s urge to run must be tempered with the pitfalls that lie ahead.

Deep thinkers are at work. We need to listen to the advice of health professionals, who understand the mortal dangers of this virus, and to economists who appreciate the long-term social and economic costs of tanking the economy.

Unemployment already exceeds anything in the past century, except the Great Depression. The sheer number of people affected is staggering. A projected 8.5 million Canadians will receive $2,000 monthly from the Canada Emergency Response Benefit (CERB). That’s nearly 40 per cent of Canada’s work force.

Unlike Employment Insurance, the CERB does not require recipients to look for work. It doesn’t require them to accept a job offer. Recipients can only earn up to $1,000 a month, anything more and the CERB is lost.

The disincentives to find work are part of the induced coma. Rest and relaxation is the prescription. Workers must stay home to avoid contagion. To encourage workers to help wake up the economy, they should be allowed to keep a larger portion of the benefit as they return to work with a gradual clawback as earnings rise.

This would be a step towards a basic annual income for all Canadians –an idea supported by both the right and left ends of the political spectrum. Sheila Regehr, chair of the Basic Income Canada Network, is urging just such a change. The group issued a policy paper in January that proposed a $22,000 annual benefit for a single adult. Under that proposal, benefits would be reduced by 40 cents for each dollar of earnings and would be eliminated entirely after a person’s income rose above $55,000.

Child care is another knotty problem. Parent returning to work need affordable child care, but they need to assured that they are not sending their children into harm’s way. Any uncertainty about public-health risks at daycares and schools will prove to be a significant disincentive for many Canadians to return to work.

The next decade may well be known as the Dark Twenties. The economy that awakes from the induced slumber might not recognize its former self.