Provinces don’t want/want to meet with feds over health care

Provinces are sending mixed messages. First they meet but reject previously negotiated terms. A month later, they want to meet but are unwilling to negotiate.

Make up your mind. Meetings require negotiations, not a hand-out.

It seemed like a done deal when provincial and federal health ministers met in Vancouver in November.

Federal Health Minister Jean-Yves Duclos had negotiated in advance of the meeting with his provincial counterparts and all seemed to be going well. In a proposed deal, the feds would give the provinces more money in exchange for two things: a human-resources action plan which would see the credentials of health care workers recognized from province to province; and the sharing of health care statistics across Canada.

Provincial health ministers had voiced no objections just days before the meeting.

Image: CTV Montreal

Then the premiers got involved.

It’s hard to know just which premiers pulled the rug from under the proposed agreement.

British Columbia Health Minister Adrian Dix, co-chair of the get-together, seemed disappointed. He told a news conference that the federal offer had moved the parties “a sound bite further ahead.”

New Brunswick Premier Blaine Higgs was ready to deal. He said there should be talks and “let’s see where the discussion goes.”

Other premiers categorically dismissed the federal plan. Quebec Premier François Legault rejected any transfer from the feds that came with conditions.

It seems reasonable to me that data on diseases and successful treatments be shared nationally. It’s reasonable to make the movement of health care workers across the country as seamless as possible.

Now, only a month after rejecting the fed’s modest proposal, premiers want to meet again to ask, again, for money without conditions. It would be a short meeting because the feds won’t, and shouldn’t, hand over money unconditionally.

Even before any new money is negotiated, the provinces and territories are already on track to get a 9.1 per cent boost next year – a $4.1-billion increase.

Federal Health Minister Duclos is ready to talk but belligerent premiers only have their hands out. What the feds want to talk about is data and indicators that measure results. “The problem is, until now, the premiers refuse to speak about those results,” Duclos said.

The problem is that money transferred to the provinces is not necessarily spent on health. The feds can specify targeted transfers for things such as mental health but provinces will do what they want with it. Ontario Premier Doug Ford was candid. He said provinces need flexibility to move money between different “buckets.”

In other words, provinces will do want they want with federal transfers.

“All that premiers keep saying is that they want an unconditional increase in the Canada Health Transfer sent to their health ministers,” said Duclos. “That is not a plan; that is the old way of doing things.”

Money alone will not fix our health care. More national data would make the system more efficient by putting resources where they are needed. Health care workers should be able to move easily from province to province where the need is greatest.

Bluffing on the part of premiers is so tedious, as Alberta Premier Smith has demonstrated so well. Let’s get past the BS and get down to honest negotiations.

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Poilievre repeats misinformation about B.C.’s safe drug supply

I just watched Conservative leader Poilievre’s tacky video set in front of a tent city in Vancouver. For dramatic effect, his video is interspersed with drive-by shots of street people. Grainy effects, except when Poilievre speaks, are added to provide a supposed gritty vérité.

image: The Hill Times

He makes sweeping statements in which he claims these people in the background are hooked on drugs. And some probably are.

But it’s more likely they are homeless because they have no homes: they can’t afford to buy and the rents are outrageous.

Rather than exploit the homeless as props for his populist rant, he could explain just who the homeless are. Rather than characterizing them as drug users, he could tell the truth but that wouldn’t suit his sensationalized video. The fact is that Vancouver’s homeless are overrepresented by indigenous Canadians and racial minorities.

The sad reality is that the homeless are victims of racial discrimination.

Despite accounting for only 2.5 per cent of Vancouver’s population, Indigenous people make up one-third of all those experiencing homelessness.

He could point out that Blacks and Latin Americans are disproportionately represented among the Vancouver’s homeless population.

But no, Poilievre prefers to ignore the racial and Indigenous discrimination represented by the tent city in his seedy video. He exploits those already discriminated by further tarring them all as drug addicts.

Poilievre spouts more populist drivel when he claims and that the “tax funded” safe supply of drugs is a failed experiment.

The opposite is true.

Prescribing drug addicts a safe supply of drugs saves tax dollars. The drugs are far cheaper than the cost of policing and to our health care system of treating addicts who overdose.

In fact, no one has died from a drug overdose at a safe consumption site. The BC Coroners Service looked into illicit drug toxicity deaths between 2012 and 2022 and found that no one had died of an overdose at a supervised consumption site. They said there was “no indication” they were contributing to the rise in narcotic-related fatalities. In fact, 56 per cent of overdose deaths in B.C. this year happened in private residences.

The safe supply of drugs to addicts saves lives because it lowers the rates of overdose and reduces in the use of fentanyl and other street drugs. It reduces the cost to the taxpayer of health care for addicts through reduced hospital admissions and emergency room visits. It improves connections to care and treatment for people who have not had support services in the past. The safe supply of drugs reduces police costs by decreasing criminal activity.

Poilievre adds to his misinformation but saying that injection sites are also to blame. B.C.’s safe injection sites do not use “tax paid drugs.” Users bring their own drugs and staff stand by in case of a bad reaction.

B.C. is leading the country in fighting the stupid laws that led to the problem in the first place.

Starting in January, 2023, adults in B.C. will not be arrested or charged for the possession of up to 2.5 grams of opioids (including heroin, morphine, and fentanyl), cocaine (including crack and powder cocaine), methamphetamine (meth) and MDMA (ecstasy).

Drug abuse is a medical issue. Shame on Poilievre for exploiting the homeless and spreading misinformation.

Mentally ill street people need institutional health care

While I don’t want to see a return of the warehousing of mentally ill patients, some institutional care facilities need to be built to care for the mentally ill people left to their own resources on the street.

I’m well aware of the old mental hospitals because my father was a patient in one. It was located north of Edmonton in Oliver, built in 1923 when eugenics was popular.

image: The Eugenics Archives

Based on animal husbandry, eugenics promoted the idea that undesirable traits could be bred out of human genetic lines.

My dad admitted himself to Oliver with “manic depression,” now called bipolar disorder, and died there in 1970.

I visited him often and wished that the drugs that were being developed could be used to treat him. I was convinced that with medication other than shock treatment, he could have led a functional life.

With advent of drug treatment and de-stigmatization of mental illness, mental hospitals were closed. Patients were supposed to be transferred to group homes and care facilities in the community. But in their haste to save money with the closure of expensive hospitals, not enough care facilities were provided and mentally ill people were left to their own resources on the streets.

Not just Alberta but all of Canada emptied their mental hospitals with few places for them to go. In B.C., Riverview hospital was the mental hospital.

Opened in 1913, Riverview was designed to hold 480 patients but had twice that number by the end of the year. With further expansion of the buildings, numbers swelled to 4,306 by 1959.

The Social Credit government of the day closed the hospital with plans to integrate patients into the community, but more often patients ended up in the Downtown Eastside of Vancouver.

Mentally ill people on the street need more than housing. They need treatment. And when they are incapable of realizing the downward trajectory of their lives, they must be forcibly institutionalized.

The forcible treatment of ill people goes against a notion of freedom: that everyone should be free to choose medical treatment.

But involuntary care is something that premier-apparent David Eby has talked about as a possibility, a stance that produced criticism from people who said forcing drug users into sobriety is inhumane and ultimately not workable.

Mayors of B.C. cities have identified mental illness as a major issue with increasingly difficult behaviour problems, along with the separate issue of repeat criminal activity in public places.

Mayors Krog and Basran, of Nanaimo and Kelowna respectively, say involuntary treatment is not about forced sobriety, but about making sure there is secure housing to protect people with brain damage and severe mental illness from hurting themselves and others.

“We have no problem doing that for someone who has Alzheimer’s,” said Mayor Basran. “Why wouldn’t we have a scenario where we do the same for these people?”

We’ve come a long way from eugenics. Mentally ill people represent a wide range of illness from behavior issues to brain disease. Surely, we can determine which of those are seriously ill and help them

When I see the bedlam on the streets of Kamloops, I can’t help but remember how much better the lives of patients were at Oliver.

Dr. Day’s marathon to commercialize health care

He may be down but he’s not out. Dr. Brian Day has lost court case after court case but he’s not giving up. I’ve got to hand it to Dr. Day for his perseverance.

image: Eoin Kelleher

He started 13 years ago and isn’t finished yet.

He started his mission in 2009. In echoes of today’s economic turmoil, the Great Recession cast a cloud over the land and Stephen Harper was prime minster. The number one song in Canada was I Gotta Feeling by The Black Eyed Peas.

Dr. Brian Day launched his lawsuit after he learned his clinics were going to be audited by the B.C. Government. The audit was triggered by dozens of patients who complained that they’d been illegally overbilled at Day’s Cambie clinic.

Dr. Day figures that the best defence is an offence. As soon as he learned that the province was going to check into his illegal billing, he launched a court case arguing that B.C.’s Medicare Protection Act violated patient’s freedom under Canada’s Charter of Rights and Freedoms.

It’s so typical. Whenever someone is up to no good they throw up a smoke screen. The guy who’s caught speeding? He’s not breaking the law; he’s taking his terminally ill child to the hospital.

After years of legal delays, the audit by the B.C. Government in 2012 uncovered 170 instances of extra-billing to patients which were contrary to the Act. The audit only sampled 468 services over 10 years, so there were probable many more.

The investigation also uncovered 93 instances of “double-dipping”, in which 19 doctors including Dr. Day charged a total of $66,734 to the province while charged patients $424,232 for the same treatment.

Oh no, said Dr. Day in his defence, we don’t charge patients for treatments, we charge them for “consulting fees,” and “facility fees” for equipment and staff. And no, we don’t pay doctors extra beyond what any doctor would bill the provincial Medical Services Plan.

Financial records later filed in court showed that wasn’t true.

They showed that clinics, including Dr. Day’s,  paid 140 people, mostly doctors, $1.5-million or more per year in “consulting fees,” over five years. That included a total of $1.36-million paid to Dr. Day during that period.

Dr. Day is soldiering on, determined to create a two-tiered health care system in which doctors are pulled out of public health care into lucrative private practices.

British Columbia’s highest court recently upheld a lower court’s ruling that countered Dr. Day’s claim that Canadians should have the constitutional right to pay for private health care. B.C. Supreme Court ruled that Dr. Day’s model would undermine the very basis of universal health care.

In the ruling, the B.C. Supreme Court supported the value of public good.  It’s a concept that greedy heath care salesmen don’t understand. It’s like those “freedom fighters” who don’t get the concept of public good. Public health during a pandemic is paramount; individual rights to refuse a vaccine are outweighed by the need to protect all.

But Dr. Day will continue to try to undermine our health care system which, while struggling, is superior to any private system.

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.

Baby boomers’ long term care goes bust

The long term care of boomers is an unfunded liability. Unlike the Canadian Pension Plan and Old Age Security, the long term care of boomers is not funded at all. Our health care is not prepared to receive their numbers.

image: genx67.com

Other countries with similar long-term care pressures, such as Germany and Japan, have established various forms of public long-term care insurance. Not in Canada.

As it now stands, long-term care falls on the shoulders of family members who provide for 75 per cent of home-care for older Canadians, unpaid. Canadians typically don’t see the gaps in the current publicly-funded care programs until they or a family member falls through them.

Research from the National Institute on Ageing at Ryerson University shows that if Canada continues on its current track, the cost of publicly funded long-term care for seniors – including nursing homes and home care – is expected to more than triple in 30 years, rising from $22-billion to $71-billion, in today’s dollars. Authors of the research, Bonnie-Jeanne MacDonald and Michael Wolfson, warn:

“There is no special fund or program to cover the costs of long-term care in Canada. And it is not covered under the Canada Health Act in the same way as physician and hospital care (Globe and Mail, October 8, 2019).”

Canadians are dreaming if they think that our health care system can deal with the onslaught of boomers that will be falling into long term care. Hospitals are now struggling to place seniors in long-term care facilities and the wave of boomers hasn’t even hit yet.

Private long-term care insurance is available but expensive because of the low number of people buying it. It hasn’t worked here in Canada and is unlikely to work in the future.

Private long-term residences are having trouble staffing. In Kamloops, Berwick on the Park’s supportive living unit will close next year leaving 20 residents without round-the-clock care, despite the fact that residents pay $5,000/month for the service. The director of Berwick wrote to residents:

“There are significant challenges to retain healthcare staff in the current labor environment. An extraordinary amount of energy has been directed at recruitment and onboarding staff to meet the obligations to successfully operate our licensed care unit. The forward looking labor forecast indicates that these challenges will continue for the foreseeable future (Kamloops This Week, October 10, 2010)”

Even if private long-term care were available, many boomers couldn’t afford it. Debt among seniors is increasing according to Stats Canada. In 2016, the proportion of senior families with consumer and mortgage debt doubled since 1999.

Boomers have led privileged lives. They grew up during a period of increasing affluence due in part to widespread post-war government subsidies in housing and education. Baby boomers were more active and more physically fit than any preceding generation and were the first to grow up genuinely expecting the world to improve with time. While they have accumulated wealth, many boomers have lived beyond their means.

Boomers’ optimism for a better world is going to be severely tested as they age.

Canada needs to establish a new long-term social insurance program.  Given that health care is controlled by provinces, a patchwork system will be the likelihood as boomers totter into old age.

The current rickety long-term care system is not prepared for the wave of boomers.

 

 

Provincial health ministers should stop bickering

The provincial health ministers should resolve in the New Year to stop bickering, take the money from the feds, and use it as intended.

 

It’s a recurring bad movie says Canadian Medical Association president Granger Avery: “The Groundhog Day-type discussions where political leaders bat around percentages and figures at meetings in hotels have to stop. Our system needs better, and most important, our citizens deserve better (Globe and Mail, Dec.19, 2016).”

The provinces have had thirteen years of increases from the feds at 6 per cent a year to improve health delivery. “The transfers have been growing quite generously,” says Livio Di Matteo, a health-care economist at Lakehead University in Thunder Bay. “If you go back to about 2007, if you look at public-health spending, which is largely provincial, it’s grown about 40 per cent. The Canada Health Transfer to the provinces has grown about 70 per cent.”

We need to spend smarter. Canada spends more on health care than Australia, for example, with poorer outcomes as measured by life expectancy and infant mortality.

The provinces have not fixed the problem during times of plenty and now are faced with problems of an aging population. In addition to increased funding at 3.5 per cent a year, the feds have offered $11.5 billion for home care and mental health. I don’t know who writes the province’s absurd scripts: let’s refuse the offer, even though it’s what we want, because we want more.

Provincial health ministers don’t get it. B.C. Health Minister Terry Lake worries that if B.C. were to take the money offered, and start home-care programs, that the programs wouldn’t be sustainable when funding dries up. That would be true if hospital costs remain the same when home-care programs are added.

Home-care programs would reduce hospital costs. Hospital beds cost $1,100 per day whereas home care is one-quarter that cost according to the Canadian Institute for Health Information. Seniors take up 85 per cent of those expensive hospital beds and one-half of them remain in beds even though they are well enough to be moved because there are no long-term care facilities or home care.

Take the money spent on hospitals and spend it in the community. That would mean that four seniors would be cared for at the same cost as one in a hospital -and they would be happier.

The politics and perception of health care would have to change. Hospitals have become a measure of a politician’s success because they are highly visible monuments to health care; something that you can be sure the B.C. minister will point to often in the campaign leading up to the provincial election next May.

It’s a problem of perception, too. Home care is virtually unseen except by the few affected. It’s hard to point to the thousands of seniors happily living at home as a measure of success. British Columbians will have to change perceptions of health, from hospitals as shrines were doctors are the high priests, to a flatter hierarchy where care is diffuse and in the hands of other professionals.

 

What Liberals say, do on health care are two different things

When you get all 10 provinces agreeing on an issue, you have to think they are on to something.  Provincial governments say that Health Care in Canada is underfunded and that the federal Liberals should pay up.

Yet, Health Minster Rock wants to study the problem further.   If  health care was Rock’s own neglected car, he’d get out  of the car during one of its frequent breakdowns, look at  the threadbare tires and stalled engine and think, “I should  get a committee together to study this problem, or maybe  redesign the car.”  Well no, Mr.  Rock, what’s needed is  immediate repair.

To premier Mike Harris, the lack of federal funding leaves few alternatives, “Either private sector is going to have to  pay more, individuals are going to have to pay more, or  somehow or other we can run this system on far fewer dollars  than we have today”.  If it’s obvious to Harris, its obvious  to all — fund public health or expect private health care.   The Liberals talk about defending public health care but I wonder.

Oh sure, Rock berates Alberta for their proposed Bill 11 that would privatize health care.  But then the Prime Minister visits Alberta and says “I’m sure all those acts  have within them absolute adherence to the Canada Health  Act.” The message may be mixed but the intent is not.  The  Liberals intend to do precisely what Rock criticises Alberta  of doing — bring private health care to Canada.

To find what the Liberals are up to, watch what they do, not  what they say.  They cut funding to health care because, they said, we have to balance the budget.  But now that there is a surplus of $100 billion in the next five years,  they are only putting $2.5 billion back.  If the budget was  the problem, then health care funding would be restored by  now.

Trade Minister Pierre Pettigrew knows the routine.  Before the talks of the World Trade Organization in Seattle, he  publicly said over and over again that education and health  care were not on the table — he would not endanger these  valuable programs.  Canada, he said, would not be trading health care and education as part of the WTO’s General  Agreement on Trade in Services (GATS).

The GATS proposes that services such as health and education  be globally traded much the way goods are traded now. The  Americans, of course, support such a deal.  The Liberals have probably already signed agreement to the deal by now.

We don’t know exactly what Pettigrew said behind the closed  door meetings on GATS.  But we do know what the reaction of others at the table was.  Through a leaked confidential memo from David Hartridge, head of the WTO services division, a  picture of compliance appears.  The memo was obtained  by  the Canadian Centre for Policy Alternatives.

It seems that in private Minister Pettigrew wasn’t so vocal  in his defence of Canada’s public health care.  In the memo, Hartridge says that the GATS agreement was the “least  controversial element” of the Seattle agenda.  Canada’s Trade Minister apparently didn’t express opposition.

Its not just me who is suspicious. A provincial health official recently said that “there’s a deliberate federal strategy afoot to talk about things other than funding”.   The Liberals know that if they stall long enough, Canada’s health care will continue to unravel to the point where the  only solution will be private health care.  And, they can say that the WTO made them do it.

As Canadians watch health care fall apart, they are getting  more desperate.  The majority want a universal, well funded public health care system and they are willing to pay for  it.  But, failing a public health care system that works,  they will spend additional money at private clinics.

It’s only human nature: when faced with the choice of keeping their health or their money, Canadians will spend  every cent they have to buy health, even if it means that  they spend the rest of their lives poverty.  A government that plays on citizen’s basic survival fears to achieve its  own political ends is unconscionable.